Wednesday, August 31, 2011

FDA Releases Strategic Plan

FDA’s strategic plan “Advancing Regulatory Science at FDA” identifies eight priority areas. FDA plans to implement the scientific programs within the agency and also collaborate with partners in industry, academia and government.

The FDA plans to:

• Modernize toxicology to enhance product safety
• Stimulate innovation in clinical evaluations and personalized medicine
• Support new approaches to improve product manufacturing and quality
• Harness diverse data through information sciences
• Implement a new prevention-focused food safety system
• Develop medical countermeasures to protect against threats to the U.S
• Strengthen social and behavioral science to make informed decisions on regulated products
• Evaluate innovative emerging technologies.

FDA will examine new ways to evaluate emerging technologies through active research and collaborating with external partners. The goal is to develop innovative medical products while concurrently developing novel assessment tools and methodologies.

One of the ways they hope to achieve their goal is to establish an “Innovation Initiative” within the Center for Devices and Radiological Health (CDRH) that will work to develop new devices and assessment tools. In developing assessment tools for novel therapies, FDA will explore the role of wireless and information technologies to use in new medical therapies and diagnostics.

FDA hopes that the “Innovation Initiative” will enable the development, assessment, and approval of important devices and encourage early conversations with developers to make sure their ideas are translated into technologies.

FDA receives a vast amount of information from a variety of sources including product submissions, voluntary adverse event repots, de-identified data from healthcare providers, and results from surveys and basic scientific research. FDA realizes that successful integration and analysis of this data available from disparate sources could provide knowledge and insight not possible from just one source.

FDA is in the early stages of constructing the IT infrastructure needed to deal with the integration of complex data but realizes that in addition, new analytic approaches and tools will also be needed. In the future, FDA plans to do sophisticated data mining activities to support the enormous number of simultaneous queries from a large set of indexed data sources.

To view the Strategic Plan, go to or go to

NIH/CDC Issue SBIR Solicitation

On August 25th, NIH and CDC released the 2012 Omnibus NIH/CDC SBIR Contract Solicitation (NOT-OD-11-108) due on November 7, 2011. The SBIR program is a set-aside program for small business concerns to engage in federal R&D with potential for commercialization.

The SBIR legislation requires the Public Health Service, HHS, and certain other Federal agencies to reserve 2.5 percent of their extramural research or R&D budgets for an SBIR program.

SBIR Phase I determines the scientific and technical feasibility and the potential for commercialization of the proposed research but it is not to exceed $150,000 for direct costs. Phase II is to continue the research or R&D efforts initiated in Phase I and not to exceed $1,000,000 for direct costs. Phase III will help small business concerns pursue with non-SBIR funds, ways to commercialize the results of the research funded in Phase I and Phase II.

A few of the research topics contained in the solicitation are:

• NIH (CDC)—Development of low cost, small sample technologies for cancer diagnosis, prognosis, and early detection

• NIH (NHLBI)—Novel technologies for powering ventricular assist devices and wireless physiologic telemetry for interventional MRI

• NIH (NIDA)—Recovery warrior behavioral activation video games for substance abuse via a commercially available active and interactive gaming platform such as Wii, Play Station Move, or Xbox Kinect. Also, looking for ways to develop effective methods for systemic in-vivo targeted delivery of shRNAi to the brain for treatment of substance use disorders and other brain disorders

• CDC—Data mining software for large scale analyses of infections caused by hepatitis viruses

Since this solicitation is contract-based and not grant-based, is not used. For more information, go to

Exporting to Japan

Even with the current global economic challenges, there are still opportunities for U.S companies to export to Japan particularly in the medical and healthcare sectors. American firms have developed a strong presence in Japan’s healthcare sector, supplying almost one-quarter of the medical device market and about 15 percent of Japan’s pharmaceutical consumption. Together these two sectors account for approximately one-third of Japan’s annual $300 billion in spending on healthcare.

In spite of the March 2011 catastrophic earthquake plus the fact that Japan and many countries are living in an era of financial strains and uncertainty, there are still new opportunities emerging for U.S. firms in the healthcare services sector in Asia and especially Japan.

The Japanese government has formed a medical IT Task Force within their Information Technology Strategic Headquarters to discuss how to promote healthcare IT in the country. Specific topics being discussed include developing a nationwide medical records database, making efforts to enable seamless regional medical cooperation, utilizing reimbursement information, and how to develop medical information databases for drug safety.

The Tokyo Chapter of Health 2.0, a U.S. industry organization started in 2010 originally was established to introduce leading online and mobile healthcare technologies to address how online and mobile healthcare technologies can be used successfully in the Japanese healthcare sector. U.S. promising areas in healthcare IT exports includes security, mobile applications, and data integration solutions.

The adoption of electronic medical records alone is a major healthcare IT priority in Japan with over 40 percent of the hospitals with more than 400 beds implementing EMR systems plus a good percentage of those hospitals use electronic ordering systems.

According to analysts at the Department of Commerce’s U.S. Commercial Services, the market for medical equipment in Japan is expected to show steady positive growth in the next few years. Japan already has certain types of medical equipment such as MRI units, CT scanners, and therapeutic systems including robotics. Market demand for high-end medical equipment is also supported by favorable changes in Japan’s reimbursement pricing system for these products.

There are indications that more foreign advanced medical technologies are introduced in China and/or Korea before being introduced in Japan. As a result, advanced diagnostic imaging equipment and other globally available sophisticated medical equipment not yet introduced into the Japanese market should have good sales potential for U.S. companies. It looks promising for U.S. companies to be especially strong in sophisticated market segments such as pacemakers, advanced interventional cardiology products, orthopedic implants, and laser surgical equipment.

One of the Japan’s goals has been to attract foreign patients and build up medical tourism. Before the massive March earthquake, tsunami, and subsequent nuclear power issues, efforts were being made to build a medical tourism market in Japan, but as expected with the catastrophe, there has been a sharp drop in the number of tourists visiting Japan. However, this also means that the Japanese government will have to make more efforts to introduce the latest medical diagnostics and treatments in order to attract foreign patients.

Another area open to expansion for U.S. companies is the Japanese biotechnology industry. Japanese pharmaceutical companies are looking for opportunities with U.S. biotech companies in the areas of new drug candidates and pipelines, strategic partnerships, licensing, and research collaborations. Also, biotech research equipment especially related to regenerative medicine is also expected to grow and present good opportunities for U.S firms.

For more information, go to or call 800-USA-TRADE.

JHU Receives $30 Million Gift

Johns Hopkins Medicine received $30 million in funding from the Commonwealth Foundation for Cancer Research to help the Johns Hopkins Kimmel Cancer Center establish a “Center for Personalized Cancer Medicine”. The Cancer Center can now bring together experts from many disciplines including oncology, biomedical engineering, public health, and surgery.

Funds for the Center will initially support three pilot projects over four years to focus on changes in cancer-related DNA mutations inside cells as well as any genetic changes outside of cells nuclear DNA, known as epigenetic alternations.

“With this important information, clinicians will be able to help cancer patients by tailoring drug treatment to their disease, track its progress, and avoid unnecessary treatments. Some cancers may be prevented altogether, which would slash the costs of new drug discoveries by limiting “hit and miss” approaches,” reports Johns Hopkins Kimmel Cancer Center Director, William G. Nelson, M.D. PhD.

The funding will support research and development of new technologies to pinpoint the novel genetic characteristics of each patient’s cancer. Hopkins scientists and officials say this will speed the development of therapies based on an individual cancer patient’s genetic “fingerprint”.

Johns Hopkins scientists have pioneered numerous ways to decipher the genetic landscape of various cancers, uncovering key genetic mutations and pathways in breast, colon, brain, and pancreatic cancer.

For example a blood test called “Personalized Analysis or Rearranged Ends” (PARE) not only detects cancer genes but also can tell if a therapy is working by measuring in real-time, the amount of a particular cancer’s DNA in the bloodstream. The test can also verify a cure or document the need for further treatment, freeing patients who are proven cancer free from unneeded treatments.

Investigators are going to examine which genomic and epigenomic factors affect responses to treatment in patients with leukemia and lung cancer and develop tests for early detection of various other kinds of cancers. Based on genetic or epigenetic markers, scientists are already creating individualized immunotherapies such as cancer vaccines using the specific genetic makeup of each patient’s tumor.

Highlighting Gaps in Care

Today primary care physicians generally lack the time, resources, and support to provide the recommended preventive screening and chronic care services to patients. In fact only about half of adult patients receive all recommended preventive care services.

As a result, standing orders are not always given. Standing orders authorize nurses and other non-physician clinical staff to provide services according to a preapproved protocol without a physician’s examination. Standing orders have been shown to improve provision of vaccinations and other health screenings but in many cases, standing orders are not yet routinely used.

To try to eliminate the problem, AHRQ funded a two year grant standing order project with the Practice Partner Research Network (PPRNet) for $458,000 to study if screening gaps in patient’s EMRs were highlighted, then would better preventive care services be provided.

PPRNet established by the Medical University of South Carolina includes 193 physicians practicing in 42 states with more than 1,000 providers and serves 2 million patients. PPRNet participants use a common EMR to submit quarterly data, to receive benchmarking and performance improvement reports, and to participate in research studies.

PPRNet launched the standing order project after successfully responding to an RFP from AHRQ. The study enables eight PPRNet primary care practices to authorize non-physician clinical staff to view a template used in the EMRs to help highlight gaps in care for 15 preventive services that can affect patients.

The eight practices include five family practices, one internal medicine practice, and two multi-specialty practices located in rural and urban regions in eight different states. Clinics ranged in size from two providers serving 1,200 patients to 25 providers serving 28,800 patients.

To start the study, each practice developed an implementation plan, which involved working with technology savvy staff to make changes to the template, create a standing order protocol for the staff, and develop a communication plan.

During the patient’s visit, a non-physician discusses preventive care needs with the patient and administers or provides a referral for all services the patient agrees to receive. The review with the patient includes preventive care screenings such as for diabetes and immunizations.

The results show that the program significantly improved the ability of the practices to accurately identify care gaps before visits and address those specific gaps during the visit, which led to significant increases in the percentage of eligible patients receiving needed services.

For more information, contact Lynne Nemeth PhD, RN at the Medical University of South Carolina or call (843) 792-9122.

ATI Seeks Prime Contractors

CMS is accepting applications for the Medicare Demonstration Project called the Community-Based Care Transition Program (CCTP) on six different dates from July to December 2011. Under this program, CMS will provide $500 million in funding to go to hospitals and community-based organizations.

American TeleCare, Inc. (ATI) in Abingdon Virginia is interested in talking to organizations submitting an application for CCTP funding. Their objective is to have organizations add ATI capabilities to organizations submitting CCTP proposals.

In the past year, several different “transition care” strategies have emerged to improve on the process of discharging patients from the hospital to home or other care settings. Most of these care models have connected with the patient while still in the hospital, meeting with them at least once in the home, and maintaining various levels of contact through telephone calls or visits.

None of the care plans, however, appear to include a key component according to ATI. By leveraging video technology with robust clinical algorithms and biometric data, ATI empowers an organization’s existing clinical teams to identify those-at-risk, and intervene remotely to stabilize an exacerbation that might otherwise require a hospitalization. ATI’s clients see an amazing decrease in readmissions (up to 70-85% drop) when managing high-risk patients remotely through video.

So if your organization is getting ready to submit an application for CCTP and want to team up, be sure to talk to J.W Hornsby, ATI Sales Executive at (276)-206-0628 or email For more details on ATI and their accomplishments, go to

Saturday, August 27, 2011

NSBRI & NASA Soliciting Proposals

The National Space Biomedical Research Institute (NSBRI) and NASA’s Human Research Program are both soliciting proposals for their “Research and Technology Development for Crew Health and Performance in Space Exploration Missions” project.

The research proposal issued by NSBRI contains one category that focuses on “Smart Medical Systems and Technology”. The proposals in this category will need to address:

• Ways to refine and implement techniques to non-invasively assess intracranial pressure in harsh remote environments such as space

• Developing diagnostic training models, and just-in-time medical care procedures using ultrasound and other modalities to facilitate autonomous healthcare by non-experts in remote extreme environments

• Ways to refine near-infrared spectroscopy technologies as part of an integrated medical system to noninvasively assess health including brain function in resource-constrained environments

Go to for more information on Smart Medical Systems.

Other NSBRI research interests concern human factors and performance, musculoskeletal alterations, neurobehavioral and psychosocial factors, and sensorimotor adaptation.

NASA’s Human Research Program is soliciting proposals in the areas of Visual Acuity and Ocular Structure and Function: Fluid Distribution, Team Social, Technical, and Task Roles, and the Effects of Constrained Asynchronous Communication on Operational Tasks

Proposals will be accepted from all education institutions, industry, nonprofit organizations, NASA centers, and other government agencies.

The solicitation document released August 25th is available at or through the NASA Research Opportunities homepage at If you go to the NASA research homepage, the next step is go to “Solicitation” then to “Open Solicitations”. On the “Open Solicitations” page, select NNJ11ZSA002N from the list of solicitations.

Proposals submitted must use a two-step proposal process. Only Step-1 proposals determined to be relevant to the needed research will be invited to submit full Step-2 proposals. Step-1 proposals are due September 22, 2011 and invited Step-2 proposals are due December 19, 2011 with the award to be announced April 2012.

Funding is to be done in the form of research grants and each selected proposals will be funded with a single grant. It is anticipated that NASA awards will average $350,000 per year and cannot exceed $400,000 per year. NSBRI will accept proposals with a maximum budget of $400,000 per year for a maximum of three years.

Maryland's CHRC Issues RFP

Maryland’s Community Health Resources Commission (CHRC) has funding for community health resources to provide and expand access to healthcare to low-income underserved communities plus funding to bolster the state’s healthcare safety net infrastructure.

CHRC is a quasi-independent commission within the Maryland Department of Health & Mental Hygiene focusing on the state’s network of community health centers and addresses evident service gaps in the state. Over the last four years, CHRC has awarded 78 grants totaling $21.6 million to provide services to more than 94,000 patients resulting in more than 288,000 patient visits.

The CHRC grant program “Aligning Community Health Resources: Improving Access to Care for Marylanders” is considering projects in five categories in this year’s Request for Proposals (RFP).

The five areas include:

• Increasing access to comprehensive women’s health services and reducing infant mortality ($200,000 to $300,000). The goal is to improve reproductive healthcare and birth outcomes, to reduce infant mortality rates and reduce the number of infants born at low and very low birth weights, and increase the percentage of women who begin prenatal care in the first trimester

• Expanding access to dental care for low-income children ($100,000 to $200,000). In Maryland in 2009, 41 percent of children in the state’s Medicaid program did not receive any dental services. The goal is to increase the number of low-income children receiving dental services and boost capacity for oral health services

• Supporting new access points and building healthcare infrastructure in primary care settings ($200,000 to $300,000) to support projects to enable local communities to build integrated, interlocking systems of comprehensive care for low-income or underserved Marylanders

• Integrating behavioral health services in the community ($200,000 to $300,000) to use to integrate mental health and substance abuse services with primary care services, using strategies such as case management services

• Facilitating adoption of health information technology ($150,000 to $300,000). Over the past five years, the CHRC has invested more than $2.9 million in health IT projects. The funding supports IT programs among FQHCs, local health departments, and community providers. Proposals to be considered would help small practices purchase EHR systems, assist community health resources to connect to the HIE, support public health reporting through the HIE, and provide training and education to support advanced operations.

The deadline for the FY 2012 CHRC RFP requires the Letter of Intent to be submitted September 1, 2011, and if selected, the full proposal is to be submitted September 27, 2011. Go to to view the RFP.

Detecting Infectious Particles

Different microbes can cause many of the same symptoms so in order to make an accurate diagnosis and identify a particular strain, it is very important to have access to all of the information needed. Current tests used for diagnostic purposes are not well suited for use at the point-of-care whether in the doctor’s office or at the local clinic because they require skilled laboratory personnel to perform the tests and it can take up to several days to get results.

Postdoctoral fellow Scott Ferguson at the University of California, Santa Barbara is working with his research advisor H.Tom Soh and other colleagues on a system that would be able to integrate three laboratory processes on a single disposable chip and accurately identify a microbe at the point-of-care. This research is being supported by the NIH’s National Institute of Biomedical Imaging and Bioengineering (NIBIB) and the Army Research Office.

The system under development is called “Magnetic Integrated Microfluidic Electrochemical Detector” or (MIMED). The device combines sample preparation and electrochemical readouts to detect viruses directly from patient samples.

The device is capable of detecting pathogens in a variety of complex biological samples, such as blood, urine, or saliva. By using multiple sensors, the chip could be adapted to detect a broad range of microbes and simultaneously detect several different microbes in the same sample. In cases where a patient displays symptoms common to multiple diseases, this single test would be very helpful in determining the actual cause of the disease, and could be useful in monitoring food and water safety, forensics, and the environment.

According to Ferguson, “In the future, researchers expect the MIMED chip to include an instrument that would integrate pumps, heaters, tubing, and other elements of the system. The disposable chip would then be part of an instrument to handle all sample preparation without any human involvement and may actually cost less than a dollar to manufacture.”

Upgrading Veterans Healthcare

When the Department of Veterans Affairs replaces present kiosks and installs new “Point-of-Service” self-service kiosks in all ten VISN 4’s medical centers and in most community-based outpatient clinics, veterans will be able to take better charge of their medical care.

Recently, the VA awarded a $20 million contract to Vecna Medical to implement the kiosks in VA hospitals and healthcare centers nationwide. Approximately 15,000 VPS kiosks will be installed in the U.S. plus the territories over a five year period.

Veterans will use the new kiosks to update their personal information, view their account balance, and check in for appointments, but the biggest change is that veterans will be able to update their medication and allergy records right at the kiosk. Some new self-service capabilities will not be available immediately, but will be added later this year.

When the Portland VA Medical Center in Oregon initiated self-service kiosks for clinical applications, they found that self-service kiosks are the best way to collect patient information. Dr, Blake J. Lesselroth a Portland VAMC Clinical Informaticist, is grateful that these kiosks will help to improve the accuracy of medication records. He reports that about 95 percent of veterans’ medication records are not accurate. Twenty-five to 30 percent of medications that veterans take are not recorded plus the fact that ten to fifteen percent of veterans are not taking medications that are in their records”.

Future kiosk capabilities will include complete health screening, be able to scan health insurance cards, enable credit card payments, be able to request pharmacy refills, veterans will be able to complete surveys, schedule or change appointments, and access personalized health information through “My HealtheVet”.

VA Medical Centers will take a look at the patient flow throughout the hospital to plan the location for the kiosks so that they will be located near clinic check-in clerks. Many will be placed in lobbies, but they will also have kiosks located in actual clinic waiting rooms. Concerns will be addressed by check-in clerks and proctors along with signage to direct patients to the kiosks.

Veterans will not need to worry about their private information being seen by others. The kiosks are “thin clients” meaning no actual information is stored on the device. All information is stored on a server that cannot be accessed from a kiosk. Since kiosks require the use of the VIC card to access, no personal identifying information will be used.

In another new program, the VA is working to help veterans especially in rural areas have better access to healthcare. The VA is now implementing a three year pilot program to provide healthcare services through contractual arrangements with non-VA care providers. The program called “Access Received Closer to Home” or “Project ARCH” is intended to not only help all veterans but especially help veterans in rural areas receive care closer to home.

Recently, the contract to perform the duties of the program and to provide specified healthcare services to eligible veterans in certain pilot sites was awarded to Humana Veterans Healthcare Services, a subsidiary of Human Military Healthcare Services owned by Humana Inc.

The program has established five pilot sites across the country and is offering the program in Maine, Virginia, Kansas, Arizona, and Montana. Care coordinators will work closely with contracted non-VA providers to make certain that all of the necessary clinical information from veteran’s medical records is available and up-to-date. Veterans are eligible to participate in the program if they reside in a location where a “Project ARCH” pilot site is located and if the veteran is enrolled in the VA healthcare system when the program starts.

The VA will pay a negotiated contract rate for the services provided by non-VA providers but the veterans who participate in “Project ARCH” will still have the responsibility for co-payments if applicable.

In another program, the VA’s “Center for Comprehensive Access and Delivery Research and Evaluation” (CADRE) program has 55 funded research projects to identify access barriers, develop feasible interventions to improve healthcare delivery, and to create a new model for partnership with VA operations. The focus areas include rural health, telehealth and e-health strategies, patient-centered behavioral and self-management interventions, and nursing health services research.

CADRE is actively partnering with the Veteran’s Rural Health Resource Center in the Central Region in their VISN 23 PACT Demonstration Laboratory to evaluate the effectiveness of VHA’s Patient Centered Model Home model, and the eHealth Quality Enhancement Research Initiative (QUERI).

Wednesday, August 24, 2011

HRSA Funding Research

HRSA’s Maternal and Child Health Research Program’s (MCHR) Funding Opportunities Announcement (FOA), plans to award FY 2012 grants to support applied research related to maternal and child health services. The grant support is available from the Division of Research, Training and Education part of HRSA’s Maternal and Child Health Bureau (MCHB).

The FOA (HRSA-12-006) includes three separate grant competitions:

• R40 MCH Research Program (MCHR) to support applied research to improve health services and delivery of care for maternal and child health populations

• R40 Secondary Data Analysis Studies (SDAS) Program to analyze and use existing secondary data

• R40 EHR Pediatric PBRN Initiative to support an existing EHR based pediatric practice-based research network to conduct comparative effectiveness research and epidemiologic assessment of psychotropic medications and commonly prescribed asthma medications in pediatric populations. The researchers will also look at the possible association between these medications and metabolic disorders in the population

Specifically, the “EHR Pediatric PBRN Initiative” plans to examine the effects of these medications by basic demographic factors that will include self-reported race, ethnicity, the child’s age and sex, and other variables. Information on side effects to be made available through EHRs will include height, weight, and blood pressure as well as the results of any routine laboratory work collected as part of well-child care.

Approximately $1,200,000 in funding is expected to be available for the R40 MCHR, fiscal years 2012-1014 to fund four grantees. Applicants may apply for up to $300,000 per year for up to three years. Funds for R40 SDAS are expected to be $400,000 to fund four grants, and the R40 “EHR Pediatric PBRN Initiative” will fund $1,000,000 for one grant per year for up to five years. Nine awards in total are estimated to be funded.

Eligible applicants can be private or state institutions of higher education engaged in research programs related to maternal and child health and/or services for children with special healthcare needs, Native American tribal organizations, and non-profits with (501) (3) status.

The FOA was released on July 12, 2011 with applications due September 7, 2011. For further information, go to or for the “EHR Pediatric PBRN Initiative”, the contact is Benjamin Margolis at

Strengthening Public Health

CDC awarded $49 million in grants to all 50 states to improve the quality of healthcare and to strengthen the public health infrastructure. The grant funding is to be used to strengthen state, local, and territorial health department’s capacity to perform critical epidemiology and laboratory work, to detect and prevent healthcare-associated infections, and to support immunization programs.

Of the grants awarded, $35.8 million in Prevention and Public Health Fund dollars and $3.8 million in additional CDC funding will go to increase epidemiology, laboratory, and health information systems capacity at health departments in all 50 states, two territories. Six of the largest local jurisdictions include cities such as Los Angeles and Philadelphia.

Almost $9 million will be used to enable the states to prevent Healthcare-Associated Infections (HAI), which leads to nearly 100,000 deaths every year. Funds will help states coordinate their HAI prevention activities, implement multi-facility, multi-disciplinary prevention efforts, improve the monitoring of antimicrobial use, and to enhance electronic reports of HAIs.

To see the list of grantees, go to

To make better use of data, New York State’s Department of Health (DOH) has launched the “METRIX” project to improve access to data assets. The Department of Health collects data and maintains a multitude of unique datasets that touch on all aspects of healthcare. While some of these datasets are limited in scope and permissible use, others have many potential applications and collectively represent an immense untapped resource to improve public health.

One area where public health can play a role involves understanding the clustering of chronic disease risk factors. Examining the clustering of risk factors and the extent to which socio-demographic characteristics account for shared variance among modifiable health behaviors can help provide an integrated approach to chronic disease prevention. Understanding the risk factors would also help public health officials address disparities in the health of this population.

The goals are to increase transparency of government with improved access to DOH data assets, identify high priority areas where analytics support the state’s health reform strategy, make data assets available for research purposes, expand policy analysis and research by using key data in public health services delivery areas, and contribute findings to the scientific evidence base to improve public health and the delivery of healthcare services.

METRIX will be delivered in stages. During the first phase, DOH will share a number of datasets previously not available to the public through the department’s web site. These data sets to be made available include:

• Behavioral Risk Factor Surveillance System designed by CDC to monitor risk behaviors and other factors contributing to the leading causes of morbidity and mortality in the population

• Cancer Mapping publishes maps showing cancer counts for small geographic areas along with certain facilities regulated by the state Department of Environmental Conservation

• Healthy Neighborhoods Program seeks to reduce the burden of housing-related illnesses and injuries with health departments implementing programs in selected high-risk target areas

• Adult Tobacco Survey developed by the NY Tobacco Control Program in partnership with RTI surveyed the non-institutionalized adult population of the state aged 18 or older. A National Comparison Survey was also developed

• Nursing Home Weekly Bed Census as required by DOH to complete electronic filings on each facility’s licensed nursing home beds and have the information available by bed category on a weekly basis

Phase Two will entail releasing a “Request for Interest” (RFI) to gather feedback on the METRIX goals from researchers, evaluators, and funders. The responses to the RFI will help the Office of Public Health provide additional RFIs to be used by other DOH offices.

The release of potential Phase Two databases will include the State Immunization Information System, Pediatric Nutrition Surveillance System, Student Weight Status Category Reporting System, and the State Early Intervention System.

Phase Three will entail releasing a Request for Application (RFA) to obtain specific answers to questions of interest to not only DOH but to external stakeholders. Answers are needed to determine costs, access, utilization, operational efficiency, measurement and improvement, and ways to identify opportunities to use public health to improve clinical care.

For more information, email

Empowering Drug Development

NIH awarded up to $50 million over five years to work on developing new drugs for disorders of the nervous system. The research aimed at treating conditions such as vision loss, neurodegenerative disease, and depression are being funded through the “NIH Blueprint for Neuroscience Research” program.

Nervous system disorders affect tens of millions of Americans, and there is a substantial unmet need for treatment but the process for developing new drug therapies is costly and carries high risks. Only about 10 to 20 percent of candidate drugs for all disease indications survive the early phases of development and reach clinical trials.

The NIH Blueprint works with 15 of the agency’s institutes and centers to leverage their resources to study major, cross-cutting challenges in neuroscience research. The “Blueprint Neurotherapeutics Network” will help make it possible for researchers to develop new drugs for nervous system disorders and conduct clinical trials using the new drugs.

“The Network will pair neuroscientists with experts in therapy development, and enable them to pursue their new ideas for new drugs without having to redirect the focus of their laboratories” said Story Landis, Ph.D., Director of NINDS within NIH.

The project teams supported by the Network will not only receive funding but will also have access to millions of dollars worth of services normally only available to pharmaceutical companies. Now it will be possible to assist investigators throughout the entire drug development process.

For example, Emory University with $969,000 in funding will be developing new drugs to use for stroke as part of the research program. The research team led by Raymond Dingledine, PhD., aims to develop drugs based on compounds called prostaglandins which have been shown to protect animals from brain damage following a stroke.

The awards went to seven research teams at six academic institutions that includes Brigham and Women’s Hospital, Ohio State University, Columbia University, Emory University, University of California San Diego, the University of Washington, and the Fred Hutchinson Cancer Research Center, plus Trevena Inc a drug discovery company. Go to for more details on each academic institution.

In another scientific project with funding from NIH’s National Institute of General Medical Sciences, Howard Hughes Medical Institute, and PhRMA Foundation, researchers at the Stanford University School of Medicine have paired up medicines and maladies with help from databases on the internet. When the scientists applied an opposites attract algorithm to databases, they found potential compatibilities between numerous existing drugs and diseases that may possibly work together to help in various diseases.

As Atul Butt MD PhD, Associate Professor of Systems Medicine in Pediatrics explained, “the degree to which a drug is effective to treat epilepsy may prove effective to use for another disorder as different as Crohn’s disease. For instance, an ulcer drug to treat adenocarcinoma of the lung might be used with topiramate an anti-seizure drug to treat lung cancer.

Today, new technologies have made it routine to simultaneously measure activity levels for every gene in a cell or tissue. Today there are 750,000 results of such analyses in publicly available databases. For a variety of reasons, in the past, very few scientists have used the data already entered to connect drug possibilities.

In another development, Butt serving on the scientific advisory board of NuMedii, a startup company that aims to commercialize some of the technologies used in the research is hoping to use the results of the research studies to help find funding sources to enable a new approach to getting both on and off patent compounds into the right clinical trials.

Innovation Center Releases RFA

The Center for Medicare and Medicaid Innovation (Innovation Center) created by the Affordable Care Act launched the “Bundled Payments Initiative” to find new and better ways to provide and pay for healthcare for a growing population of Medicare and Medicaid beneficiaries.

Today, hospitals, physicians, and other clinicians who provide care for Medicare beneficiaries, are paid separately for their services. This new initiative will bundle care for a package of services patients receive to treat specific medical conditions during a single hospital stay and/or recovery from that stay.

By bundling payments across providers for multiple services, providers will have a greater incentive to coordinate and ensure continuity of care across settings. Better coordinated care can reduce unnecessary duplication of services, reduce preventable medical errors, help patient heal without harm and lower costs.

Released today, the Innovation Center’s “Request for Applications” (RFA) outlines four broad approaches to bundled payments. Providers will have flexibility to determine which episodes of care and which services will be bundled together.

The Bundled Payments Initiative is based on research and previous demonstration projects that suggests that this approach has potential. For example, a Medicare heart bypass surgery bundled payment demonstration saved the program $42.3 million or roughly 10 percent of expected costs, and saved patients $7.9 million in co-insurance while improving care and lowering hospital mortality.

Go to for more details on the Request for Applications.

Organizations interested in applying to the Bundled Payments for Care Improvement Initiative must submit a Letter of Intent by September 22, 2011 for Model 1 and November 4, 2011 for Models, 2, 3, and 4.

Disparities in Trauma Outcomes

On an average day in Massachusetts, eight people die from traumatic injuries with more than 2,800 lost lives annually but the injuries alone result in more than 50,000 hospitalizations costing the state $2.5 billion. While demographic and geographic disparities in access to trauma care have been documented independent of whether or not individuals have health insurance, little is known about the impact of healthcare reform on eliminating these disparities and improving the survival rate of trauma victims.

A new, three year $1.2 million grant from the National Institute on Minority Health and Health Disparities will enable researchers to study disparities in trauma outcomes for patients in the state. Researchers from the Massachusetts Department of Public Health, University of Massachusetts Medical School, Brigham and Women’s Hospital, Massachusetts General Hospital, and the University of Vermont Medical School will take part in the study.

The researchers would like to find out why such great disparities exist in a state with such an advanced medical infrastructure and almost universal health insurance coverage. The team will use the new Erwin Hirsch State Trauma Registry and other hospital and vital record repositories to help understand why there are disparities and how these disparities have impacted Massachusetts healthcare reform’s ability to deliver quality trauma care.

The team will analyze data related to utilization, mortality, quality indicators, discharge dispositions, and the cost of trauma care. These population-based data sources comprise retrospective information on traumatic injuries both prior to and after the healthcare law’s enactment, allowing investigators to analyze geographic, socioeconomic, and clinical factors associate with all episodes of care.

Still Time to Submit Entries

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.

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.

Sunday, August 21, 2011

HHS Awards $40 Million

Grants for $40 million will be used to identify and enroll children eligible for Medicaid and the Children’s Health Insurance Program (CHIP). The grants have been awarded to 39 state agencies, community health centers, school-based organizations, and non-profit groups in 23 states. Grants amounts range from $200,000 to $2.5 million with the largest grants going to the technology focus area.

The major focus area involving technology will use $20 million for 10 grants to develop systems capable of signing up children for health coverage. Some of the grants included in this focus area are going to:

• Fresno Health Communities Access Partners (CA) for $1,259,565 will use a web-based application called “One-e-App” to facilitate enrollment and renewal in Medicaid and CHIP

• Georgia Department of Community Health for $2,500,000 will use electronic data matching capacity to verify citizenship, provide portable scanners and laptop computers to facilitate off-site enrollment and verification, implement an on-line renewal module, and develop an electronic referral from Medicaid to “PeachCare for Kids”

• North Dakota Department of Human Services for $1,690,867 will adapt the “e-find” system so that multiple databases for wage unemployment insurance, child support enforcement, social security data, and other information can be electronically checked for the purpose of determining eligibility and renewing coverage for Medicaid and CHIP

The other organizations and states to receive funding under the technology focus area include Sacred Heart Health Systems Inc in Florida, State of Maine Department of Health and Human Services, Hudson River Healthcare Inc in New York, New Mexico Human Services Department, South Carolina State Office of Rural Health, South Dakota Department of Social Services, and the Washington Department of Social and Health Services in Washington state.

Other grant awards in other areas will focus on retention (4 grants), engaging schools in outreach, enrollment and renewal activities (7 grants), reaching out to groups likely to experience gaps in coverage (14 grants), and ensuring eligible teens are enrolled and stay covered (4 grants).

Go to and then go to the press release for a complete list and more information on the grantees.

DOD & VA Addressing Unseen Wounds

Both the Department of Defense and the Veterans Administration look at both PTSD and TBI as the unseen wounds of war and both conditions can share a complex relationship. For example, an explosive device that causes a TBI can also produce a trauma leading to PTSD. In addition, common symptoms can make it even more difficult to diagnose each condition.

DOD’s initiatives to address the problem:

• Center for Deployment Psychology (CDP) and the National Center for Telehealth & Technology (T2) are component centers of the Defense Center of Excellence for Psychological Health and TBI. CDP trains train military, civilian psychologists, and other behavioral health professionals while T2 develops communications and information technologies to address psychological health and TBIs

• Defense and Veterans Brain Injury Center collaborates with organizations to advance research on TBIs. A major focus is to evaluate the quality and cost-effectiveness of treatments delivered to military personnel and veterans

• Deployment Health Clinical Center (DHCC) provides a gateway to information on deployment health and healthcare for providers, service members, veterans, and families. RESPECT.Mil is a treatment model designed by DHCC to screen, assess, and treat active duty soldiers with depression and/or PTSD

• National Intrepid Center of Excellence provides an interdisciplinary team assessment approach combined with high technology diagnostics to follow combat-related psychological health and TBI

The Department of Defense funded and developed virtual reality programs that allow soldiers with PTSD to revisit past wartime experiences and get past those events at their own pace. The virtual reality program helps a war fighter recognize their symptoms and find ways to obtain professional help.

Another Department of Defense product called “Mood Tracker” helps users monitor swings in moods, emotions, and behaviors resulting from therapy, medications, or other daily events. The application is designed for smart phone use and is able to record emotions for up to several months so that patient mental health can be documented over time.

TATRC developed and provides “Neurocognitive Baseline Testing” for troops prior to deployment. More than two million tests have been performed making it easier to detect changes and identify mild TBI later on if necessary.

The Army’s TriWest Healthcare Alliance takes care of all the active duty, retired military, and their families in 21 western states and is a leader in treating the unseen wounds of war. Stress related issues have increased dramatically in the past three years with repeated deployments. As a result, TriWest has increased their behavioral health professional staff from 7,000 to 25,000. TriWest’s ten year old behavioral health hot line is so successful that both the Army and Marine Corps asked TriWest to help them set up their own hotlines.

The Veterans Administration is also very active in serving the needs of veterans with PTSD through their National Center for PTSD. The Center has developed state-of-the-art assessment measures and treatments for clinicians to use to diagnose and treat patients with PTSD. Information is disseminated to clinicians through the Center’s web site, publications, and treatment manuals, also through assessment tools, nationwide training, and their in-person clinical training program.

Increased adrenergic activation among veterans with PTSD has led to clinical trials using anti-adrenergic medications. The Center is also working to identify a biomarker for PTSD that would help identify true cases with the disorder. This marker would be very useful for diagnostic purposes, for monitoring treatment responses, and for evaluating veterans seeking service-connected disability status for military-related PTSD.

The Center established the “Published International Literature on Traumatic Stress (PILOTS) electronic index to traumatic stress literature and other mental health issues. The PILOTS index includes all relevant publications regardless of their origin, linguistic, or geographic limitations.

A new initiative “Integrated Mental Health Strategy” highlights the most resourceful psychological health services available to assist the military and veterans available from not only from DOD and VA but also from other Federal agencies such as SAMHSA, Department of Labor, and HUD. All of these agencies have been involved in developing ways to provide the best resources in the field to help with psychological problems.

LifeBot Acquires Exclusive Rights

LifeBot® has acquired exclusive worldwide rights to DREAMS™, the $14 million advanced EMS ambulance and hospital telemedicine system developed by Texas A&M, UTHealth, and the Department of the Army.

The Digital EMS is the first and only system providing interactive simultaneous live transmissions of critical patient data, audio, and video. The system brings hospital specialists to the scene, giving doctors and nurses a virtual tele-presence to collaborate in saving lives and managing disasters in real-time on the battlefield or at home or abroad.

“Most attempts at ambulance-based telemedicine systems have had extremely limited success but DREAMS has actually delivered on its promise to get the job done over a number of years,” says LifeBot CEO, R. Lee Heath best known as the inventor of the Automatic External Defibrillator.

DREAMS™ developed with funding from the Army’s Telemedicine and Technology Research Center (TATRC) has been deployed and has been in use for over six years in five prototype ambulances in Liberty County Texas.

The project was headed by renowned surgeon James “Red” Duke JR who used the system to triage and treat victims in New Orleans “live” during Hurricane Katrina in the Memorial Hermann emergency room at the Texas Medical Center in Houston. DREAMS family products were also used to support remote clinics during the Katrina and Rita disasters.

The Super Ambulance™ system is operated by using multiple remote controlled cameras to provide hospital-based emergency specialists with live intelligence in order to provide prompt and safe life-saving assessments.

The patient’s physiologic vital signs, data, and medical record reporting are accomplished by using either EHRs or e-PCRs to provide updates between the hospital and the scene. The system can treat cardiac, trauma, stroke victims, and can be vital to use in remote areas.

The DREAMS system is not solely for use in ambulances, but can be used to provide telecardiology, telestroke, teletrauma, can be used in intensive care, plus other hospital-to-hospital and physician-to-hospital applications. In addition, LifeBot mobile telemedicine carts and desktop systems use the DREAMS system.

The DREAMS system has been tested on the 1.5 pound portable LifeBot Tablet PC as well. This will enable intensivists, cardiologists, neurologists, trauma and emergency disaster specialists to login and achieve telepresence from almost any location and at any time.

Other LifeBot technology products include a stand-alone system called a “Deployable Telemedicine System” used by hospitals to expand their facilities during disasters or the system can even be dropped into the battlefield to deliver telemedicine as well. The Back-Pack Telemedicine System provides battlefield, mobile or tactical medics with wearable telemedicine systems enabling them to work in difficult access locations.

LifeBot is now involved in building full call centers or telemedicine hubs to provide the latest technology to coordinate care. These centers will be able to use triage solutions and telemedicine to intelligently coordinate and safely determine if patients need either emergent, non-emergent care. It will then be possible to send ambulances to only real emergencies and at the same time, match the needed medical expertise with each medical situation.

For more information, go to or call (877) 466-1422 or email

ONC to Fund AHA Survey

Since 2008, the Office of the National Coordinator (ONC) has partnered with the American Hospital Association (AHA) through grants administered by NIH to track the use of health IT in U.S. hospitals. ONC now has its own grant management capability and is tasked through the HITECH Act to oversee federal efforts relating to health IT.

As a result, ONC wants to continue to track the status and adoption of electronic health records in hospitals, evaluate the impact of ONC programs, the impact of Medicare and Medicaid incentives in the U.S related ONC programs, and assess the effects of health IT adoption on all aspects of care such as quality and efficiency.

The grant notice (EP-NARRA-AHA-11-001) was published in on August 16, 2011 to specify that ONC intends to continue the collaboration with AHA through a new sole source document to be submitted by AHA by August 22, 2011.

The estimated program funding is $204,000 and will be available for 16 months across Fiscal Years 2011, 2012, and 2013.

Partners Symposium: Over 1,200 to Attend

Partners Healthcare 2011 Connected Health Symposium promises to bring together the most up-to-date thinkers involved in the field of health and technology. This premier opportunity will enable healthcare executives and key thought leaders to have tough in-depth debates on how to handle this tumultuous new era of debt reduction politics, plus talk about healthcare issues that the U.S and other countries all over the world face in the 21st century. Register today 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 1,200 health technology leaders, community-based practitioners, health plan executives, large employers, government policy makers, and investors. Exchange ideas with tech entrepreneurs, business executives, academic researchers, and patients.

Joe Kvedar, MD, Director for Partner’s Center for Connected Health is looking forward to hearing new stimulating ideas from all of the health innovators and attendees at the Symposium as well as take part in the discussions and debates on how best to deliver quality care outside traditional medical settings in spite of the difficult healthcare environment.

Top keynote speaker Brent James M.D., Chief Quality Officer, Intermountain HealthCare will talk about his New York Times Sunday Magazine article “If Health Care is Going to Change, Dr. Brent James Ideas will Lead the Way”

To consider economic inequality’s impact on health, listen to 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.

For a probing analysis come to hear keynoter Atul Gwande, M.D. Surgeon, Brigham and Women’s Hospital in Boston, New Yorker Magazine healthcare writer, and Director for the World Health Organization’s Global Challenge for Safer Surgical Care.

Attendees will want to hear Janet Dillione GM for Healthcare, Nuance talk about 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.

Be sure to hear Clifford Nash, PhD, Thomas M Storke Professor at Stanford University, author of “The Media Equation”, “Wired for Speech”, and “The Man Who Lied to His Laptop” discuss his books plus his ideas from his publications on the psychology and design of interactive technologies.

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

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.

Other prominent speakers just added to the list include:
• David Blumenthal, Professor of Medicine and Professor of Health Policy, Harvard Medical School and former National Coordinator for HIT
• George Church, Co-founder, and Chief Scientific Advisor for Knome
• Jonathan Gruber, Professor of Economics at MIT and high profile advisor on healthcare reform for the Commonwealth of Massachusetts and the Obama administration
• Jessica Haberer, Research Scientist at the MGH Center for Global Health
• Debra Lieberman, Director, the Health Games Research National Program at the University of California, Santa Barbara
• Halle Tecco, Founder and Managing Director of RockHealth.

Also on the agenda are many breakout sessions with vital information on accountable care organizations, innovative ways to provide wireless for poor communities, convergence of genomics, 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.

Meet all of the exhibitors 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 special inaugural event 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.

Sanjiv Chopra, M.B.B.S., M.A.C.P. Professor of Medicine, Faulty Dean for Continuing Education, Harvard Medical School will speak on “The Ten Tenets of Leadership” a topic that he is passionate about and has presented to audiences world-wide.

Other speakers will include:
• Ambassador Swanee Hunt, Adjunct Lecturer at the Kennedy School of Government
• Alvaro Pascual-Leone, MD, Professor of Neurology, Harvard Medical School
• Charles Denham, MD, CEO and Founder HCC Corporation, Chairman and Founder TMIT
• Jim O’ Connell, MD, President, Boston Health Care for the Homeless Program
• Scott Snook, Senior Lecturer at the Harvard Business School
• Venkat Srinivasan, CEO, Rage Frameworks, Inc, Chairman and Founder of English Helper
• Zunaira Munir, Founder and Managing Director, Strategize Blue

Go to for more information on sponsorships, exhibiting, and registering for this major Symposium along with registering for the Leadership Summit.

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 for the Symposium at or email Margaret Spinale at

Wednesday, August 17, 2011

Technology for the Disabled

The U.S. Department of Education’s National Institute on Disabilities and Rehabilitation Research (NIDRR) awarded 16 SBIR grants for $75,000 each to small businesses to develop technology to make life and learning easier for individuals with disabilities.

NIDRR’s SBIR program has two phases. Phase I determines the scientific or technical merit of the idea with awards made for up to six months for a maximum of $75,000 and Phase II projects awarded to expand on the previous results for up to two years and a maximum of $500,000.

“The projects awarded are designed to help people with disabilities maximize their job productivity and economic self-sufficiency,” said Alexa Posny, Assistant Secretary for the Office of Special Education and Rehabilitative Services (OSERS).

Some of the awardees and projects are:

• AbleLink Technologies, Inc.— to develop a remote scheduling management and monitoring system to support personal scheduling by individuals with intellectual and cognitive disabilities plus develop a cloud-based activity support system

• CreateAbility Concepts, Inc.— to develop a talking Smartphone and tablet application to help people who are blind or visually impaired to fully be able to use devices with visual flat-panel displays

• Institute for Disabilities Research and Training, Inc.—to develop computer and online software providing ASL translation and publishing capabilities

• Assistech Systems LLC—to further develop “HealthChecker” an accessible web-based application for self-assessment of personal health and wellness by individuals with cognitive disabilities

In another program, NIDRR’s Rehabilitation Engineering Research Centers (RERC) conduct advanced research to apply advanced technology to solve rehabilitation problems and remove environmental barriers. Each center is affiliated with one or more institutions of higher education or nonprofit organizations to find the newest technologies, products, and methods that can help individuals maintain their independence in spite of living with disabilities.

The NIDRR “Wireless RERC” is funded to promote universal access and use of mobile wireless technologies and explore innovative applications for people with disabilities. The Wireless RERC works directly with consumers by assessing the usability of wireless products by users with disabilities, creating an online forum, and promote awareness about accessible wireless options with consumers and providers.

Currently, the Wireless RERC has several projects under development:

• Prototype systems for location-based services in public places

• Next-generation, digital emergency alerts to ensure equitable access to emergency information by people with disabilities over wireless networks and devices

• Prototypes of universal interfaces that accommodate diverse user abilities

• Guidelines and tools for the design of wireless interfaces that will accommodate users with visual limitations

The Wireless RERC is also involved in regulatory activities. The RERC examines and analyzes accessibility policy issues related to the use of wireless communications and other information technologies. Key activities include regulatory filings, producing policy brief and timely advisories to stakeholders on municipal wireless networks, emergency communications. and related issues.

The RERC has developed a “Collaborative Policy Network” to bring together experts on various aspects of the policy process in the telecommunications and IT related fields. The plan is for the Network to provide support internally to the RERC and to other RERCs in the field.

The RERC also created “SUNspot” to share findings from the ongoing “Survey of User Needs (SUN). This survey focuses on the use and usability of wireless technology by people with disabilities. The information is shared with manufacturers and carriers, as well as with policymakers and SUN data is used in guiding industry and government initiatives.

For more information, go to

Chronically Ill & Team-Based Care

“Caring for the complex chronically ill accounts for a high proportion of national spending and spans the healthcare system” according to Cathy Schoen, Senior Vice President for the Commonwealth Fund. She was speaking at the Alliance for Health Reform briefing “Improving Care and Managing Costs: Team-based Care of the Chronically Ill” held on Capitol Hill August 11th.

Schoen reports, “Twenty one percent of spending is for the five percent of the population that has five or more chronic conditions. Payment changes, team-based care, and system innovations including the use of registries and EHRs are key to achieving better outcomes and lowering costs.”

How to provide team-based care for dual eligible seniors with complex chronic conditions was described by Lois Simon, M.P.H., Co-Founder and Chief Operating Officer for the Commonwealth Care Alliance (CCA). CCA is a Massachusetts state-wide not-for-profit consumer governed prepaid care delivery system taking care of Medicaid and/or dual eligible seniors with the most complex and expensive chronic conditions.

CCA put in place a primary care and care coordination model by deploying multidisciplinary primary care teams. To further explain, Simon presented a case which needed a fundamental primary care redesign.

Anna C. a 55 year old woman SSI eligible Medicaid beneficiary, was ill with long standing Multiple Sclerosis resulting in completer paralysis in both legs, partial paralysis in both arms, and impaired bladder function. This has resulted in a long standing history of depression, a prior major suicide attempt, and a history of severe asthma exacerbated by heavy smoking.

For many years, Anna was able to use a manual wheelchair and perform self catheterizations but with slowly progressive upper extremity weakness this became impossible for Anna. To help her, Anna received two hours of care from a Personal Care Assistant each morning and each evening for the past five years without any adjustment despite her functional decline.

During the past two years, there have been multiple hospitalizations for urinary tract infections, asthma exacerbations, and two long sub-acute hospital stays for pressure sore management caused by extended hours in bed and from a poorly fitted manual wheelchair.

Anna was found to have no consistent primary care or behavioral health relationship and as a result, she was severely depressed, emotionally withdrawn, functionally bedbound, incontinent, and experiencing rapidly worsening ulcers.

Obviously, continuity clinical management in Anna’s care was non-existent and not only reflected in her lack of care, but also influenced the cost factor. Costs and service use patterns with individuals such as Anna’s represent 12 percent of Medicaid beneficiaries, and represent 30 percent of Medicare expenditures. Anna’s predicted monthly total medical expenditures are about $3800 per month with nearly 50 percent going to recurrent hospital care for predictable complications from her chronic illnesses.

At this point, a primary care redesign was implemented for Anna. A team was put in place to include an in-home nurse practitioner, a behavioral health clinician, plus physical therapy is provided, along with durable medical equipment to enable the following individualized care plan:

• 72 hours of personal care assistant support per week was instituted to help with daily living activities but was later reduced to 40 hours a week over time

• A consultation with an in-home wound care nurse specialist provided a clinical management plan

• A specialized air mattress was delivered within 24 hours along with a motorized wheelchair with needed seating adaptations

• An in-home behavioral health assessment was made along with an individualized care plan that includes medications and counseling

• Transportation was arranged for specialty appointments, dental care, and other activities

• Smoking cessation strategies were instituted

• A primary care physician with support by a nurse practitioner responds first to new problems via home visits.

One year later, Anna was engaged with life, family, community and was able to self manage her care which greatly improved. Also, ulcers were healed, behavior health, psychopharmacology. and in-home counseling was established, smoking cessation efforts were partially effective, asthma exacerbations were greatly diminished, and a continuous relationship with the primary care physician was established although more primary care occurs via a nurse practitioner in the home.

Most importantly, there were only two emergency department visits for asthma exacerbation management and one three day hospitalization for urinary tract infection management, and as a result, hospital utilization was markedly lower than before.

The CCA team-based approach works well with Medicare and Medicaid patients with five or more chronic conditions. According to an AHRQ report “The roles of “Patient-Centered Medical Homes and Accountable Care Organization in Coordinating Patient Care” published December 2010 discusses in detail what has not worked in providing coordinated care.

The report finds that targeted care coordination services provided to low-risk Medicare patients have not been shown to improve the quality or utilization of care and at times have increased overall costs. However, well-designed, targeted care coordination interventions delivered to the right people with multiple chronic conditions can improve patient, provider, and payer outcomes.

Several successful coordinated care models in the U.S show major reductions in emergency room visits, reductions in all-cause hospital admissions, readmissions, nursing home days, and indicate that these care models have achieved net savings and improved quality outcomes especially for high risk patients.

Managing Patient Transitions Effectively

Preventing readmissions and shortening the time to do preadmission screenings is very important to Northeast Rehabilitation Hospital located in New Hampshire since the hospital specializes in stroke and traumatic neurological injuries very often resulting in timely and complex patient transitions.

When Patricia Buiocchi, joined Northeast Rehabilitation Hospital, as Vice President of Business Development and Strategic Planning, she was surprised to find liaison clinicians spending most of their day doing data entry work as part of pre-admission screening. The team handles referrals for two acute hospitals with a third on the way, 23 outpatient facilities, and a home care service in southern New Hampshire and northern Massachusetts.

One of Buiocchi’s first moves as was to turn to Curaspan’s “ReferralCentral” a web based referral management software to speed up the process. By using the software, it no longer takes hours of phone calls, emails, and faxes to communicate and find the answers to specific questions.

“It used to take liaisons two hours to input information for each incoming patient. By using “ReferralCentral”, data is delivered in a complete legible referral package. As a result, referrals have jumped 15 percent in 12 months.

In another case, Laura Davie, Project Director for the University of New Hampshire Institute for Health Policy and Practice, has been working with community partners on behalf of the New Hampshire Bureau of Elderly and Adult Services to develop and implement a long term patient-centric hospital discharge planning model to discharge individuals back into the community and hopefully prevent unnecessary readmissions.

Specifically, several models such as the “Better Outcomes for Older Adults through Safe Transitions” (BOOST) and “Care Transitions Intervention” (CTI) developed at the University of Colorado Denver are used to help patients when they are discharged.

New Hampshire’s ServiceLink Aging and Disability Resource Centers are supported by a strong technology-based infrastructure and a team-based approach for operations management. They operate as a single point of entry for all long term care and the transitions specialists provide follow up support intended to prevent readmissions.

Using technology such as the BOOST model enables ServiceLink staff to follow discharges with individuals in high need of social support, and follows patients with complex medications and needs. Under the CTI model, transition coaches are trained to help individuals identify goals and problems but the coaches don’t provide direct medical care to the patient when they leave the hospital

In addition, a workshop held in New Hampshire has been organized that includes three hospitals, three ServiceLink Aging and Disability Resource Centers, several community and case management agencies covering three counties, to support individuals so that they can make informed choices and find access to long-term support including a wide range of in-home, community-based, and institutional services and programs.

RFPs for Inmate Health Services

Two states have issued RFPs to find qualified vendors to manage and operate healthcare services for their state Departments of Corrections. Both RFPs include requirements for Electronic Health Records and telemedicine to efficiently deliver healthcare to inmates in the prison setting.

The North Carolina Department of Corrections on July 21, 2011 issued RFP (201100607) with will proposals accepted until May 16, 2012. Services are to be provided onsite but specialized services may be provided through agreements with area providers such as hospitals, clinics, medical specialties, and laboratories.

The North Carolina Department of Corrections would like to increase the number of inmates using telemedicine clinics presently held at two correctional facilities and expand these services to other prison facilities. The Department encourages the use and expansion of telemedicine to the extent possible if used without jeopardizing inmate health status and security.

Presently, telemedicine services are available in cardiology, dermatology, endocrinology, ear, nose, and throat, gastroenterology, infectious disease, internal medicine, pulmonary, physical therapy, speech pathology, rheumatology, podiatry, sound management, and psychiatry.

The Unified Electronic Health Record System with a data integrated software application in the correctional facility must comply with the Reform Act to allow access to patient information at all North Carolina Department of Corrections facilities. The system needs to be able to integrate all clinical patient data plus any treatment data from any external providers. The system needs to support at a minimum 40,000 active patients dispersed over a minimum of 70 geographic locations.

For more information, contact Mildred Christmas, Division of Purchase and Contract at or call (919) 807-4525. To view the RFP, go to

The state of Maryland on July 8, 2011 issued a Request for Proposals for Inmate Medical Healthcare and Utilization Services RFP (DPSCSQ0012013) to be delivered September 7, 2011.

Telemedicine has priority for inmates located in the western and eastern parts of the state. The contractor will need to continue to maintain the Department’s Hepatitis Tele-medical program as required by the department’s infectious disease manual. Telemedicine specialty care will need to be available within the first 6 months of the contract award for cardiology, wound care orthopedic optometry, dermatology, and for trauma care. The contractor will need to maintain the electronic log documenting the use of telemedicine.

Presently, the EHR system known as NextGen maintains demographics notes, outside consults, dialysis flow sheets, obstetrical prenatal flow shees, and data on specialty care, diabetics, cardiology patients, and patients with infectious diseases.

For more information, contact Andrea R. Lockett at or call (410) 260-7374. To view the RFP, go to

CMS Issues Presolicitation

CMS plans to award multiple “Indefinite Delivery/Indefinite Quantity” (ID/IQ) contracts to support Virtual Data Centers (VDC) to do complex operations with fairly simple hardware. The VDCs will provide the IT infrastructure and services to operate CMS business systems and safeguard the data.

The original presolicitation was posted on on August 4, 2011 with a new posting on August 8, 2011. The presolicitation number is (APP130023).

Some of the RFPs will award contracts to manage all the activities while other RFPs will provide desk support, funding to maintain the centers and provide the training as needed. Task Order 1 is the Large Umbrella ID/IQ and Task Order 2 provides for a national data warehouse.

CMS will conduct an Industry Day Webinar at 9:00A.M (Eastern) time on October 14, 2011. If vendors wish to participate in this webinar, vendors must RSVP by 12 noon (Eastern) on August 26, 2011 with an email. The words “VDC WEBINAR RSVP” must be in the subject line and send to

In preparation for the VDC Industry Day Webinar, questions and comments need to be submitted by 12 noon (Eastern) September 2, 2011 with the words “VDC WEBINAR Questions/Comments” in the subject line. Send the email to

Participating parties will be limited to 5 access lines, so conferencing at the vendor’s sites is encouraged. Additional detailed information about the VDC Industry Day Webinar will be provided to those vendors that RSVP.

Sunday, August 14, 2011

FCC's 5 Step NG9-1-1 Plan

The FCC’s 5 Step Action Plan charting the transition to Next Generation 9-1-1 (NG9-1-1) services, was presented by FCC Chairman Julius Genachowski at the Association of Public Safety Communications Officials conference held in Philadelphia. He told the attendees how he used to work in emergency response. In the 1980s, he was a certified EMT, worked on ambulances in Manhattan, and taught CPR. Like many others, he was in New York on 9/11, walking to work on 8th Avenue when the planes struck.

He explained how NG9-1-1 allows consumers to use any communication device that is available in an emergency. People are going to reach out for help with whatever means of communications they are accustomed to using. A growing number of people use texting but unfortunately the current emergency system doesn’t support texting. It’s hard to imagine that airlines can send text messages if your flight is delayed, but you can’t send a text message to 9-1-1 in an emergency. NG9-1-1 will make sure that your call for help in an emergency is delivered.

Imagine if someone is in a car accident. With NG9-1-1, someone in the car could send pictures of the injuries and the scene to 9-1-1, which EMTs could review in advance. Once on the scene, EMTs could send critical information back to the hospital, including on-site scans and diagnostic information.

With NG9-1-1, dispatchers could access hospital capacity data, real-time road and traffic conditions, and videos from the crash scene available from traffic cameras to decide who to dispatch and where to transport the crash victims.

In another possible scenario, if a patient wearing a 27/7 cardiac monitoring device experiences a cardiac event at home, the device could automatically send a wireless signal to the NG9-1-1 system to request aid, and be able to transmit the patient’s location, identifying data, and relevant medical information.

At the conference, Genachowski presented FCC’s new five stop plan to meet the future needs for NG9-1-1:

• NG9-1-1 location accuracy mechanisms need to be developed. The FCC has already taken steps to improve the accuracy of mobile 9-1-1 and is tackling NG9-1-1 location accuracy.
Last month, the FCC strengthened existing enhanced 9-1-1 location accuracy rules, by requiring all wireless carriers to meet more stringent metrics

• NG9-1-1 technical standards defining the system’s architecture needs to be implemented. Hardware and software has to help carriers and Public Safety Answering Points (PSAP) communicate NG9-1-1 information seamlessly. The 9-1-1 community has completed much of the necessary standards work, but some issues remain on how the architecture will be implemented

• A NG9-1-1 governance framework needs to be developed but the biggest challenge facing NG9-1-1 deployment is that no single entity has jurisdiction. The FCC is working with other federal agencies and 9-1-1 authorities to create a governing framework

• Ways to fund NG9-1-1 in a cost-efficient way needs to be established. The FCC’s Public Safety Bureau is preparing a cost model to identify the expenses associated with deploying the network infrastructure to link PSAPs and carriers.

• The FCC will consider a Notice of Proposed Rulemaking to accelerate NG9-1-1 adoption. The intent is to help answer the practical and technical questions on how to enable the transmission of text, photos, and videos to 9-1-1. The rulemaking will also consider how to ensure adequate broadband infrastructure to deliver the bandwidth that PSAPs will need to provide NG9-1-1

Genachowski commented that not only is the FCC working on building a 21st century 9-1-1 system, but industry is taking part in trials. For example, The City of Durham, North Carolina, Verizon and Intrado have launched a six month text-to-9-1-1 trial. In addition, Neustar has been demonstrating “Text Everywhere” a text-to-wireline solution holding real promise for NG9-1-1.

The FCC Chairman explained how the FCC’s five step action plan builds on the launching a few months ago of the Personal Localized Alerting Network (PLAN). PLAN will enable government officials to send text-like alerts to everyone in a targeted geographic area with an enabled mobile device. Since the alerts are geographically targeted, they will reach the right people, at the right time, with the right messages. He announced that PLAN will launch nationwide in April 2012.

Northa Dakota HIT Update

North Dakota is involved in several initiatives and rapidly providing essential broadband services and health technology needs in the state. Today, the Dakota Carrier Network (DCN) CCI Broadband project provides high-speed fiber connectivity to more than 175 largely rural and underserved areas where many community anchor organizations lack access to necessary last mile broadband speeds. DCN received $10.7 million in grant dollars but will provide a cash match of $4.6 million. DCN will complete 100 percent of the project by August 2013.

DCN intends to deploy 169 miles of new fiber with backhaul speeds as fast as 1 gigabit per second (Gbps) to enable last-mile service across the state. The project also proposes to enhance e-health in the state by deploying a dedicated 10 Gbps healthcare network to over 200 hospitals, clinics, and other healthcare providers. They are committed to providing telemedicine, teleradiology, telepharmacy, and enabling the exchange of health information electronically. For more information on DCN, email Seth Arndorfer at

The procurement of an HIE system began in late 2010 with the release of a RFP. At that time, the proposals and demonstrations by the top three vendors were reviewed. In June 2011, the team recommended to the Health Information Technology Advisory Committee (HITAC) that the contract be awarded to Optuminsight.

The first phase of the HIE project will deploy “Direct” functionality by November 2011. “Direct” is a bridge to meaningful use while the state HIE is being implemented. Direct is a simple and secure method for participants to send encrypted health information directly to known trusted recipients.

Once the HIE is fully implemented in 2011-2012, participants will be able to use a robust bi-directional HIE to fully support meaningful use and health IT requirements. The state Department of Health, Division of Disease Control, will be able to receive electronic messages to include laboratory results, surveillance data, and be able to update immunization registries.

HITAC has formed HIE Domain Workgroups currently being rolled out. These workgroup teams are playing a key role in planning, advising, and providing guidelines that will cover topics related to governance, business opportunities, legalities and policies, technical infrastructure, and also tackle issues related to the clinical workforce, communications and education, and finance.

The Clinical Workforce Team was specifically formed to:

• Support HIT and HIE adoption and meaningful use among state providers

• Develop and evaluate the project in terms of data collection and performance measurements

• Define and address high-value/high priority uses and/or use cases for HIE consistent with proposed meaningful use of certified EHR technology and additional clinical priorities

To help providers obtain the skills and tools needed to make technology changes in their practices, the Regional Extension Assistance Center for HIT (REACH), a nonprofit federal HIT Center is helping Minnesota and North Dakota primary care providers advance HIT. REACH provides readiness assessments, practice and workflow redesigns, help selecting a certified EHR product, help connecting with vendors, and provides information on privacy and security best practices. For more information, go to

To provide financing assistance, Senate Bill 2332 established a HIT planning revolving loan fund with the Bank of North Dakota to provide low-interest loans to healthcare entities to help build their HIT infrastructure. The loan fund can assist with the purchase, installation, and be used to support functional standards based interoperable HIT systems.

It is anticipated that available funds for loans could be $5.4 million which includes the additional $5 million appropriated by the 2011 Legislature. The maximum loan amount per applicant is $100,000 for standalone individual practitioners not affiliated with a multi-professional entity, provider system, or network, $400,000 for hospitals and multi-professional entities, and $800,000 for entities with three or more provider-owned facilities as in the case of a hospital with two or more clinics or three hospitals all under common ownership/governance.

North Dakota residents are eligible for the loans to purchase install and/or support software and hardware required to implement a fully functional, standards-based, interoperable EHR system certified by ONC. The loans can be used towards systems containing patient medical histories, electronic personal health records for people with chronic diseases, along with using the system for electronic prescribing.

Initial applications are due by August 22, 2011 with applicants to be notified by September 9, 2011 if their loan has been approved. For more information, go to

There is also a Federal financing option available to help meet the expense for EMR software to help rural areas and towns with up to 20,000 in population. The USDA Community Facilities Program provides flexible financial tools including the Community Facilities Guaranteed Loan Program, the Community Facilities Direct Loan Program, and the Community Facilities Grant Program. For more information, email or call (701) 530-2037.

For more information on North Dakota’s progress, go to

States Announce Funding

The New York State Department of Health, Bureau of Community Chronic Disease Prevention’s Asthma Program seeks applications to establish and/or expand Regional Asthma Coalitions (RAC) in high-risk geographic areas of New York State. The overall goal is to control asthma through a regional, population-based and sustainable systems approach. The objective is to decrease the number of hospitalizations and emergency department visits, decrease the number of school/work days lost, and decrease the number of clinic/provider office urgent care visits.

The RACs will implement interventions outlined by the “National Asthma Education Prevention Program”, “Expert Panel Report”, and “Guidelines for the Diagnosis and Management of Asthma” into practices in their regions.

Eligible applicants must be public and private not-for-profit organizations in New York State including but not limited to hospitals, primary care practices and networks, clinics, physician groups, health plans, local public health agencies, universities and colleges, schools and school districts, voluntary associations, foundations, scientific or professional associations, and community-based organizations with experience and expertise in the administration of coalitions or collaborative partnerships to address public health problems.

Applicants applying must have experience with:

• Engaging stakeholders and leading a coalition/collaborative on a regional level
• Using data to assess local asthma burden
• Developing a strategic plan to address local health problems
• Monitoring, evaluating, and reporting the results on collaborative efforts
• Applying the “Chronic Care Model”
• Utilizing process and outcome data to make system improvements

Up to eight contracts will be awarded. The estimated annual funding amount per contract is $18,000. The final number of awards and final award amounts will depend on funds available.

RFA (1012090253) was released in June with applications due August 29, 2011. To view the RFA, go to For more information, email Marianne Heigel, RN at

The Mississippi Department of Information Technology Services has released (RFP 3660) seeking proposals to enhance or replace an existing clinical Laboratory Information Management system (LIMS) for the Mississippi Public Health Laboratory (MPHL). The MPHL performs over 600,000 tests annually to support public health activities in the state and has two laboratory facilities located within three miles of each other in Jackson Mississippi.

The LIMS needs to improve the MPHL’s level of automation by improving the functionality of current testing algorithms to meet the needs of changing laboratory practices, create new test-specific configurations to enable additional test data to be released electronically through HL7 technology, create user-specified data retrieval reports, and provide additional instrument/LIMS interfaces to automatically release data from the instrumentation into the LIMS.

The RFP released August 2, 2011 requires the proposal to be submitted September 1, 2011. For more information, contact Donna Hamilton at (601) 432-8114 or email

The Minnesota Department of Human Services (DHS) is interested in an integrated service delivery and payment system to support all DHS programs. DHS on August 1, 2011 issued a Request for Information (RFI) to find out about available commercial-off-the-shelf software. This RFI is the first step in the possible development and implementation of a comprehensive, fully integrated human services delivery management system.

The software will be used to support case management, eligibility determinations, benefit payments, provider payments, healthcare enrollments, and child support collections. DHS seeks a product designed to be easily installed and to be interoperable with existing system components.

The RFI in writing is due August 29, 2011 with presentations or demonstrations if applicable to be held in September/October 2011. For more information, email Jennifer Trombley at or go to