Monday, November 28, 2011

HRSA Seeks Applications

On November 16th, HRSA’s Office of Rural Health Policy (ORHP) issued a funding announcement seeking applicants capable of synthesizing and analyzing key policy issues and changes to support the work of the Rural Policy Analysis Program. This information is needed to enable public policy makers, providers, leaders, and decision makers to understand the challenges ahead for rural populations.

Just like the U.S. population as a whole, the rural population is aging, report poorer health and more physical limitations than urban residents, experience greater financial and geographic barriers to access to care, and less likely to have health insurance coverage than the metro population. Added to these facts, rural communities have fewer healthcare providers and services due to declining rates for family medicine residencies, redistribution of J1 Visa waivers, plus the shortage of allied and other healthcare professionals in the workforce.

In addition to these challenges, there are also significant changes taking place in Federal and State policies. The Affordable Care Act is going to have a profound impact on rural communities since the Act contains a wide variety of rural-specific provisions that are specific to rural populations.

Eligible applicants can include domestic public, private, non-profit or for-profit organizations along with state, local, and Indian tribal governments, institutions of higher education, and hospitals. Applicants must have knowledge of Medicare and Medicaid policies, rural delivery systems, and public health.

The program will provide funding during fiscal year 2012 to 2016. Approximately $225,000 is expected to be available annually to fund one award for up to five years. The application is due January 17, 2012. For additional information, go to or email Nicole Comeaux at or (301) 443-5433.

NIH Streamling Tech Transfer

NIH has just launched the “Electronic Research Materials” (eRMa) catalogue to streamline the agency’s technology transfer process. The new eRMa web site should reduce response time for unpatented materials from six months to a few days and can be found at eRMa was designed and developed by NIH’s Office of Technology Transfer (OTT) with support from the NIH National Cancer Institute’s Center for Cancer Research.

More than 6,000 researchers at NIH laboratories help to drive the research and discovery process. These NIH researchers make unpatented materials available to companies through internal use licenses executed by OTT. An NIH internal use license is a contract that governs the transfer of tangible research materials from NIH to a company for commercial research use.

The new system will streamline the licensing process by:

• Providing a website for companies to find and license unpatented materials using a ready-to-go contract

• Allowing a company to pay online through and to receive the materials quickly from the labs

• Providing faster turn-around time and simplifying the process for companies to find research materials available from NIH labs

For non-profit research organizations interested in obtaining NIH materials through a material transfer agreement, NIH will launch the “Transfer Agreement Dashboard” in December. This web-based system will have a broad array of beneficiaries to include NIH scientists and technology transfer staff as well as researchers and technology transfer offices at universities and non-profit research institutions.

The NIH Office of Technology Transfer administers about $97 million annually in royalty payments from about 500 companies that have reported product sales of about $6 billion last year. OTT manages the patenting and licensing of the wide range of inventions made by NIH and FDA scientists as mandated by legislation.

For more information, go to the Office of Technology Transfer web site at

California HIT Forging Ahead

Both Linette T. Scott MD, Interim Deputy Secretary for HIT for the California Health and Human Services Agency, and Laura Landry, Interim CEO, for Cal eConnect spoke at the recent 2011 California HIE Stakeholder Summit. Both speakers updated the 300 attendees on major developments related to the transformation of healthcare in the state.

One recent development is the passage of the “Telehealth Advancement Act of 2011” that opens the door for the expansion of telehealth in the state. The Act will enable telehealth to provide a broader range of services and reach more providers and care settings.

To enable the delivery of telehealth, broadband must reach all of California’s rural communities. With help from the FCC Rural Health Pilot Project’s $22 million available over three years, the goal is to connect to over 800 sites. This funding will enable the Broadband Opportunities & Training Program to be executed by the California Telehealth Network (CTN) and the UC Davis Health System to provide $5 million in “Model eHealth Communities” awards to go to 15 communities.

In May, FCC granted a one year extension to the RHPP program and will accept applications through June 2012. Secondly the FCC has authorized CTN to provide subsidized low-cost broadband rates to RHCPP for an additional year.

Both Scott and Landry emphasized that the HIE landscape continues to evolve and develop. The big news is that San Diego Beacon Community plans to launch a Regional Health Information Exchange Infrastructure in December to connect hospitals, medical groups, public health, and emergency medical services. The selected sites for participating organizations include Children’s Primary Care Medical Group, Rady Children’s Hospital, UC San Diego Health System, Sharp Community Medical Group, and the VA San Diego Healthcare System.

The HIE is expected to be implemented to other sites throughout the San Diego healthcare community over the next 14 months. At that time, health IT will be integrated into care delivery, pre-hospital data will be available, immunization forecasting will be possible, medical device data on implantable wireless devices will be available to enable more effective treatments.

The HIE will help public health to improve with real-time syndromic surveillance available, enable bi-directional integration with the San Diego Immunization registry, make possible electronic reporting of notifiable conditions and laboratory results, and provide an emergency medical services hub.

The presenters at the meeting reported on the success of the EHR incentive programs in the state by pointing out that the Medicare EHR incentive program has enabled 224 providers to receive $4 million in incentives and the Medi-Cal EHR incentive program has 141 hospitals registered with CMS.

They also that reported the regional extension centers received $55,875,335 in federal dollars. This means that today, Cal HIPSO has 6,567 providers enrolled with 1, 935 EHRs installed, HITEC-LA has 2,950 providers enrolled with 850 EHRs installed, COREC has 800 providers enrolled with 405 EHRs installed, and the National Indian REC-CA has 148 providers enrolled with 148 EHRs installed.

Enabling Better Rural Healthcare

Agriculture Secretary Tom Vilsack on November 18th announced grant awards to establish telemedicine and other rural healthcare projects in the Delta region. The grants will fund ten projects in six states to deliver health services to areas currently lacking adequate care and deliver services to 25 persistent poverty counties.

Some of the grants are going to:

• Delta Health Alliance Inc ($699,142) will finance the Delta Electronic Intensive Care Unit network to link five hospitals in the most rural and impoverished counties in the Mississippi Delta

• The Tombigee Health Care Authority ($384,742) to finance “Healthcare on Wheels” a totally independent unit to provide healthcare services, education, telemedicine, and outreach linkage to community resources

• Murray State University ($233,366) to finance the East Kentucky TeleCare Project by providing equipment and resources for telehealth infrastructure for five rural critical access hospitals, two small hospitals, and one acute care hospital in the Delta Region of western Kentucky. The project will link eight hospitals into the Kentucky Telehealth Network

• Building Healthy Communities, Inc. ($364,443) will finance the Louisiana Nursing Home Telehealth Project to provide healthcare consultations to five rural nursing homes in the Louisiana Delta,

• Ochsner Clinic Foundation ($270,254) will finance the Acute Stroke System for Emergent Regional Telemedicine to connect eight rural hospitals in Central Louisiana

Other funding for projects includes $519,924 for Connect SI Foundation Inc., City of Mound Bayou for $2,993,954, University of Arkansas for Medical Sciences for $162,002, Arkansas State University for $384,742, and Franklin Parish Hospital, Service District No. 1 for $62,870.

In other news related to helping Rural Health Clinics (RHC), Congressman Aaron Schock (R-IL) introduced HR 3458 to enable RHCs to become eligible for electronic health record incentive payments through the Medicare program.

Due to the unique reimbursement structure of RHCs, their healthcare providers are not eligible for EHR incentive payments through CMS. “RHCs should not be discriminated against simply because they bill Medicare differently than hospitals or other healthcare practitioners who practice in rural areas” according to Congressman Schock. He represents 20 counties in Illinois and several of these counties include health clinics that are being penalized by this accounting error. “This is a flaw in the system that needs to be fixed,” said Schock.

OPM Issues HIT Report

The U.S Office of Personal Management (OPM) encourages the Federal Employees Health Benefits Program (FEHBP) to increase their use of health IT. Currently there are 207 health plan choices in the FEHB program with about 8 million Federal employees, retirees, and family members covered.

The FEHB carriers were asked to make PHRs available, provide healthcare costs transparency, provide incentives for e-Prescribing, and to protect the privacy of individually identifiable health information. To report on how these goals are being accomplished, OPM issued their fifth report on FEHBP relating to HIT.

This program-wide “HIT and Transparency Report” is based on individual reports collected from health plans participating in FEHBP. The report shows that 92 percent of FEHBP health plans have taken proactive steps to educate their members on the value of HIT.

This year’s findings include:

• 97 percent of plans representing 98 percent of total FEHBP enrollment have PHRs available to their members
• Members using PHRs vary widely. Some plans report about 6 percent of members use PHRs while others indicate that all members use them
• 59 percent of plans report that they have online physician or hospital cost estimators or comparison tools on their websites
• 75 percent of plans report that they have online tools to compare physician or hospital quality
• 75 percent of plans report that their physicians can order prescriptions online
• 100 percent of FEHBP plans indicate that they provide members with access to privacy policies describing their compliance with HIPAA

Go to to view the “HIT and Transparency Report for 2011”.

Efforts to Study Genomic Medicine

In November, the New York Genome Center (NYGC) was established with $125 million from the City of New York as well as funds from private companies and foundations. NYGC’s eleven leading academic medical centers and research universities include Cold Spring Harbor Laboratory, Columbia University, Cornell University/Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, Mount Sinai Medical Center, New York-Presbyterian Hospital, NYU School of Medicine, North Shore-LIJ Health System, the Jackson Laboratory, the Rockefeller University, and Stony Brook University. The Hospital for Special Surgery is an associate founding member.

Genomics are already a significant growth factor in the economy representing a $7 billion plus industry. NYGC will leverage existing strengths in genomics and attract new talent to create a hub where companies can develop applications for research. By 2025, the economic impact associated with commercial spin-off activities of NYGC is expected to represent the largest component of the total impact associated with the Center.

In another ongoing project, the “Electronic Medical Records and Genomics” network or referred to as eMERGE, received $25 million over the next four years to demonstrate that patients genomic information linked to disease characteristics and symptoms in their EMRs could improve care. eMERGE operates as a consortium with more than 120 members with grants from NIH’s National Human Genome Research Institute (NHGRI) plus additional funding from the National Institute of General Medical Sciences.

The original eMERGE program started several years ago and in July wrapped up the first phase of the program. It was demonstrated that disease characteristics data contained in EMRs along with patient’s genetic information can be used in large genetic studies. So far, the eMERGE network has identified genetic variants associated with dementia, cataracts, high density lipoprotein cholesterol, peripheral arterial disease, white blood cell count, type 2 diabetes and cardiac conduction defects.

In the next phase, researchers will identify genetic variants associated with 40 more disease characteristics and symptoms, using genome-wide association studies across the entire eMERGE network. DNA from about 32,000 participants will be analyzed in each study.

eMERGE network members in this phase include Vanderbilt University Medical Center, Group Health Cooperative and University of Washington, Northwestern University, Geisinger Weis Center for Research, Essentia Institute of Rural Health, Mayo Clinic, and Mount Sinai School of Medicine.

The eMERGE Network Phase II Pediatric Study was announced last summer. The funding will support existing pediatric biorepositories with EMRs and genome-wide genotyping data to incorporate state-of-the-art methods generated in eMERGE Phase 1. The applications were due in September 2011.

In the spring of 2012, NHGRI plans to award up to $1.5 million to as many as three investigators for three-year pediatric eMERGE studies. Another NIH Institute the Eunice Kennedy Shriver National Institute of Child Health and Human Development plans to co-fund these grants with NHGRI.

Improving Maternal & Neonatal Health

More than 98 percent of maternal and neonatal deaths occur in low-resource settings. Strategies to reduce maternal and neonatal deaths are needed to improve access and care especially in home and community settings where over half of the more than 60 million births occur each year.

Delivering innovative technologies across the continuum of care including technologies for frontline workers to use not only in homes and communities but also in first level clinics may significantly improve pregnancy outcomes. However, no quantitative process currently exists to evaluate and prioritize technology development options based on the potential to save lives in low resource settings.

To address the problem, the Bill and Melinda Gates Foundation issued a new grant program to address “Grand Challenges in Global Health”. The grant program in partnership with the “Global Alliance to Prevent Prematurity and Stillbirth” (GAPPS) is seeking letters of inquiry starting in November with final letters of inquiry due January 31, 2012. For more information on this new grant program, go to

This initiative is hoping that the scientific knowledge on the causes and mechanisms important to preterm birth in developing countries would lead to low-cost novel technologies to address the problem

In another grant project to improve maternal and neonatal healthcare in low-resource countries, RTI International developed a web-based tool to objectively assess the impact of new medical technologies on maternal, fetal, and neonatal mortality. The assessment tool “Maternal and Neonatal Directed Assessment of Technology” or referred to as MANDATE is also being developed with funding from the Bill & Melinda Gates Foundation.

By calculating the potential number of maternal and neonatal lives saved, the tool allows users to identify and compare the potential impact of a technology. Users may adjust variables related to a technology’s availability, appropriate use, and efficacy to determine how a technology might be improved to have the greatest impact.

Once the variables are set by the user, MANDATE can determine the technology’s potential impact by patient category, medical condition and healthcare settings in sub-Saharan Africa and South Asia, the regions with the highest burden of mortality. The tool will soon be available to the public on the MANDATE website at free of charge.

“Some very good technologies are simply not practical for use in low-resource settings,” said Doris Rouse, PhD, Project Director and Vice President of Global Health Technologies at RTI. “In some cases, innovative, low-tech solutions are more appropriate in these settings. MANDATE enables the user to assess the reduction in maternal and neonatal mortality that might results from a new or improved technology that is more appropriate or effective in specific settings.”

With other grant funding, researchers at Ecole de Technologie Superieure in Canada with funding from the Gates Foundation Grand Challenges Exploration Grants are designing and testing a diagnostic tool using computer acoustical analysis of newborn cries to better detect medical conditions such as asphyxia, hypoglycemia, and infections.

With funding from another Gates Foundation Grand Challenges Exploration grant, researchers of Global Health Partnerships and the University of New Mexico are going to work with care providers in Nepal to evaluate the use and acceptance of inexpensive devices constructed from local materials that works to decrease blood flow to the pelvic organs for treating post-partum hemorrhage, a major cause of maternal morbidity and mortality in the developing world.

Sunday, November 20, 2011

CMS Announces Challenge

CMS through the Innovation Center on November 14, 2011, announced their “Health Care Innovation Challenge” (CMS-1C1-12-001) with awards up to one billion to be made through cooperative agreements. CMS is looking for the most compelling new service delivery and payment models to drive system transformation and deliver better outcomes for Medicare, Medicaid, and CHIP beneficiaries.

The aims of the initiatives are to:

• Produce better, care, better health, and reduced costs for high cost/high-risk groups. These groups include populations with multiple chronic diseases and/or mental health or substance abuse issues, poor health status due to socio-economic and environmental factors, multiple medical conditions, high-cost individuals, or the frail elderly.

• Identify new models of workforce development and related training and education to support new models either directly or through new infrastructure activities. Currently, reimbursement payment policies do not necessarily support all workforce needs but there are care coordination models that may be able to use less expensive but potentially highly effective individuals who are trained to interact with patients in a focused way

• Support innovators who can rapidly deploy care improvement models (within six months of the award) through new ventures or expand existing efforts to new populations of patients, in conjunction where possible with other public and private sector partners.

It is recognized that new types of infrastructure activity are needed to support more effective and efficient system-wide functions and to rapidly diffuse best practices. Infrastructure support might include the development of new registries, support the coordination of care in communities, develop preventive care models, telemedicine and remote monitoring models, medication reconciliation systems, shared-decision making systems, and innovation networks or community partnerships.

Eligible applicants and potential partners can include provider groups, health system payers and private sector organizations, faith-based, local government, public-private partnerships, and for- profit organizations.

Individual awards will range from approximately $1 million to $30 million for a three year period. A letter of intent is due December 19, 2011 with the application due January 27, 2012. To view the funding announcement, go to or email for more information.

Studying Healthcare Financing

The Health Care Cost Institute (HCCI) is going to provide researchers and policymakers access to a comprehensive collection of health plan and government payer data to gain new insights into healthcare costs and utilization. HCCI will provide access to data from plans operated by Aetna, Humana, Kaiser Permanente and UnitedHealthcare along with government data from Medicare Fee for Service and Medicare Advantage.

The data will include more than 5 million medical claim records representing more than $1 trillion of healthcare activity from over 5,000 hospitals and one million service providers from calendar year 2000 to the present. For the first time there will be comprehensive data on the privately insured that make up the majority of health consumers in the U.S according to Professor Martin Gaynor PhD of Carnegie Mellon University.

The de-identified data will be in accordance with HIPAA requirements and HCCI will establish a Data Integrity Committee whose primary focus will be on all matters related to data privacy, security, and integrity.

HCCI’s governing board will be controlled by independent national physician leaders and academic researchers to broaden the list of participating health plans and to add more data from government payers, including Medicaid. Beginning in 2012, HCCI plans to publish its own “Scorecards” that supports analysis on aggregate trends of healthcare cost and utilization.

In another project, the University of Pennsylvania Health System (UPHS) is partnering with the Leonard Davis Institute Center for Health Incentives and Behavioral Economics on a new initiative called the “UPHS Center for Innovations in Health Care Financing.”

It has been reported that the U.S. spends about $2.5 trillion per year on healthcare with costs growing at several percentage points faster than the growth of the economy. Wellness incentive programs are gaining popularity among employers and government. Medicare and insurance companies are moving to modify payment models while reducing health expenditures. However, proven models for doing so are rare and it is this gap that the new UPHS Center seeks to fill.

The new Center will combine the expertise of faculty members at the School of Medicine and the Wharton School. They will test how insights from behavioral economics and health economics can improve patient health and reduce the rate of growth in healthcare costs.

RFI Addresses Medicaid Fraud

The Texas Health and Human Services Commission (HHSC) released RFI (No. 529-12-0056) “Pre-Payment Review of Claims and Other Strategies to Reduce Medicaid Fraud”. Feedback is needed by December 10, 2011 from capable sources to provide leading cutting-edge technology capabilities for predictive modeling/management software as well provide claim review services and workflow management tools.

HHSC is trying to determine what products exist in the marketplace that will help eliminate pre-payment fraud. HHSC also wants to know about products that are not ready and when the product release is planned. HHSC may use the information contained in the RFIs received to develop a future procurement.

HHSC wants more information on systems that can:

• Handle high volume of transactions
• Be integrated into the existing Medicaid claims flow with minimal effort, time, and cost
• Provide a rapid, real-time, or near real-time solution with large data storage available to provide for data mining and pooling capabilities
• Analyze Medicaid managed care encounter data as HHSC transitions from FFS to a MCO delivery system
• Permit modifications to the software in a rapid and timely manner
• Provide a change control process to enable quick changes to be made to changing patterns of behavior
• Mark each flagged claim with a Medicaid-defined reason code to help the human reviewer understand the reason the claim is potentially improper and recommend an action
• Allow HHSC visibility into data analysis so that patterns of excessive usage, unusual patterns, are identified, scored, and implemented rapidly
• Provide views for all provider and patient activities across all federal health program payers
• Provide workflow management and workstation tools that can systematically present scores, reason codes, and treatment actions

Go to to view the RFI. For more information, email Steve R. Bailey at or call (512) 206-4653.

Oral Health Initiative Launched

Delta Dental of Wisconsin awarded $1.1 million to Marshfield Clinic Research Foundation the largest private medical research institute in Wisconsin. The funding to be used for dental research will provide $500,000 towards dental-informatics research, $500,000 will help the oral-and-systemic-health research project, and $100,000 will go towards clinician-initiated dental and craniofacial research through the Delta Dental Oral and Systemic Health Research Initiative.

The dental-informatics research brings computer-based research, biological science, and medical-dental integration down to an individual level. The research will create a dental-health information exchange to incorporate historical medical and dental information and electronic dental-health records.

The oral-and-systemic-health research center focuses on the connection between a healthy mouth and body and on expanding the links between oral health and diabetes, heart disease, and preterm births. The dental and craniofacial research uses the latest molecular and genetic tools to explore health and disease.

The research builds on an earlier Delta Dental-funded project that integrated medical and dental records in a single electronic health record so that a detailed picture of an individual’s whole-body health is now provided.

New Mobile-Ready Guide Available

A new interactive guide to aid deployed medics, nurses, and commanders in recording medical information is now available on iPhone, iPod Touch, iPad, and android devices, according to the Army’s Combined Arms Center for Training. The initial Guide was only available in a PDF format on computers via Army Knowledge Online.

The new guide enables the mobile medical force to use the ATN2GO app on their mobile device to access best practices, guidelines, and procedures for using MC4 in the field. Users can create direct links to procedures specific to their specialties and link to updated checklists, presentations, and step-by-step procedures.

Deployable medical staff use MC4 to document and track patient care, digitally manage medical supplies, and conduct health surveillance in the combat zone. The new guide ensures a continuous, systematic approach to supporting the creation and transmission of EMRs and automated maintenance of class VIII medical supplies.

“Mobile devices are driving the Army’s training delivery model,” said Lt. Col. William Geesey MC4 product manager. “By empowering deployable medical forces with the ability to get answers to questions on the fly, we are in effect improving their ability to make informed decision on the healthcare delivered to soldiers in theater.”

In addition to offering mobile access, the 2.0 MC4 guide focuses more on specific guidance and need-to-know information and as a result, has reduced the volume by 60 percent and is making data retrieval fast and easy.

For more information on STN2Go, visit

Wednesday, November 16, 2011

Addressing Health Concerns

Mesa Tech, a spinoff of Los Alamos National Laboratory (LANL) in New Mexico received a $400,000 Phase I SBIR grant from NIH’s National Institute of Allergy and Infectious Disease. The funding will develop an inexpensive instrument-free nucleic-acid testing device to diagnose various respiratory diseases in record time. Mesa Tech is currently developing a prototype plan to target the global diseases surveillance market.

They also envision developing applications to use in point-of-care diagnostics, particularly in poor areas of the world reports former LANL scientist Hong Cai, who co-founded Mesa Tech and principal investigator for the effort. For the point-of-care applications, Mesa Tech plans to develop an inexpensive handheld device about the size of a cell phone with a disposable cartridge. Cai said, “In the case of a pandemic, such as SARS or avian influenza, the device could also be made disposable.”

In another project, LANL completed a Cooperative Research and Development Agreement (CRADA) with Biomagnetics Diagnostics, Inc. and licensed the LANL-developed prototype waveguide-based optical biosensor to Biomagnetics.

Under the CRADA, Biomagnetics will continue to work to develop a commercial product to detect a specific biomarker in urine that could aid in the diagnosis of tuberculosis infection. So far, a commercially available product has not yet been built or clinically tested to aid in diagnosing tuberculosis infections. With further research, scientists at LANL believe that a portable biosensor can become a reality and could greatly improve field-based detection of active tuberculosis infection.

“Excellent progress has been made to detect tuberculosis-specific biomarkers and to explore biomarker choices” according to David Hadley in the LANL Technology Transfer Division. “To convert this R&D into a commercial product, the antibodies need to be licensed and the surface chemistry needs to be better understood. At this point, a field site in Southeast Asia or South Africa should be identified where the population with HIV co-infection could be evaluated.

State Developing Data System

The State of New Hampshire Department of Health and Human Services (DHHS) is implementing the federal “Maternal Infant & Early Childhood Home Visiting” (MIECHV) Program. The state intends to contract with Home Visiting New Hampshire –Health Families America (HVNH-HFA) to implement the program.

HVNH-HFA an initiative of the Division of Public Health Services (DPHS) received funding to implement MIECHV to help the diverse needs of children and families in communities. The plan is to improve health and development outcomes for at-risk children through evidence-based home visiting programs.

HVNH-HFA uses specialty trained visitors and nurses to regularly visiting pregnant women and their families in the home. They provide health and parenting education, information and referrals, and other support for the participants.

On November 7, 2011, RFP (2012-009) seeking a “Home Visiting Data System” was issued by the New Hampshire DHHS, Division of Public Health Services. The RFP is looking to procure secure, web-based, Commercial-Off-The-Shelf (COTS) software or Software as a Service (SaaS) model to collect and manage the data and reporting requirements for this program. Proposals are due December 21, 2011.

The requirement is to develop a Home Visiting Data System to measure progress and report on:

• Participants and their outcomes

• DPHS performance measurements

• Measurements for MIECHV benchmark data constructs

• The data collected that is required for HFA home visiting model accreditation,

• The tools needed to provide for continuous quality improvement

• Future activities to streamline data collection across multiple home visiting and family service programs in the state

In future years, the goal for the state’s Home Visiting Data System is to meet the needs for multiple programs in the state to reduce the administrative burden for agencies. The data system in the future will need to have the capacity be able to track multiple programs that a family might need, including multiple individualized Family Service Plans.

The amount available for this contract is $100,000 for the first year of the contract (SFY 12) and $60,000 for each subsequent year. However, the state will accept and consider proposals that exceed available funding.

Go to to view the RFP. For more information, email or call (603) 271-4566.

Software Identifies Cancer Cells

The Office of Naval Research’s (ONR) funded software to find and recognize undersea mines is now being applied to help doctors identify and classify cancer-related cells. “The results are spectacular,” said Dr. Larry Carin, Professor at Duke University and developer of the technology. “This could be a game-changer for medical research.”

The problem that physicians encounter in analyzing images of human cells is surprisingly similar to the Navy’s challenge of finding undersea mines. When examining tissue samples, doctors must sift through hundreds of microscopic images containing millions of cells.

To pinpoint specific cells of interest, they are using an automated image analysis software toolkit called “FARSIGHT” funded by NIH and DARPA. FARSIGHT identifies cells based upon a subset of examples initially labeled by a physician. Up to now, the problem has been that the resulting classifications can be erroneous because the computer applies tags based on the small sampling. Also, it can take days even weeks for a pathologist to manually pick out all the endothelial cells in 100 images. The enhanced FARSIGHT toolkit can accomplish the same feat in a few hours with human accuracy.

By adding ONR’s active learning software algorithms, the identification of cells is accurate and FARSIGHT’s performance more consistent, according to the researchers. The enhanced toolkit also requires physicians to label fewer cell samples because the algorithm automatically selects the best set of examples to teach the software.

A medical team at the University of Pennsylvania is applying the ONR algorithms embedded in FARSIGHT to examine tumors from kidney cancer patients. Focusing on endothelial cells that form the blood vessels that supply the tumors with oxygen and nutrients, this research could one day improve drug treatments for different types of kidney cancer.

NSF to Award Grants

The National Science Foundation (NSF) though their “Smart Health and Wellbeing (SHB) program issued their cross-cutting grant solicitation (12-512) on November 10, 2011. The purpose for the funding opportunity available across three NSF directorates is to draw expertise from multiple domains of science and engineering including social, behavioral, and economic sciences. The estimated program funding if funding is available is $15,000,000 for 18 awards.

The work to be funded by the solicitation must relate to a key health problem and make a fundamental contribution to engineering, computer and information sciences, or social behavioral and economic sciences. Traditional disease-centric medical, clinical, pharmacological, biological, or physiological studies and evaluations are outside the scope of the solicitation.

Addressing the challenges will require research and the development of new tools and methods for:

• Researchers to develop effective ways to enable the effective sharing and use of EHR data and networked applications, be able to access the data, and be able to exchange current and future health and wellness data originating from a number of diverse sources available in multiple formats

• Developing PHRs while aggregating clinical, biomedical, and environmental data about each patient to include in their EHRs and PHRs in order to take the knowledge obtained to make vital decisions

• Individuals to be empowered by investigate the underlying socio-economic and behavioral principles underlying patient participation in healthcare and wellness

• Researchers to develop medical prosthetic and embedded devices and devices to be used for storage and the transmission of physiological state and environmental data

Proposers may submit proposals in two project classes to include Type I (Exploratory Projects) for $200,000 to $600,000 total budget to last from two to three years, and Type II (Integrative Projects) for $600,000 to $2,000,000 total budget to last from four to five years.

Proposals may be submitted by universities and colleges, nonprofits, non-academic organizations, independent museums, observatories, research laboratories, professional societies and other organization associated with educational or research activities.

The closing date for application is February 6, 2012. For more information, go to

ONC's App Challenge

ONC is looking for projects where multidisciplinary teams can come together to build technology solutions to address specific issues. Any government agency, community organization, foundation, healthcare and technology company, software developer, UI designer, and subject matter expert is eligible to apply.

The ONC “Reporting Device Adverse Events Challenge” seeks multidisciplinary teams to develop an application to facilitate the reporting of adverse events related to medical devices, whether implanted or used in the hospital, clinic, or home.

The objective is to make it easy for patients to report adverse events that occur with any medical device to their providers who would then use the EMR or PHR embedded software to auto-populate relevant report fields, as well as add additional EMR/PHR-based text and information. The information would then be reported to the “Manufacturer and User Facility Device Experience (MAUDE) database.”

The first prize is $25,000 plus the awardee would be asked to set up a demonstration at the CMS Quality Net Conference plus two free passes and paid travel expenses to the Health 2.0 Spring Conference. The second prize is $10,000 with a third prize of $5,000.

The submission period began in September with the submission period ending December 2, 2011. Go to for more information.

Tracking Hospital Antibiotic Use

CDC is launching a new antibiotic tracking system to allow hospitals to monitor antibiotic use electronically. The agency wants to help hospitals make better decisions to improve their use of antibiotics and to enable hospitals to compare themselves to other hospitals. Before now, CDC was only able to track antibiotic use in doctor’s offices.

The antibiotic use tracking system is part of CDC’s “National Healthcare Safety Network” (NHSN), in place to monitor infections in healthcare facilities that includes 4,800 hospitals. CDC has funded four health departments and their academic partners and implemented the tracking system in 70 hospitals.

Any hospital that participates in the NHSN can use the tool to work directly with their pharmacy software vendor so data can be transmitted electronically from drug administration or from bar code records. There is no manual entry of data, thus saving a facility time and money.

CDC is implementing “Get Smart About Antibiotics Week” November 14 to 20, 2011. CDC and partners are teaming up to promote appropriate antibiotic use among the nation’s healthcare facilities and doctors offices to preserve the strength of existing antibiotics and to prevent resistant infections.

“The threat of untreatable infections is real,” reports Arjun Srinivasan, M.D. in charge of CDC’s Get Smart for Healthcare program. “Although previously unthinkable, the day when antibiotics don’t work in all situations is upon us. We are already seeing germs that are stronger than any antibiotics we have to treat them, including some infections in healthcare settings.”

In conjunction with the Get Smart campaign, CDC is working with the Institute for Healthcare Improvement to pilot test a tool to help hospitals implement practical strategies to improve antibiotic use. The pilot testing is currently under way in eight U.S. hospitals.

Additionally, CDC is part of the Federal Interagency Task Force on Antimicrobial Resistance. During the Get Smart campaign, the task force will meet in Washington D.C. to discuss the issues related to antibiotics.

To access a list of pharmacy software vendors who are working with CDCs new tracking system go to the Society for Infectious Disease Pharmacists website at

Sunday, November 13, 2011

Agency Programs Discussed

Available federal grants, cooperative agreements, loan, and contract programs were discussed in-depth at the Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” on November 7th. As Neal Neuberger, Executive Director for the Institute for e-Health Policy explained, “Many of the agency funding programs and opportunities help to transition healthcare to where it is really needed not only in urban areas but also for rural and disparate populations.”

Overall, the $2 billion that was appropriated for health IT activities, supports new grant programs, established new committees and workgroups, and provided funding for dozens of new contracts, according to Matt Kendall, Director for the Office of Provider Adoption Support within the Office of the National Coordinator for Health IT.

As he sees the future, the health IT implementation trajectory from 2013 to 2014 points to the widespread adoption and exchange of data by 2015. In addition, breakthroughs will be achieved in healthcare delivery and in payment reform.

Tom Morris, Associate Administrator for Rural Health Policy at HRSA, emphasized the role that health IT investment can play in developing and maintaining health centers. To provide more funding for health centers, HRSA Administrator Dr. Mary Wakefield and the National Coordinator Dr. Farzad Mostashari recently announced $8.5 million available from the Affordable Care Act to fund the adoption of health IT in 85 health centers in 17 Beacon Communities.

Morris gave examples of several current grant programs that emphasize the use of telehealth. For one, the Telehealth Network Grant Program funds projects to demonstrate the use of telehealth networks to help in medically underserved populations in rural and urban communities. Secondly, the Telehomecare Grant Program focuses on placing telehealth technologies in the home, and lastly, the Telehealth Resource Center (TRC) Grant program establishes regional and national TRCs to provide experts to help others.

The EHR incentive program expects to make $18 billion in payments and produce better health, quality, along with a reduction in errors, according to Robert Tagalicod, Director for the Office of E-Health Standards & Services at CMS. He reports that the electronic health record program now has 114,000 registered with 10,600 providers paid, registered, and moving to “meaningful use”.

Wilson Washington, Public Health Advisor for the Substance Abuse and Mental Health Services Administration (SAMHSA) described how health IT fits into one of 8 strategic initiatives at SAMHSA. The agency’s HIT portfolio has multiple components for FY 2011 and expects to provide the HIT portfolio with $32.5 million.

He talked about several SAMHSA grant programs. For example, the agency provides one year supplement grants for $10 million (FY 2011) to achieve Primary and Behavioral Care Integration (PBHCI). The grants support HIT adoption, infrastructure support, and technology assisted treatment services by providing linkages and communication between primary and behavioral health care services.

A one year supplemental grant of $600,000 will be used to establish a PBHCI Technical Assistance Center (TAC). Other funding will support $3.2 million in sub-awards to go to five State Designated Entities (SDEs) to help them participate in HIEs and encourage behavioral health collaboration at the state level.

SAMHSA is also providing multi-year grants for their Substance Abuse Targeted Capacity Expansion (TCE) program. The (FY 2010) program has funding available for five existing grantees averaging $400,000 each. The funds support technology assisted treatment to expand service delivery through the existing TCE program for underserved communities and rural areas.

Vicki Seyfort-Margolis, Senior Advisor for Innovation for the Office of the Commissioner at FDA sees problems in monitoring massive amounts of very valuable information collected from a variety of sources. This data includes product submissions, adverse event reports, patient data from healthcare providers, along with results from basic scientific research.

As Seyfort-Margolis explained, “It is important for FDA to successfully not only integrate and analyze the data but FDA also needs to be able to analyze large scale clinical and preclinical data sets. In addition, FDA needs to refine methods for analyzing post-market data that requires mining data from large healthcare databases.

FDA is currently taking steps to unlock the data to be reviewed. For example, according to the FDA Strategic Plan “Advancing Regulatory Sciences at FDA” published last August, FDA is funding the “Partnership in Applied Comparative Effectiveness Science” project to detect which interventions will be most effective for which patients under specific conditions to find the right treatment for a particular patient.

“The Indian Health Service (IHS) provides healthcare for a specific population of 1.9 million American Indian and Alaska Native people in 35 states and manages federal hospitals, outpatient clinics, and health centers. The IHS manages tribally operated facilities plus urban Indian health programs”, reports Dr. Howard Hays, Acting Director for the Office of Information Technology, at the Indian Health Service.

He noted that the Resource and Patient Management System deployed at over 300 facilities nationwide and similar to the VA’s VistA system, is a comprehensive, integrated suite of clinical, business, practice management and infrastructure applications and is the only certified EHR in the federal space.

Telehealth plays an important role in Indian country. Some examples include, the Alaska Federal Healthcare Access Network (AFHCAN) providing store and forward telehealth, Joslin Vision Network Tele-Ophthalmology providing screenings and consultations for diabetic retinopathy, a tele-behavioral health center of excellence operating in Albuquerque New Mexico, a tele-trauma consultation services available in Gallup New Mexico, home monitoring available for disease management plus teledermatology, chronic disease management, nutrition, and other specialty services.

The IHS achieves health information exchange by moving laboratory orders and results, by exchanging immunization data with the states, using electronic prescribing, monitoring prescription drug usage, and enabling epidemiologic surveillance.

Trent Harkrader, Chief of the Telecommunications Access Policy Division at FCC, gave an update on the existing FCC program referred to as the Rural Health Care “Primary” Program supporting telecommunications and internet access. In 2010 alone, $90 million was spent on the program with figures based on Universal Service Administrative Company estimates.

He reports that a three year pilot program supports broadband deployment for healthcare networks. The pilot funds up to 85 percent of the costs associated with deploying dedicated broadband networks needed to connect providers in rural and urban areas within a state or region. Presently there are 50 active projects operating with total funding of $417 million

Other examples of pilot programs underway include the new California Telehealth Network to eventually connect 863 healthcare facilities by using video and audio streamed through a closed-circuit system to connect smaller hospitals and clinics to physicians, specialists, and other networks at larger hospitals.

Secondly, the West Virginia Telehealth Alliance is a statewide network to connect approximately 450 facilities to improve connectivity for rural health centers. The Alliance has two components a fiber ring connecting 3 teaching hospitals connected to internet2 backbone and WAN connecting to rural clinics via internet2.

Jessica Zufolo Deputy Administrator for the USDA Rural Utilities Service (RUS) along with Aaron Morris Community Programs Specialist at USDA both reviewed the numerous USDA RUS grant and loan programs.

These programs include the FY 2012 Telecommunications Infrastructure Loan Program to build telecommunications service in rural communities of less than 5,000, the Rural Broadband Loan Program to provide loans to build and upgrade broadband services in rural high cost areas in communities with less than 20,000, the Broadband Initiatives Program (BIP), awarded $3.5 billion in loans and grants and building projects in 45 states and one U.S. territory but the program is now closed, and parts of the Farm Bill passed in 2008, containing provisions that apply to parts of the Telecommunications Infrastructure Loan Program.

In addition, there are other programs such as the Distance Learning Telemedicine (DLT) program with both grants and loans to help rural residents living in communities of 20,000 or less obtain needed health IT. DLT so far has awarded $465 million awarded in grant and loans and in FY 2011, $24.9 million was available with 209 applications received.

In FY 2011, the Community Connect Grant program had $13.4 million available, received 140 grant applications, and awarded 19 grants. The project provides free broadband service to critical community facilities in the community for at least two years and provides a community center with at least 10 computer access points within the proposed service area.

The application windows for FY 2012 for the Distance Learning and Telemedicine and the Community Connect programs has not yet been announced. Funding availability is usually announced in the January/February timeframe with a 60 day application window.

The Congressional Luncheon Seminar Series is a project managed by the Institute for e-Health Policy and coordinated by Neal Neuberger. The Capitol Hill Steering Committee on Telehealth and Healthcare Informatics will hold a session on Wednesday November 16th from 12:00 to 1:45 to hear officials from CDC to discuss how biosurveillance technologies can improve public health. Representative Phil Gingrey (R-GA) will kick off the program. To receive an announcement, email Neal Neuberger at or call (703) 508-8182.

State Leveraging Novel Ideas

The Indiana Clinical and Translational Sciences Institute (CTSI) has partnered with GVK Biosciences, Asia’s leading Contract Research Organization to provide researchers in the U.S. access to the GVK BIO’s Clinical Biomarker Database (GOBIOM). The goal is to advance research on a wide range of diseases.

The Indiana CTSI Bioinformatics Core and Indiana Institute for Personalized Medicine will work together to manage the process so that researchers will have access the new resource. Anantha Shekhar, Director of the Indiana CTSI, said, “The Indiana CTSI is very pleased to partner with the Indiana Institute for Personalized Medicine to make this resource available to all clinical and translational researchers in the national consortium and also to partner with the Indiana Economic Development Corporation.”

GOBIOM houses a comprehensive collection of all clinically evaluated exploratory and preclinical biomarkers associated with different therapeutic areas reported in global clinical trials and preclinical studies. The resource will be available nationwide to 55 medical centers and universities supported by the NIH CTSI awards.

The Regenstrief Institute established in 1969 by Sam Regenstrief on the Indiana University-Purdue University Indianapolis campus and supported by the Regenstrief Foundation and closely affiliated with the Indiana University School of Medicine and the Health and Hospital Corporation of Marion County, Indiana is involved has announced another project to stimulate innovation.

The Regenstrief Institute just announced a $500,000 grant to launch an initiative to propel innovation. This innovative program will focus on providing higher quality, lower cost healthcare, and encourage research teams to work together to develop high risk, high reward ideas that could help to find and develop new approaches to perplexing problems.

This new innovation program is seeking creative ideas that might not be proposed or considered for traditional grant funding to enable Regenstrief investigators to prove the feasibility of ideas before submitting more substantial proposals to funding agencies. A recent call for proposals is encouraging investigators to not only submit their ideas but also to learn from many other successful organizations such as Google and Facebook.

“Innovation is our core business,” said Regenstrief Institute President and CEO, William Tierney, M.D. discussing the new innovative initiative. “Working out ideas by proving feasibility and obtaining pilot data will give our investigators a leg up on their peers in competing for increasingly scarce research dollars.”

For more information, go to

Healthcare Costs on the Agenda

Senator Sheldon Whitehouse (D-RI) brought together a panel of experts to the Capitol Hill to discuss ways to reduce the skyrocketing costs in our healthcare system while improving the quality of care. On November 10th, Senator Whitehouse chaired the Senate Health, Education, Labor and Pensions (HELP) Committee hearing on “Healthcare Savings Through Delivery System Reform”.

The hearing examined the tools needed to drive down costs and to improve quality of care by advocating prevention, improving quality, reforming the payment system, and simplifying the process. In addition, in the past several years, Senator Whitehouse has been working hard to create a robust, secure health IT infrastructure not only in his state but in the entire country.

One of the panelists Jonathan Blum, Deputy Administrator and Director the CMS Centers for Medicare and Medicaid Services outlined how hospital payments account for the largest share of Medicare spending and Medicare is the largest single payer for hospital services.

Earlier this year, CMS established the new Hospital Value-Based Purchasing (VBP) Program, which is going to change how CMS pays hospitals for inpatient acute care. This program which ties payment to value is expected to foster higher quality care for all hospital patients across the U.S health system.

In FY 2013, CMS will implement the new budget-neutral value-based incentive payments. In the future, CMS plans to add new measures that focus on improved patient outcomes and the prevention of hospital-acquired conditions.

ACOs are part of CMS and will bring together doctors, hospitals, and other healthcare providers to better coordinate care for patients. Blum announced that CMS has released the Medicare Shared Savings Program final rule (CMS-1345-F) on October 20, 2011. Under this program, providers who voluntarily form an ACO and meet quality standards based upon patients outcomes and care coordination as well as other measures, may share in the savings they achieve for the Medicare program. ACOs that commit to share in savings and losses for the duration of the agreement may receive a higher share of any generated savings.

In addition, CMS in their Innovation Center is testing alternative payment models and preparing organizations to provide accountable care. These initiatives include:

• The Pioneer ACO Model to allow providers groups to move more rapidly to a population-based payment model on a track consistent with but separate from the Medicare Shared Savings Program

• The Advance Payment ACO Model to provide additional support to rural and physician-based ACOs who participate in the Medicare Shared Savings Program, but lack the start-up resources to build the necessary infrastructure

• The Accelerated Development Learning Sessions to help providers with information on how to become an ACO

In recent months CMS has launched several new initiatives through the CMS Innovation Center that involves investments in primary care and medical homes. For example, the Comprehensive Primary Care Initiative (CPC) works with public and private healthcare payers to help strengthen primary care. The CPC initiative will test two models simultaneously such as a service delivery model and a payment model to see how primary care practices can best coordinate care for their patients.

Another example is the Innovation Advisors Initiative which is currently accepting applications for up to 200 health professionals to undertake intensive efforts to expand their health systems skills and knowledge, apply what they learn in their organizations and areas, and work with CMS to test new models of care delivery in their own organizations and communities.

CMS is helping doctors to begin using EHRs through the EHR incentive program. HHS has also issued administrative simplification rules (CMS-0032-IFC) to improve the use of electronic standards to help eliminate inefficient manual processes. CMS estimates that these changes will save providers and health plans $12 billion over the next 10 years.

In addition, recently, the Medicare-Medicaid Coordination Office announced a new opportunity for states to participate in demonstration projects designed to improve the quality of care for Medicare-Medicaid enrollees. The states now have the opportunity to share in reduced costs and CMS is reporting that 37 states and the District of Columbia have indicated interest in the demonstration project.

Cloud Roadmap Available

NIST released the draft “U.S Cloud Computing Technology Roadmap” in two volumes that describes the agency’s strategy in terms of both strategic and tactical objectives. The first volume “High Priority Requirements to Further USG Cloud Computing Adoption” summarizes strategic requirements that must be met for federal agencies to further adopt cloud computing.

However, Volume II, “Useful Information for Cloud Adopters”, is the nuts and bolts publication. It is valuable to use as a technical reference to help those working on strategic and tactical cloud computing initiatives and is applicable even if you don’t work in government agencies. Volume II integrates and summarizes the work completed to date, explains the assessment findings based on this work, and describes how these findings support Volume I.

Also, Volume II specifically:

• Presents USG target business use cases and technical use cases pertaining to the cloud

• Identifies existing interoperability, portability, and security standards applicable to the cloud computing model and specifies high priority gaps for which new or revised standards, guidance, and technology needs to be developed

• Discusses security challenges in the context of cloud computing adoption, high priority security requirements, and current and future risk mitigation measures requirements

The third volume, “Technical Considerations for USG Cloud Computing Deployment Decisions” is under development as part of an interagency and public working group collaborative effort. It is intended to be used as a guide for decision makers who are planning and implementing cloud computing solutions.

Volumes I and II can be viewed at Comments on the first two volumes are due December 2, 2011 and should be emailed to

Wednesday, November 9, 2011

VA Selects VAi2 Winners

The Department of Veterans Affairs “Industry Innovation Competition” (VAi2) just awarded thirteen new awards. Several of the new projects will improve telehealth while others will improve dialysis, improve communications with healthcare professionals, detect adverse drug reactions, provide education, assist veterans in business, and provide permanent telehealth enabled housing for homeless veterans.

American Well Inc located in Boston Massachusetts one of the award winners, received recognition for their online care system that provides two-way video enabling patients to have secure chats with their providers and their multidisciplinary care teams.

Today, the company is using their telehealth solution to establish three “online practices”. One program at the Minneapolis VA Health Care System will establish an online behavioral health practice. Another program part of the Nebraska-Western Iowa Health Care System will establish an online oncology practice to bring healthcare providers from the Omaha VA Medical Center together with cancer patients across the state. A third program will establish an online practice to allow surgeons to deliver post operative care to patients via the internet.

The other VAi2 winners include:

• Pharmacy OneSource, Inc (Seattle, Washington) to improve the availability of online medication information and allow for on-demand notifications for potential adverse drug interactions

• Vigilanz Corp (Minneapolis, Minnesota) to provide tools to help clinicians actively develop and manage the rules that define potential drug issues and be able to apply those rules in real-time to the patient’s information

• AWAK Technologies, Inc. (Burbank, California) to develop a wearable dialysis device that substantially increases the patient’s freedom for normal activities

• Medical Education Institute, Inc. (Madison Wisconsin) to develop patient-navigated education in a video game-live format to guide patients through the complexities of managing chronic kidney disease

• Affinity Networks, Inc., (Arlington Virginia) to develop disease management content to deliver over mobile phones to veterans being treated for TBI

• Interactive Performance Technologies (Cambridge Massachusetts) to develop a system so patients can report hard-to-gather information on chronic conditions from their homes to healthcare professionals

• Kinetic Muscles, Inc. (Tempe Arizona) to develop new equipment to enable home-based physical therapy for stroke victims and to collect data from remote monitoring

• Service Wing Healthcare (San Diego, California) to provide a mobile platform for clinicians to do mental health assessments

• SweetSpot Diabetes Care, Inc. (Dayton, Ohio) to automatically collect and report in-home readings from blood glucose monitors and then transfer the information to patients and clinicians

• Ridgewood/5Stone Real Estate Partners (Ashburn, Virginia) working with LaCite Development from New York, NY to construct sustainable telehealth-enabled housing for homeless veterans

• Soldier On (Leeds, Massachusetts) to construct energy efficient housing for homeless veterans and offer supportive services

• Eadvantage (Potomac, Maryland) to develop a new e-learning platform and education content to help veterans become entrepreneurs by learning how to do an initial self assessment and how to prepare a business plan

For more information, go to

HIE Taking Shape in Kansas

Hays Medical Center (HaysMed) is the first major hospital in Kansas to submit data to the Kansas Health Information Network (KHIN). As of October, HaysMed began testing data capabilities to enable the exchange of secure clinical information between providers.

The Medical Center has successfully transmitted test data on patient demographics and problem lists, plus information on diagnoses, procedures, on allergies, immunizations, along with laboratory results. The center plans to test send medications data later this year.

Over the next several weeks in further testing, KHIN will transfer data back to the medical center. According to Laura McCrary, the network’s Executive Director, “They will look at how the data is populating the exchange to make sure it is populating correctly before going live and actually making the data available to other provider organizations.”

So far, more than 70 medical practices have signed on with KHIN which has also received agreements from more than a dozen hospitals and several more hospitals in various states of reviewing and approving the agreements.

Also in October, Via Christi Health, Wesley Medical Center, and the Kansas University Medical Center constituting the three largest hospitals in Kansas, signed up with the Wichita Health Information Exchange and KHIN. KHIN also works closely with the Missouri-based LACIE network.

McCrary anticipates KHIN to be an approved Health Information Organization (HIO) by the end of the year. This is important since providers who exchange information via an approved HIO are granted some immunity from lawsuits should they inadvertently breach patient privacy while exchanging electronic health records.

Providers in the state can now participate in KHINex, which is KHIN’s secure clinical messaging system that functions much like e-mail with attachments but works with a security level adequate for exchanging health records.

In August, an optometrist in Hiawatha became the first provider to share electronic health records with KHINex during a test of the new system. As McCrary explained, “Hutch Clinic located in a rural area is sharing information with the optometrist on diabetic patients who need eye exams. The patient’s medical information is sent electronically with a referral and their attached clinical information.”

KHIN is also building a bi-directional interface with the Kansas Immunizations Registry called “WeblZ” to enable KHIN participants to submit immunization information to the state electronically as well as to query the registry. The full functionality for immunizations is scheduled to be completed in 2012.

For more information, go to

AHRQ's Simulation Research

In 2011, AHRQ funded eleven multi-year demonstration grants to evaluate the use and effectiveness of various simulation approaches and the role they play in improving the safety and quality of healthcare delivery.

For example, one project is aimed at helping medical teams deal with pediatric emergencies. Since critical consequences happen infrequently in community hospitals, medical teams in these hospitals have very few opportunities to perfect their skill in pediatric resuscitation skills.

To address pediatric resuscitations, researchers at Rhode Island Hospital in Providence are working to find effective ways to use situ medical simulation to assess how emergency departments are performing pediatric resuscitations.

In another project, researchers will assess the effectiveness of using simulator-based training in component tasks of cardiac surgery. They will examine the overall procedures based on three types of cardiac surgery plus the significant adverse events that can occur during cardiac surgery.

The researchers will use a computer-controlled, tissue-based cardiac surgery simulation that is able to duplicate an actual patient undergoing cardiac surgery. Eight institutions will participate and while the project focuses on cardiac surgery residents, the results could potentially apply across a broad spectrum of surgical practices.

At the University of North Carolina at Chapel Hill, researchers will demonstrate how training in cardiac surgery techniques can be improved by combining cardiac surgery simulation technology with a rigorous, simulation-based curriculum.

A demonstration to perfect a way to measure laparoscopic skills is taking place at Old Dominion University in Norfolk Virginia. Although clinicians can use simulators to practice their skills outside of the operating room, there is no standard method to determine whether a surgeon has achieved or maintained laparoscopic proficiency.

The goal for the researchers is to validate a new secondary task that targets the spatial skills needed to mentally translate 2-D display images into the 3-D operational space. The researchers will use laparoscopic simulators and fresh cadavers to demonstrate that the secondary task can be used to measure laparoscopic skills.

Other simulation demonstrations will:

• Develop simulation-based performance assessment tools
• Develop simulation to be used in emergency departments
• Use simulation to improve leadership and team performance
• Use simulation to improve the recognition of sepsis
• Use simulation to teach femoral arterial access
• Develop serious gaming so that physicians and nurses can improve communications
• Improve cancer care patient safety through pathology training simulation
• Improve patient safety related to medication infusion pump technology using systems engineering
• Create simulation-based performance assessment tools for practicing physicians

For more information, go to

Congress and the "Doc Fix"

On January 1, 2012, a 27.4 percent cut in Medicare payment rates to physicians will take place unless Congress does something to stop it according to Health Affairs and the Robert Wood Johnson Foundation’s latest “Health Policy Brief”. The brief examines the various proposals and their possible effects on federal spending and on healthcare providers.

As the deadline approaches, Congress, the Administration, and other government entities are deciding whether to pass another short-term “doc fix” or find a longer term solution while weighing the impact any plan will have on the federal deficit.

More than one million providers of vital health services including physicians, limited license practitioners such as podiatrists, nurse practitioners, and physical therapists are paid under the Medicare Physician Fee Schedule (MPFS).

Under current law, providers will face steep across the board reductions in payment rates, based on a formula referred to as the “Sustainable Growth Rate” (SGR) that was adopted in the Balanced Budget Act of 1997. The “Health Policy Brief” discusses the proposals on the table that would replace the formula.

In a statement released by Donald M. Berwick, M.D., CMS Administrator, “We need a permanent SGR fix to solve this problem once and for all. That’s why the President’s Budget and his Plan for Economic Growth and Deficit Reduction calls for permanent, fiscally responsible reform and why we are committed to working with Congress to achieve a permanent and sustainable fix.”

Congress is awaiting recommendations from the Joint Select Committee on Deficit Reduction or what is referred to as the “Super Committee”. Depending on what happens, it is possible that Congress will pass another short-term fix before the year’s end to prevent rate cuts from taking effect in 2012. Under current budget rules, putting off the cut yet again would not require any immediate offsetting savings elsewhere in the budget. However, the overall cost of postponing the repeal of the SGR formula becomes higher every year.

To view the full policy brief on the topic, go to

Washinton State Issues RFP

The Washington State Health Care Authority (HCA) issued RFP (K521) on October 28th for the state “Health Benefits (Insurance) Exchange” seeking Systems Integrator Services. The state is required to establish an operational exchange to offer qualified health insurance plans to individuals and small businesses by January 1, 2014, Once implemented, the state anticipates that the Exchange will serve 160,000 to 440,000 individual and group customers in 2014.

The state needs qualified vendors to provide development, implementation, and hosting services in order to implement the Washington Health Benefits (Insurance) Exchange by December 2013. The solution obtained through this RFP may consist of one or more commercial off-the-shelf (COTS) software products or a custom developed software offering or a combination of both.

The exchange solution must be a web-based solution hosted at a secure location and provide the following:

• A hosting solution meeting the requirements of the Exchange in terms of hardware, software, network, and infrastructure services

• An integrated exchange solution based on a single exchange portal to support individual Eligibility and Enrollment, Plan Management, Financial Management, and Small Business Health Options Program (SHOP)

• Operations and Maintenance of the exchange for one year with provisions for extensions

The new Exchange is to have a consumer focus and provide automated interaction with stakeholders. Since it is expected that consumers will access the exchange from their homes and other locations, the exchange web portal is expected to be available to users 24/7.

The State conducted a detailed Information Technology Gap Analysis for the exchange. The IT Infrastructure review and assessment developed a high level understanding of the requirements of the exchange and reviewed the State’s current Medicaid technology investments and architecture.

Proposals are due December 8, 2011. To view the RFP, go to

Saturday, November 5, 2011

DOD Issues Program Announcement

The Army Medical Research Acquisition Activity issued a program announcement seeking solutions on how to help care for critically injured burn patients and how to further advance the state of medical sciences for treating burn injuries. The Department of Army program announcement released October 28th is looking for innovative approaches to transition medical technologies into deployable products to provide new standards of care to prevent burn injuries, treat casualties, and provide rehabilitation.

One of the four priority areas for FY 2012 listed in the program announcement specifies pursing device and drug development for Inhalation Lung Injuries. The combination of inhalation injury and burns results in mortality rates that far exceed the rate for burns alone. Research is needed to develop a device to provide “Extracorporeal Lung Support (ECL) or other therapeutic devices to treat severe inhalation injuries. The total funding allotted to develop the ECL device and for drug biologics is $2 million

ECL has been shown to allow the lungs to recover while respiratory demand is partially or fully met. DOD is looking for research efforts to design and or better develop an ECL or other device that weighs less, is reduced in size, and has less oxygen requirements as compared to hospital-based units. Research is also needed to produce a device that could improve outcomes in times of severe organ failure.

The prototype must be viable to use at level III/Combat Support Hospitals, during Enroute Care and can be used by a variety of personnel such as emergency physicians, ICU nurses, general surgeons, and intensivists that have little to no prior experience with such technologies.

In addition to an ECL device, there is still an urgent need for therapies that can be applied quickly post-injury to mitigate further damage and initiate healing. These therapies can be pharmacologic, biologic, or mechanical in nature.

The other priority areas in the program announcement are seeking to develop and assess the impact of checklists on standardizing burn care, perform multicenter studies of ICU-based rehabilitation outcomes based on evaluating physical and rehabilitation technologies and therapies, and develop appropriate therapies to manage scarring conditions.

The program announcement “Care for the Critically Injured Burn Patient” has a Pre-application submission deadline of December 2, 2011 and the application submission deadline is March 9, 2012. The total amount of funding available for the CCC/JPC 2012 initiative is $7.3 million with six awards anticipated.

Applications from investigators within the military services and other federal agencies are encouraged as are applications involving multidisciplinary collaborations among academia and industry.

TATRC is administering the application process for this funding opportunity and the U.S. Army Medical Research Acquisition Activity will be negotiating all resulting awards.

For more information, go to announcement (W81XWH-12-CCCJPC-CCIBP). For questions email or call TATRC Help Desk at 1-703-674-2500 extension 207.

Harris Corp Receives Task Order

Harris Corporation has been awarded its first task order from the Department of Veterans Affairs to support the tracking of medication and treatment for veterans suffering from mental health disorders. The task order falls under the three-year “My Recovery Plan” blanket purchase agreement which has a ceiling of $4.5 million.

The “My Recovery Plan” is an interactive personal treatment planner for veterans to use in conjunction with their care providers. The “My Recovery Plan” application within the “My HealtheVet” Personal Health Record provides a web-based interface to allow veterans with behavioral or mental health concerns to track their progress towards recovery, track mental health symptoms, track changes in their level of functioning, identify how medications may affect them, and make guided changes in their treatment to compliment to the services delivered by VA clinicians.

Under the task order, Harris will provide support services for the “Medication Monitoring and Tracking Module” and the “My Goals Module” through requirements development, testing, and implementation support. “My recovery Plan” gives veterans an invaluable tool to monitor their own mental health regime, develop life goals, and stay in constant contact with their clinicians,” said Jim Traficant, President of Harris Healthcare.

For more information, go to

Developing New Cardiac System

A researcher from Cornell University along with Blue Highway Inc. a new technology incubator in New York state are working together on a non-contact cardiac imaging system called “Magnetocardiography” (MCG). The system uses extremely sensitive novel sensors to measure magnetic fields produced by the heart’s electrical activity and is a new way of accurately analyzing cardiac function without using nuclear imaging, functional MRI, or ultrasound.

An MCG device will output data reflecting cardiac functionality by mapping the heart’s magnetic field and identify functional abnormalities. Magnetic field detection is enabled by an array of chip-based sensors and digital signal processing modules integrated on a planar substrate.

When the sensor array is moved over a patient’s chest, magnetic data is collected and proprietary algorithms generate a map of the patient’s cardiac function which can be represented as an image or wave form.

Present ECG available technology cannot locate conductive pathways in the heart. Because conduction pathways are often the source of arrhythmias, clinicians lack complete cardiac function information. To date, detecting arrhythmias has been a time consuming process for clinicians but with the advent of a low-cost non-contact assessment tool could revolutionize cardiac screening across the continuum of global healthcare settings. The MCG device is able to identify abnormalities or weaknesses not detected by ECGs.

In addition, the device does not transfer energy into the body, measurement is unaffected by the patient’s clothing and body size, the device has superior electrical sensing sensitivity, operable in electrically noisy environments, and doesn’t require electromagnetically shielded exam rooms.

It is expected that the total available market for MCG is $242 million and the targeted market segments include cardiology clinics, emergency departments, large primary care practices, hospitals, and out-patient clinics.

Blue Highway envisions a first generation embodiment of the MCG device to include a full array system of sensors connected to a processing and computing system capable of imaging the magnetic field generated by depolarization and repolarization currents in the chest cavity during a cardiac cycle. The device will enable clinicians to map the heart in both time and space. Second generation development may include a portable device.

For more details, email David Eilers, Vice President for Business Development at or call (315) 443-6212.

Health eVillages & Mobile Solutions

The Robert F. Kennedy Center for Justice and Human Rights in partnership with Physicians Interactive recently launched Health eVillages to assist healthcare professionals practicing medicine in the most challenging clinical environments. This is the first consortium of healthcare and human rights organizations that is providing mobile medical technology to challenging regions worldwide.

According to Kerry Kennedy, Founding Partner and President of the RFK Center, “The program will provide mobile clinical reference and decision support tools to use for medical training, diagnostics, and clinical references. Currently, more than one billion people live in rural, underserved areas with inadequate access to healthcare and nearly one third of countries are experiencing critical shortages of skilled healthcare workers.”

Health eVillages is a consortium of international healthcare advocacy organizations, mobile healthcare solution providers, health information technology companies, communication providers, and public health foundations.

Through in-kind contributions and fundraising, healthcare professionals in disadvantaged areas will function with new and refurbished mobile phones and handheld devices that do not require internet access and are preloaded with clinical decision support reference tools. So far, Healthy eVillages has conducted pilot projects in several regions, including Hati, Kenya, Uganda, and the Greater Gulf Coast.

All of the devices provided include drug guides, medical alerts, journal summaries and references from over 50 medical publisher’s resources powered by, Inc a subsidiary of Physicians Interactive.

For more information, go to

Protecting Data on Mobile Devices

Diversinet Corp was awarded a U.S patent for an encryption method that addresses growing concerns on protecting sensitive personal data stored on a mobile device. The U.S Patent No. 8,051,297 for “A Method for Binding a Security Element to a Mobile Device,” covers the security needs for mobile devices such as for smartphones or tablets.

The patented technology prevents unauthorized access to the data on a mobile device via encryption and prevents access to the information if it is transferred to another mobile device. Unlike other methods, it uses characteristics of a mobile device’s unique identity such as its serial number to create the encryption passkey.

Diversinet has integrated the patented solution into its MobiSecure® mobile healthcare products to help healthcare organizations quickly and cost-effectively deploy HIPAA-compliant mHealth applications anytime, anywhere on mobile devices.

The technology can benefit any industry that requires information to be stored securely on mobile devices. Mobile industry analysts estimate that more than 50 percent of the U.S. population will have smartphones by the end of 2011 and that number will grow to more than 70 percent by 2013.

Diversinet Chairman and CEO Albert Wahbe said, “We believe that our technology creates a highly secure information source on mobile devices which is particularly important in our current environment of patent stockpiling and litigation related to mobile communication technology.”

Diversinet’s intellectual property portfolio includes 16 patents in the U.S, Canada, and Israel, with 32 patent applications pending.

For more information, go to

Snapshots on Lessons Learned

“Project HealthDesign” a national program of the Robert Wood Johnson Foundation’s “Pioneer Portfolio” supports research teams working alongside patients and clinicians to help develop personal health applications useful to patients managing chronic diseases.

Current “Project HealthDesign” teams are working with patients and clinicians to examine how patient-sourced observations found in daily living such as pain, mood and energy levels can be captured and integrated into clinical care and influence daily health decision-making.

Five grantee teams are working with a variety of patient populations using technologies such as smartphones and sensors and designing applications that can effectively and efficiently be incorporated into care processes used by real patients and providers. The team is working with the University of California at Berkeley, Healthy Communities Foundation, and the University of California at San Francisco.

The new RWJF report “Project HealthDesign: Early findings and Challenges” gives several snapshots on lessons learned. For example, chronically ill patients are eager to try technologies to help them take charge of their health. Because symptoms can fluctuate hourly, Crohn’s disease is a complicated condition for both patients and clinicians to manage.

Clinicians rely on patients to self-report their symptoms using an iPad during office visits, but these accounts may provide an incomplete picture of the patient’s health. However, Crohn’s patients tend to be highly motivated and willing to try new technologies and approaches that might limit their symptoms or improve their quality of life.

Project HealthDesign’s “Crohnology.MD” team developed a mobile application to help Crohn’s patients track pain levels, along with other Observations of Daily Living (ODL) symptoms. They also developed a mobile application that allows clinicians to view summary level or detailed reports of ODL data collected by patients. The use of technology enables patients to accurately record their day-to-day ODL and symptoms and helps clinicians to obtain a more robust picture of their patient’s health.

Other grantee teams include “BreathEasy” which is using smart phones with patients who have asthma, “dwellSense” uses household sensors to monitor how elders complete routing tasks, the “Estrellita” team is using smartphones to gather information from their caregivers with high-risk infants, and the “in Touch” team is using iPod Touch to monitor ODL pertaining to obese teenagers as to the amount of exercise, moods, food intake, that they consume or the socializing that they do with other people.

For more information, go to

Tuesday, November 1, 2011

Advancing Medication Adherence

Adherence to medications is still a tough challenge according to William Shrank, MD, Director of Evaluation for the CMS Center for Medicare and Medicaid Innovation speaking at Partners Healthcare’s Connected Health Symposium held October 20-21, 2011 in Boston. Dr. Shrank pointed out that patients adhere 50 to 70 percent of the time in taking their essential medications for chronic conditions.

The average user taking a medication to lower their blood pressure also takes a number of additional medications to maintain all of their chronic conditions. The barriers to full compliance can include problems such as understanding how to use the medication and understanding affordability and coverage factors. Physicians need to be able to communicate knowledge on drug costs, medications safe use, and be familiar with their patient’s medication adherence. In addition, at the system level, there needs to be information on access and coverage of medications, administrative barriers, and additional information on health IT.

Health IT interventions are promising tools in the fight to improve medication adherence. However, while many studies have been done to boost medication adherence, very few have been done on using health IT to accomplish this goal. So while promising results are available, even more research needs to be done.

Dr. Shrank explained that with the explosive growth in e-prescribing, it is now possible to identify patients who fail to adhere in real-time, find patients who fail to initiate prescriptions, communicate with providers and pharmacists when patients fail to adhere, predict which patients are at risk for non-adherence, link medical and pharmacy information to the largest groups of high risk patients, and send out electronic reminders.

Social networking is another major advancement to help people deal with their medication regime and is proving to be very effective with great potential for the future. For example, Dr Shrank as the author of a landmark study on the health uses of Face Book by patients with diabetes, points out that social networking can provide diabetic patients with a rich community of emotional support by enabling the diabetic community to share personal stories and learn from each other.

According to Dr. Shrank, “To be effective we need to make better use of data, need to provide real incentives to reward adherence to medications, and do a better job of benefit design. The Post-MI FREEE trial due to be published soon is geared to patients with coronary artery disease. The trial was designed to evaluate the effect of providing full prescription drug coverage for some drugs and will be the first randomized study to evaluate the impact of reducing cost-sharing for essential cardiac medications in high risk patients on clinical and economic outcomes.

For more information on the Symposium, go to

Grant Funding in Minnesota

The “Minnesota e-Health Connectivity Grant Program for HIE” has funding of one million currently available to help rural or underserved communities. These communities are potentially eligible for federal incentives for the meaningful use of EHRs in order to exchange health information. The funding can also be used to increase the number of rural Minnesota pharmacies capable of accepting electronic prescriptions. Grant awards are available up to $10,000 with the applications due December 31, 2011.

Eligible applicants include:

• Qualifying Hospitals—Critical Access Hospitals and small rural hospitals with less than 100 beds, rural health clinics, FQHCs, and rural physician clinics can apply for funding to pay consultant costs associated with planning for HIE capabilities and for costs associated with establishing connectivity with the State Certified Health Information Exchange Service provider

• Qualifying Rural Pharmacies—serving ambulatory patients in cities with populations of less than 10,000 that are currently unable to accept electronic prescriptions or meet requirements for exchange without updating their existing pharmacy system are eligible for hardware for up to $5,000, software, and transaction costs for up to one year

Go to, for more information, or email Anne Schloegel at MDH at or call (651) 201-3850.

The Minnesota Commissioner of Health is now able to award grants to eligible hospitals under the “Rural Hospital Capital Improvement Grant Program”. The state program helps small rural hospitals with 50 or fewer beds undertake needed modernization projects to update, remodel, or replace aging hospital facilities and the equipment necessary to maintain the hospital.

Previous legislation a few years age made several changes. The state’s legislation clarified that hospitals are eligible for the funding if they are located in a rural area or a non-Twin cities rural community with a population of less than 15,000. The legislation also added electronic health records systems as an eligible project for funds. Eligible applicants must be able to demonstrate that at least one quarter of any grant amount is available from non-state sources.

The FY 2012 funding will be approximately $1,755,000 much less than the $2.6 million available in 2003 and the $4.6 million available in 2002. Given the reduced level of funding, MDH is limiting the maximum award amount to $125,000. MDH expects to make approximately 17-20 grant awards.

The Pre-Application is due to MDH December 16, 2011 with the Final Application due to MDH on March 16, 2012. Projects will be awarded in April 2012 with contracts completed around June 1, 2011.

Go to or contact Doug Benson, MDH Office of rural Health & Primary Care at 800-366-5424 or 651-201-3842.

NIH & mHealth Technologies

The distinction between health applications by smartphone versus applications on the web will diminish in the future, according to an article appearing in the newsletter “PPP Advisor” by William T. Riley PhD, Program Director at the Clinical Applications and Prevention Branch at NHLBI.

The article in “PPP Advisor” published by the Private Partnership Program at NIH discusses the role of NIH and mhealth. He questions if private industry is developing innovative wireless and mobile applications and FDA is working to regulate the industry to achieve safety and effectiveness then what is the role of NIH as it relates to mHealth?

As he explained, mHealth technologies have greatly outpaced the research needed to evaluate the technologies plus if mHealth applications are not making a medical claim, FDA approval is not needed. The result is that numerous mHealth applications commercially available very often lack research support. Therefore the role of NIH should support research that evaluates the validity and efficacy of mobile applications.

Today, NIH supports approximately 100 grants to develop and/or evaluate mobile technologies applied to health but much more needs to be done. With the current timeline from grant submission to the completion and publication of a randomized clinical trial, many of the mHealth applications currently being published are already dated or obsolete.

To facilitate mHealth efforts at NIH, the NIH mHealth InterInstitute Interest Group (mHealth IIIG) coordinated by the NIH Public-Private Partnership Program in the Office of Science Policy, Office of the Director at NIH, with over 100 members from various NIH Institutes, Centers, and offices is addressing the issue.

In addition to sharing mHealth research support efforts across NIH, (mHealth IIIG) also develops trans-NIH initiatives and coordinates workshops and training efforts. Right now, one of the major efforts has been to coordinate the research track for the 3rd Annual mHealth Summit to be held at the Gaylord National Resort and Convention Center at National Harbor in Maryland coming December 5-7 2011. For more information on the mHealth Summit supported by the Foundation for the NIH and other partners, go to

Go to to view the newsletter.

OMH Plans for Network & EHRs

The HHS Office of Minority Health (OMH) announced a project to build a collaborative research network to document the spread and contributions of mobile health clinics across the U.S. The project will be conducted by the Mobile Health Map, a project of the Harvard Medical School, and the Mobile Health Clinics Network, a San Francisco-based national membership organization with more than 300 members.

The project will allow mobile health projects to share data and enable researchers to describe the reach and accomplishments of the mobile health model, the populations served, and cost-effectiveness. Academic, government, and providers are going to launch a formal research network in 2012.

One of the prime purposes of the project will be the creation of a web-based service to help people locate clinics across the U.S. to find sources for preventive screenings.

Another demonstration project has been announced by OMH, American Health Information Management Association (AHIMA), and North Shore Medical Labs, Inc. of Williston Park NY to help foster broader adoption and use of EHRs.

AHIMA will provide six hours of web-based training on health IT to providers who work in underserved communities. About 100 providers who complete training will receive EHR licenses, including subscription fees for 12 months. Nortec will help to integrate the necessary information technology components within participating physician practices. Plus, North Shore Medical Labs will donate 75 percent of the cost of the Nortec EHR licenses, program integration, monthly subscription fees, as well as provide discounted education and training.

Provider recruitment efforts will be conducted by the Mississippi Institute for Improvement of Geographic Minority Health and the North Carolina Health Information Management Association.

Health care providers who wish to participate in the initiative must:

• Be providers in Medically Underserved Areas (MUA) or Health Provider Shortage Areas as designated by HHS

• Have an internet connection and be using an electronic billing system

• Be a small practice group of one to five providers or a FQHC within the MUA and/or PSA

• Be eligible to receive meaningful use incentives as defined by the HITECH Act

• Complete an initial application and be able to submit monthly reports

For information on this initiative, email Dr. Bill Rudman at or Dr. Abid Sheikh at