Sunday, January 29, 2012

Health Policy Center Launched

Philanthropic pioneers Gary and Mary West launched the West Health Policy Center in Washington D.C at the Health Care Innovations Summit held January 26th in Washington D.C. The goal is to save up to $100 billion in cumulative healthcare costs within ten years.

The event partnered by CMS, Office of the National Coordinator for Health IT, West Wireless Health Institute, and Health Affairs brought together health delivery systems, physicians, innovators, policymakers, academics, and investors to help find payment solutions already working in the marketplace.

“Healthcare costs are rising at an unsustainable rate and which has caused a national crisis, has threatened our economy and national security, weakens our global competitiveness, causes millions of jobs to be “offshored” and violates public trust,” said Gary West. “It is vital for the future of our country to begin immediately to focus on some common sense changes in healthcare reimbursement and regulation.”

Independently funded by a multi-year, multi-million dollar commitment from the Wests, the Policy Center is the only non-profit, non-partisan organization with the single aim of lowering healthcare costs.

The Policy Center will initially work to:

• Provide patients with the right care, at the right time, wherever they are, whenever they need it. This will be enabled by new models of care coordination powered by smart technology

• Provide timely, easily accessible, easily understandable and actionable price data that enables consumers and providers to fully understand the costs associated with diagnostic, therapeutic, and routine healthcare choices

• Advocate for reimbursement models that incentivize development and use of equally or more effective low cost high value alternatives to the status quo

• Provide research and analysis for clear regulatory pathways to expeditiously bring tools to enable infrastructure-independent low-cost care to consumers and clinicians

• Identify wasteful, costly, unnecessary, or duplicated healthcare spending

The Policy Center will establish a competitive fellowship program where five established researchers will be selected through a nationwide application and interview process each year based on their ability to identify at least $1 billion in actionable annual healthcare cost savings.

The Policy Center’s first fellow is Dr. Peter Neumann, an internationally renowned researcher on the use of cost effectiveness analysis in healthcare decision making. He currently serves as the Director of the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy at Tufts Medical Center in Boston.

He will join the other fellows to identify opportunities for regulatory and reimbursement changes ensuring that the rules across CMS, FCC, and FDA are aligned with each other to allow for equal or better clinical outcomes at lower costs.

For more information on the West Health Policy Center, go to, for more information on the West Wireless Health Institute, go to and for more information on the Health Care Innovations Summit, go to

State Legislative Issues

The Commonwealth of Virginia spends $42.3 billion each year on their Medicaid program and this amount is expected to increase with the implementation of federal health care reform and spending requirements. Therefore, the state is looking at using telemedicine to help reduce Medicaid costs.

House Joint Resolution No. 171 introduced by State Delegate Daniel W. Marshall III (R-VA) on January 11, 2012 would establish a joint subcommittee to study how telemedicine could play a role in reducing Medicaid costs.

The joint subcommittee with a total membership of 15 members, would examine the current use of telemedicine in the Commonwealth and in other states, research methods that could be used to reduce Medicaid costs using telemedicine, and consider other new technological advances used in other states to help solve the problem.

In New York State, a roundtable discussion was held on January 9th with the Legislative commission on rural resources. The hearing was held to identify what state legislators and policymakers can do to eliminate the remaining barriers to using telemedicine.

At the roundtable, the Healthcare Association of New York State (HANYS) and other stakeholders identified issues related to telemedicine that need to be addressed:

• Encourage all private payers to recognize telemedicine and telehealth services including new models of care emerging at the state and federal levels

• Expand Medicaid support for telemedicine to include service provided from licensed providers and private physician offices, especially with the critical need for child and adolescent psychiatry needed in many areas of the state

• Expand Medicaid support for consultations provided to nursing home residents

• Identify and address areas of the state that still lack broadband access

• Allow for peer review responsibilities when a hospital is contracting with another entity for specialty telemedicine consultations since the receiving hospital may not have the specialists on staff to appropriately conduct quality assurance activities that are part of the credentialing and privileging process

Participants in the roundtable also identified barriers at the federal level that included discussion on Medicare support for telemedicine. For example, there is limited payment for services to patients located in designated rural Health Professional Shortage Areas.

Startups Receive Funds

Technology developed by the Georgia Institute of Technology and Emory University to help deliver drugs and other therapeutics to specific locations in the eye is the foundation for a startup company. The startup “Clearside Biomedical” was formed with the assistance of Georgia Tech’s VentureLab program which helps obtain early-stage seed funding from the Georgia Research Alliance.

The technology was developed by the research team led by Mark Prausnitz, a Professor in Georgia Tech’s School of Chemical and Biomolecular Engineering in collaboration with Henry Edelhauser, a Professor in the Department of Ophthalmology at Emory School of Medicine. The research leading to the development of the technology was sponsored by NIH.

The Atlanta-based “Clearside Biomedical” received a venture capital investment of $4 million to develop the microinjection technology. The funding came from Hatteras Venture Partners, a venture capital firm based in Research Triangle Park, North Carolina that focuses on seed and early-stage investments in companies developing products in biopharmaceutical, medical device, diagnostic, and related human health areas.

The microinjection technology will use hollow microneedles to precisely target therapeutics within the eye. If the technique proves successful in clinical trials and wins regulatory approval, this technology could provide an improved method for treating diseases that affect the back of the eye, including age-related macular degeneration.

Drugs today can be delivered to the retinal tissues at the back of the eye in three indirect ways. One way is to inject using a hypodermic needle into the eye’s vitreous humor, the gelatinous material that fills the eyeball, or use eye drops which are limited in reaching the back of the eye, or taking pills that expose the whole body to the drug.

With the development of new the technology researchers are able to use a hollow micron-scale needle to inject therapeutics into the suprachoroidal space located between the outer surface of the eye known as the sclera and the choroid which is a deeper layer providing nutrients to the rest of the eye. Preclinical research has demonstrated that fluid can flow between the two layers where it can spread out to the entire eye, including to the retina that is difficult to reach.

So far, the technique has been tested only in animals. The funding will enable the company to conduct additional efficacy and safety testing needed to seek regulatory approval. The company’s first product is expected to address macular edema and retinal vein occlusion.

For more information, contact Holly Korschun at (401) 727-3990 or Joy Bell at (404) 778-3711.

In a project in Virginia, the Center for Innovative Technology (CIT) a nonprofit corporation has invested CIT Gap Funds of $50,000 in the University of Virginia’s based start-up Rivanna Medical, a company specializing in portable low cost, radiation free x ray replacement technology based on medical ultrasound.

Rivanna Medical’s ultrasound technology is set to create a pipeline of advance handheld ultrasound products. The company’s technology enables clear delineation of bone structures with 3D imaging capabilities all contained in low cost handheld devices. According to the company their devices provides sharper contrast, resolution, and reduced noise when compared with standard ultrasounds due to advance signal processing technology. The product is a smart phone sized device targeting the spinal anesthesia market as a replacement for fluoroscopy guided or blind needle insertion.

Markets for the technology include spinal anesthesia, the diagnosis of bone fractures, and guidance for orthopedic surgeries. The combined market size is approximately $664 million per year in the U.S. and for Rivanna Medical’s product alone, the U.S. market is estimated at $208 million per year due to a population of 41,000 anesthesiologists and the fact that 18 million spinal anesthesia procedures performed each year.

For more information, email Hap Connors at or Stephanie Boucher at

CBO Discusses CMS Demos

The Congressional Budget Office (CBO) released an issue brief on January 18th reviewing the outcomes on 10 major CMS demonstrations. The evaluations by independent researchers show that most programs have not reduced Medicare spending.

The report explained that the programs where care managers had substantial direct interaction with physicians and significant in-person interaction with patients were more likely to reduce Medicare spending than other programs, but on average, even these programs did not achieve enough savings to offset their fees.

Results from demonstrations of value-based payment systems were mixed. In one of the four demonstrations examined, Medicare made bundled payments that covered all hospital and physician services for heart bypass surgeries. In those cases, Medicare’s spending for those services was reduced by about ten percent under the demonstration. Other demonstrations of value-based payment appear to have produced little or no savings for Medicare.

The report recommends that future efforts focus on collecting better data, targeting resources at patients really in need, and encouraging care providers to work together.

According to Rick Gilfillan, Acting Director of the CMS Innovation Center, reports that today the Innovation Center is engaging doctors, hospitals, and other providers to try new approaches. This can be achieved by keeping patients healthy and out of the hospital by having:

• Health systems participate in the Pioneer ACO and ACO Shared Savings models
• The Community-Based Care Transition Program invest up to $500 million in organizations such as Area Agencies on Aging to help seniors as they leave the hospital, and include home visits
• The Demonstration to Reduce Hospitalizations of Nursing Facility Residents invest $134 million to provide additional care and supports to help reduce preventable hospitalizations among nursing home residents
• The Comprehensive Primary Care Initiative provide new support from both Medicare and private health insurers to make sure that participating primary care practices have robust care teams
• The Medicare-Medicaid Coordination Office and the Innovation Center is empower states to invest in new models targeted towards beneficiaries that are eligible for both Medicare and Medicaid
• The Innovation Center is testing several new payment models, such as the Pioneer ACO Model and the Bundled Payments for Care Improvement with no upfront payments to participating doctors and hospitals. These groups will be rewarded once their innovative approach is proven to have reduced costs and keep patients healthier

To view the entire document, go to

Accuracy in Hospital Reports Questioned

The HHS Office of Inspector General recently reported that 13.5 percent of hospitalized Medicare beneficiaries experience adverse events during their hospital stays. This lack of reporting by incident reporting systems has resulted in prolonged hospitalizations, sometimes causing required life-sustaining interventions, has caused permanent disabilities, and has even resulted in death.

All of the hospitals reviewed for the report had incident reporting systems designed to capture events and their hospital administrators indicated that they rely heavily on the systems to identify problems. However, hospital accreditors report that they do not investigate event collection methods such as incident reporting systems unless evidence of a problem emerges through the survey process.

OIG recommends that AHRQ and CMS collaborate to create and promote a list of potentially reportable events for hospitals to use. They further recommend that CMS provide guidance to accreditors regarding their assessments of hospital efforts to track and analyze events.

The report "Hospital Incident Reporting Systems Do Not Capture Most Patient Harm" published January 2012 suggests that when hospitals collect information they use AHRQ’s Common Formats. Additionally, CMS should scrutinize survey standards when assessing hospitals and their compliance with the requirement to track and analyze events. They should also reinforce the assessment of incident reporting systems to improve event tracking.

OIG received comments on the draft report from AHRQ and CMS. AHRQ concurred with the recommendations and stated that they will collaborate with CMS to create a list of potentially reportable events and provide technical assistance to hospitals that use the list.

CMS also concurred with OIG’s recommendations stating that strengthening hospital reporting systems and practices is essential to preventing patient harm. Also, using a voluntary list of adverse events could be highly beneficial for improving incident reporting practices and that CMS is developing draft guidance for surveyors regarding assessment of patient safety improvement efforts within hospitals.

The full report is available at

Developing Low Cost Tech

The biomedical device startup Praxis Biosciences LLC is the fifth company to move into the California Institute for Telecommunications and Information Technology (Calit2) technology business incubator called TechPortal. The firm founded in 2010, has been developing low-cost technologies aimed at the medical industry.

Their sinus-screening tool uses near-infrared light to illuminate patient’s sinus cavities when signs of blockage are indicated. The tool is intended for use in primary care settings and will be tested for efficacy alongside CT scans, which is the current and more expensive tool used for sinus scans

The sinus screening tool uses a light wand type device placed inside the patient’s mouth that emits near infrared light which is not absorbed by tissue. Instead, it scatters and lights up the whole face. “However, if you have blocked sinus cavities, the shape of the light pattern differs. A digital camera outfitted with special filters captures the images, which can’t be seen with the naked eye, and then automatically uploads the images wirelessly,” reports Chief Technology Officer Joan You.

Praxis is collaborating on this tool with researchers Bruce Tromberg and Albert Cerussi at the University of California at Irvine’s Beckman Laser Institute. Along with developing the light-wand device, Praxis plans to work on organizing and managing the data for seamless integration into patient care databases.

The company has already developed a cartilage-reshaping instrument that molds cartilage in the ears using electrical stimulation that can be used in a medical office setting. So far the instrument is in the early stages of development. Currently, the device is focused on ear reshaping to correct trauma or genetic defects, but the technology can also be adapted for other procedures such as rhinoplasty.

By using electric current to reshape the tissue, doctors would be able to perform their work incrementally while eliminating the need for costly surgical procedures. The process is relatively painless and a topical anesthetic can eliminate the discomfort entirely.

In other Praxis research, the “EarTrumpet” could be the answer for some of the approximately 36 million people in the U.S. who need hearing assistance but can’t afford expensive hearing aids. The iPhone, iPad, and iPod app features a self administered hearing test to identify user specific frequencies that require amplification, and then is able to deliver a personalized hearing aid program. The app is already available but Praxis seeks to refine it to the level of a medical device. The current device is being upgraded to include more testing options and better amplification capabilities.

“In addition to their collaborations with researchers at the Beckman Laser Institute, Praxis Biosciences seeks additional partnerships with Calit2-affiliated faculty in the areas of telemedicine, medical informatics, and micro-devices,” said CTO Joan You who also serves as the company’s business affairs officer.

For more information, email

Wednesday, January 25, 2012

Army's Health Technology

The Army lists soldier medical readiness as its number one priority and wants to do a better job of screening to keep today’s service members healthy. Currently, almost half of all non-deployable soldiers have suffered preventable musculoskeletal injuries. It has been found in studies, that those at risk for injuries can be identified by using an up-to-date screening process referred to as MP3.

The MP3 research team with faculty and students from the Army-Baylor University Doctoral Program in Physical Therapy and researchers from the University of Evansville, and Duke University are conducting a study through the Army’s Medical Department of Advanced Medical Technology Initiative (AAMTI) with TATRC providing $239, 547 in funds.

The Army by using hand held devices (Motorala MC75) and netbooks are able to speed up the assessments and screen 35-40 soldiers in less than 90 minutes. The soldier’s data is translated into a score and then sent to a computer that uses an algorithm to determine whether the soldier is at risk for musculoskeletal injuries and to what degree. If a soldier is found to be at risk for injury, prescribed corrective steps are taken under the supervision of an Army physical therapist to help decrease risk factors. With the data, the medical team is able to track the soldier’s performance throughout their career.

As for the development of other devices, Lt. Col Eric Drynan, Division Chief the Medical Information Systems Directorate at the AMEDD Center and School, reports that the Army is examining the future of several hand-held devices. Lt. Col Drynan is working with the IT system and radio platform experts to develop the operational architecture to enable a commercial hand-held device to be used in the field which would greatly help medics and behavioral health providers.

According to Drynan, the Army’s work on the next generation device seems to be moving in the direction of Android-based phones perhaps similar to the Android EVO that’s already available in the commercial market. The Army is setting up its own 3G network with mobile antennas which are now being tested.

Another initiative being studied is the Electronic Casualty Report (ECR). If a soldier in a convoy is hit by an IED, another soldier can provide buddy aid and then document the information in the ECR, which is part of the mission command system in every Army vehicle. The ECR is an electronic version of the Tactical Combat Casualty Care Card which is used to document care provided by first responders.

To meet the needs of telemedicine, a telehealth Integrated Process Action Team (iPAT) is looking at telehealth requirements and capabilities in the AMEDD from the operational tactical level to the generating force. The iPAT team is going to conduct a capabilities-based assessment to identify gaps in current capabilities document where telemedicine could provide solutions.

A Virtual Behavioral Pilot program initiated in 2009 tried several methods to provide behavioral care. These methods included face-to-face care, high bandwidth Video Tele-Conferencing (VTC), and low bandwidth Defense Connect Online. It was discovered that service members were really helped with VTC encounters.

As a result in December 2011, the Tripler Army Medical Center in Hawaii opened their Pacific Regional Medical Command’s Tele-Behavioral Health Center. So today, Tripler is providing healthcare VTC not only in the Pacific islands but as far away as Alaska, Texas, and Kansas.

Pilot Project Helping Veterans

Many veterans with some types of blood clotting conditions need to take blood thinners or anticoagulants. Warfarin, an anticoagulant is one of the most frequently prescribed drugs in the U.S. with more than 17.8 million prescriptions dispensed annually to prevent strokes or heart attacks. Once warfarin therapy begins, the International Normalized Ratio (INR) must be tested periodically to ensure the proper warfarin dosing.

To address the problem, a pilot project was funded by the VA’s Office of Rural Health, enabling the West Texas VA Health Care System to create a Telehealth Anticoagulation Clinic to help veterans currently taking blood thinners. The goal is to improve the clinical care received by veterans in rural and highly rural areas while developing a program flexible enough to handle the population shifts at multiple locations.

About 600 veterans within the 55,000 square mile primary service area of the West Texas VA Health Care System are enrolled in the telehealth clinic. Veterans routinely report to the West Texas VA Medical Center or to one of the Community Based Outpatient Clinics to have regular blood draws to check the INR levels monthly with results available to Dr. Jason Cornish, the Clinical Pharmacist in Big Spring. Then the results are sent to the veteran’s provider within 24 to 48 hours.

The Clinical Pharmacist discusses the results with the veteran at a different location using a telehealth unit. The patient and Clinical Pharmacist both use a computer screen during this communication and then adjustments are made to the veteran’s medication immediately if needed.

Although the Pharmacist managed anticoagulation clinic has only been in full implementation at distant sites for a few months, the results have been very successful. Significant improvements in INR control have been demonstrated at all the clinics and significant improvements have been demonstrated in decreasing the number of critical INR values.

Tech Diagnostics Help Rural Areas

The “Extractionator" device could bring high tech medical diagnostics to rural areas according to information posted at Vanderbilt University. The prototype could be the basis of an easy-to-use low-cost sample collection and preparation system that could help bring medical diagnostic testing to people in poor rural areas in the world.

The research and development on the device to be performed at Vanderbilt was funded with $1 million grant from the Bill & Melinda Gates Foundation. The researcher’s ultimate goal is to make sample collection and preparation so simple that it can be operated properly with people with little training and can be easily integrated with the other detection methods under development by other grantees.

The device consists of a length of clear plastic tubing filled with a series of liquid chambers separated by short lengths of air. At one end, the tube also contains a number of tiny magnetic beads.

The prototype works something like a miniature car wash. When a patient sample is introduced into the end of the tube, the operator of the device uses an external magnet first to coat the beads with the target material. The beads have special coatings that bind with the specific biological molecules needed for a given diagnostic test.

At this point, the operator drags the beads through the air spaces into the subsequent chambers. Each of the sequential chambers contains special chemicals that remove molecules that interfere with the accuracy of the test. As a result, when the beads reach the other end of the tube, they carry a purified and concentrated sample of the sort required for testing.

Researchers have explored how the system works with biomarkers for the RSV respiratory virus and for malaria and have found the system effective. They evaluated the extraction and concentration of the RSV biomarker in great detail and found that the “Extractionator” works as well as the commercial lab-based kits that are currently available.

The principal investigators on the “Extractionator” project include biomedical engineer Rick Haselton, biochemist Ray Mernaugh, and Chemist David Wright. For more information, email David Salisbury at

State Telemedicine Challenges

The Maryland Telemedicine Task Force is addressing the challenges to the widespread adoption of a comprehensive statewide telemedicine system in the state. The Task Force established a Leadership Committee to prepare specific recommendations on the use of telemedicine that was submitted to the Maryland Quality and Cost Council in December.

Key recommendations to improve the use of telemedicine in the state are for:

• State-regulated payers to provide reimbursement for healthcare services delivered through telemedicine to the same extent as healthcare services provided face-to-face, regardless of the location

• An interoperable telemedicine network to be built on existing standards and integrated into the state designated health information exchange. This would enable broad provider participation, allow networks to connect to other networks, and provide access to clinical information through the exchange

• Regulations to be aligned with revised CMS rules to permit privileging and credentialing by proxy, a process by which an originating-site hospital may rely upon the credentialing and privileging decisions made by distant site telemedicine entities. Future changes in licensure will be needed to enable reciprocity of licensure for physicians practicing in border states

Today 12 states covering over 106 million Americans have legislated mandates for the reimbursement of telemedicine. In most states, payers may not create barriers to care or reimbursement solely because the care is being provided via telemedicine.

In general, according to the Environmental Scan of Telemedicine Initiatives in Maryland, existing telemedicine initiatives are fragmented and oversight of the functions to render care at a distance using licensed providers and health IT rests within several state agencies. These agencies include the Maryland Board of Physicians, Maryland Health Care Commission (MHCC), Maryland Institute for Emergency Medical Services System (MIEMSS), and the Department of Health and Mental Hygiene, Office of Health Care Quality.

Some of the stakeholders involved feel that a state entity should be designated to be a lead agency with regard to telemedicine, a telemedicine Advisory Council should be established consisting of public and private representatives, the state should designate a not-for-profit private entity to provide expert guidance to telemedicine providers, and the barriers to telemedicine adoption need to be addressed.

Payment policies for telemedicine services were reviewed. Determining when telemedicine services are medically necessary or when clinically equivalent to face-to-face services are required still remains a significant challenge in setting payment.

To support adoption of telemedicine, payments must accurately reflect the cost of delivery for providers and the effectiveness of the treatments must be proven to payers and patients. Payment must be sufficient to cover actual costs but should not favor telemedicine over face-to-face services.

Paying for medical services via telemedicine is now being implemented by some states, federal programs, and private payers. A number of initiatives are underway and while there is some overlap, the initiatives are largely fragmented.

Medicare’s incremental approach to reimbursing for telemedicine was reviewed as a potential model for provider reimbursement in Maryland. Medicare’s FFS model includes reimbursement for limited professional services only and limits distant site practitioners eligible for reimbursement. Distant site practitioners are paid 80 percent of the appropriate Medicare Physician Fee Schedule amount while originating sites receive a small fee that is billed separately. Originating sites must be located in a rural Health Professional Shortage Area or in a county outside of a Metropolitan Statistical Area.

Some of the participants in the clinical advisory group identified the need to establish a demonstration project at MIEMSS to improve access to specialty center consultations for patients with time critical conditions such as acute stroke, heart attack, and trauma. The pilot program could reside in the 24/7 emergency medical resource communications center at MIEMSS and would be able to test the feasibility of providing immediate access to specialty consultants for patients with time critical conditions.

Potential benefits of the pilot would reduce unnecessary and costly transfers to tertiary care facilities, faster access to emergency interventions, and improved patient outcomes. A demonstration project might yield information around broadly deploying telemedicine that could be applied to a statewide telemedicine initiative.

Go to to view the complete report prepared for the Maryland Quality and Cost Council in December.

Global Initiatives at JHU

Johns Hopkins University recently established the Global mHealth Initiative (JHU-GmI) to provide for a university-wide community of excellence. JHU-GmI is connecting faculty, staff, and students across schools so they can collaborate in the field of mobile health according to an article appearing in the JHU December 2011 newsletter “The Globe” published by the Department of International Health.

In a project undertaken last summer, a student Nadi Nina Kaonga, JHU-GmI Intern, worked on the Ghana Telemedicine Project in the Millennium Villages Project site of Bonsaaso. She helped conduct an evaluation of the mobile phone intervention using social network analyses along with other qualitative and quantitative methods.

In Nigeria less than a third of the births are recorded and the capacity to obtain mortality and cause-of-death data is very weak. Because most births and many deaths occur at home or outside of health facilities, the majority of vital events are missed by existing civil registries and facility-based health information management systems. This can undermine efforts to make sound policies and to plan and evaluate programs.

Therefore, a two step process to identify and verify vital events has been initiated. When a child is born or a death occurs, trained community contacts will send SMS alerts to their local health authority which will trigger a home visit to be made by an outreach worker. This data is collected and sent by mobile phones to local governments, to the state level, and integrated into the existing HMIS and other vital registries.

The global mHealth initiative is exploring ways to combat chronic diseases and is focused on developing and evaluating easy-to-use personalized mHealth interventions to improve feedback loops. The researchers are now assessing the effectiveness of smartphones and text messaging platforms to help engage feedback to help prevent cancer and to help individuals manage weight. The next step is to apply technologies to help diabetics adhere to their medications.

Another JHU-GmI key project called “mCare” is an innovative community health worker scheduling and pregnancy monitoring system. This system is being used to help improve the delivery of antenatal and postpartum services in a short period of time between crisis and care in rural Bangladesh by using mobile systems

The eMOCHA project is a free open-source applications designed to assist health programs in developing countries and to help improve provider communication and education as well as patient care. This is being accomplished by using wireless devices with local server-based clinical training and patient care support services

A complete list of project and researchers affiliated with the program are available at

Competition Awards Top Prize

The European Association of Healthcare IT Managers and the European Association of Hospital Managers encouraged all IT managers, healthcare organizations, hospitals, and individuals worldwide to participate in the competitive IT@NETWORKING AWARDS held January 18-19 2012 at the General Secretariat of the EAHM in Brussels, Belgium.

Ian de Vega from the Medical Research Council in South Africa took home the IT@2012 Trophy and the $2,500 euro cash prize. In addition, the winning project is going to be featured in a number of Europe’s leading healthcare management publications.

The winning solution, “Successful Development and Implementation of a Primary Healthcare Information System” (PHCIS) is being implemented at all primary healthcare facilities in the Western Cape Province. Since the start of the project in 2006, PHCIS has been implemented in 103 facilities and has created electronic records for 3.75 million patients. PHCIS processes 130,000 patient visits a month and tracks 5.6 million folders. The system supports patient registration, appointment scheduling, clinical record keeping, reporting, and workload monitoring

Challenges since using PHCIS have overcome the shortage of funding, initial resistance and lack of buy-in, absence of adequate network infrastructure and connectivity, insufficient space for computers and printers, unstable electricity supply, and the need to create positions for information officers and data capturers.

Second place was awarded to the entry “Individualized Patient Disease Diagnosis and Treatment through Whole Genome Sequencing and Comparison” which was presented by Peter van de Spek. In this project, an Oracle Exadata server was installed as the initial component for the Erasmus Medical Center Translational Research Center’s personal cloud architecture.

The project’s objective is to provide scientists easy access to Next Generation Sequencing data, to provide access to the results of experiments performed at the Erasmus Medical Center, and to develop a Benelux reference to reference genomes with 3-4 million variations per individual genome.

Third place went to “eyeSmart EMR-Intelligent IT Solution for Eyecare” presented by Anthony Vipin Das. eyeSmart is an Ophthalmic Electronic Medical Record and Hospital Management System developed in house by L. V Prasad Eye Institute in India.

eyeSmart enables clinical data entry, generates instant medical reports, and provides information on prescriptions, refractions, and surgical records. The EMR provides complete patient records which are handed out to patients at every visit. So far the system is in place in seven centers ranging from tertiary, secondary, to primary centers which are now running totally paperless.

For more information, email HITM General Secretariat at or call +32/2/286 8501 or go to

Saturday, January 21, 2012

MVP's Vast Amount of Data

The amount of data to be collected through the Veterans Administration’s “Million Veteran Program” (MVP) is enormous. The MVP program launched earlier this year with 15,000 veterans enrolled is on target to build the world’s largest database of health and genetic information according to the VA publication “VA Research Currents”.

A team at the Boston VA Healthcare System has designed an ambitious project called the “Genomic Information System for Integrated Science” (GenISIS) to maintain the data. Backed by huge clusters of servers housed in two locations, the system links de-identified patient DNA samples and health information with a multitude of VA and non-VA databases, and links to a call and mail center that manages MVP enrollment, appointments, and gathers information.

Genetically speaking, each person’s cells carry within them some 3.2 billion bits of data since many pairs of nucleotides or chemical bases are in the human genome. This figure represents tens of thousands of protein-coding genes, plus large amounts of other DNA. The scientists are trying to determine the precise role for just one stretch of DNA versus another stretch of DNA. There are countless possible variants that could affect health, and scientists have yet to learn about most of them.

According to Leonard D’Avolio, PhD, Associate Director for Biomedical Informatics at VA’s Massachusetts Veterans Epidemiology Research and Information Center and Manager of the MVP Project, “Each patient has hundreds if not thousands of relevant pieces of information such as current and past medical conditions, laboratory data, information on prescriptions, family histories, lifestyle issues, plus environmental exposures.”

Some veterans who take part in MVP can have a VA EHR going back two decades. Multiply the billons of data points for each person by the million veterans that are expected to take part in MVP and the figure is in the quadrillions.

However, the larger the figure, the easier it is for meaningful patterns to emerge. With a study on 500 or 1,000 people, the association between a gene variant and a certain trait would have to be quite striking to catch the attention of the researcher.

“To detect meaningful patterns, researchers will need to analyze samples numbering in the tens of thousands. These connections are going to be discovered only by looking across many data points to make that possible”, said D’Avolio.

In the future, researchers will be able to access GenISIS remotely, ask questions, and then move the data with appropriate permissions into a secure environment that will be needed to deal with the huge amounts of storage required. The system through its nexus with various VA and non VA databases, could also gather specific data relevant to a researcher’s question even of the data is not retrieved and brought over to the MVP on a routine basis.

D’Avolio reports the first scientific contribution of MVP will likely deal with mental health illnesses which today affects some 170,000 veterans using VA care. The study is recruiting thousands of veterans who have schizophrenia or bipolar disorder. “It’s no small thing to get up to 10,000 patients with schizophrenia or bipolar disorder but then you have to match that with another 10,000 who don’t have either disease”, says D’Avolio.

For more details, go to

Monitoring Rheumatology Conditions

Rheumatologic conditions are common, debilitating, and costly but close monitoring could help to reduce disease activity, joint damage, and improve patient functionality without involving additional costs. However, even today, relatively few organizations have systems in place that can give providers usable easy-to-access information at the point-of-care to allow for effective monitoring and support as needed.

Geisinger and the American Institutes for Research together developed a proposal for AHRQ”s “Accelerating Change and Transformation of Organizations and Networks” (ACTION) program to address the ability to monitor rheumatology conditions. The two organizations were able to secure AHRQ funding for $339.999 to develop a portion of the costs for system development and implementation as well as the total costs associated with evaluating the project.

Geisinger was very interested in developing a system to provide the information needed, as they operate three rheumatology clinics including a large clinic in Danville and two smaller clinics in State College, and Wilkes-Barre. The impetus to develop the Patient-Centric Electronic Redesign” referred to as the PACER system came from leaders in the Danville clinic. Clinic leaders wanted to investigate how to develop a parallel software-based system that could pull relevant information from multiple sources.

To begin to address the problem the system pulls data from a separate EMR and a patient touch screen questionnaire is completed at the start of each visit gives clinicians easy access to all relevant information. Clinicians are now able to systematically analyze the patient’s progress and condition right before the visit allowing them to focus scarce visit time on solving problems and provide the support needed.

Early results show that PACER has been widely adopted by physicians and has generated improvements in providing needed services, having patient symptoms reported, patients adhering to recommended care processes, and patients self reporting symptoms.

So far, data on the upfront development and implementation costs are not available. However, creating a similar system from scratch could be prohibitively expensive for many organizations, consequently, organizations wishing to adopt this system may decide to build on the existing PACER system and customize the system to the organization’s specific needs.

The system is separate from the EMR and can be used with multiple EMR systems. The program developer at Geisinger is in the process of developing mechanisms to allow PACER to be licensed for adaptation, implementation, and to be used in other settings.

For more information on the project titled “Rheumatology Clinics Leverage Technology and Redesign Care Processes to Provide Physicians Relevant Patient Information, Improving Symptoms and Adherence to Recommended Care” go to

The contact at the Geisinger Medical Center is Eric Newman M.D at and the contact at the American Institute for Research is Lauren Smeeding at

Using Wireless in HF Cases

Heart failure affects 5.8 million in the U.S. alone and is responsible for nearly 1 million hospitalizations each year. Most hospitalizations result from a build-up of body fluid in the lungs and other organs due to the heart’s inability to pump effectively. UCLA researchers want to see patients with heart failure closely tracked in order to avoid hospitalizations and researchers also think that home-monitoring interventions along with patient follow-up would be especially useful.

Today, it is possible to use a number of home monitoring strategies to identify and manage heart failure early. These strategies include obtaining daily weighing and information on medications, phone calls from a nurse or automated response system, home health visits, and the use of telemedicine along with remote monitoring devices.

Several researchers have just published a paper appearing in the online edition of the “Journal of the American College of Cardiology” that discusses the importance of heart failure disease management and monitoring that can be done in the home. Their research was funded by the Ahmanson Foundation and AHRQ.

One of the authors of the research paper, Dr. Gregg C. Fonarow, UCLA’s Eliot Corday Professor of Cardiovascular Medicine and Science, Director of the Ahmanson-UCLA Cardiomyopathy Center, and Co-Chief of Cardiology at the David Geffin School of Medicine at UCLA, sees new promising devices on the horizon to track heart-ventricle and pulmonary artery pressures.

UCLA is currently testing wireless monitoring in a trial referred to as the “Heart Failure in their Better Effectiveness After Transition-Heart Failure” (BEAT-HF) study. The trial is comparing using wireless remote monitoring combined with structured telephone monitoring versus current care provided.

The researchers are studying and hoping to learn if using wireless remote monitoring will improve the care for heart failure patients at six medical centers that include UCLA, Cedars-Sinai Medical Center, UC Davis, UC Irvine, UCSD, and UCSF.

During the trial, approximately 1500 patients of both genders 55 or older hospitalized at any of the six medical centers with a principal diagnosis of heart failure will be educated on their condition. They will be taught to use a wireless remote monitoring device from their home on a daily basis for six months following their hospital discharge. Information will be gathered on weight, heart rate, blood pressure, etc and transmitted daily by their remote wireless monitoring device.

Patients will receive structured telephone calls from a centralized call center nurse at least once a week for the first month after their discharge and monthly calls for the remainder of the six month study period. Patients may receive additional calls depending upon the information gathered during the scheduled call center phone calls on their health status.

North Carolina's HIT Initiatives

According to the recent quarterly legislative report prepared by the North Carolina Department of Health and Human Services, health IT partners have received grants totaling about $630 million across all federal HIT funding categories. This figure includes funding for EHR incentive payments to individual eligible hospitals and providers over the next four years with the total funding approaching $1 billion in federal investments to support HIT in the state.

The state is involved in a number of HIT initiatives such as their Health Information Exchange where the state received $12.9 million in a Federal grant plus $1.7 million from a supplemental Challenge Grant to enable the secure exchange of patient health information between providers and hospitals statewide.

So far, the selection of the vendor and development of the core HIE infrastructure continues under the North Carolina HIE (NC HIE) and Capgemini/Orion Healthcare Consortium. The NC HIE is scheduled to launch during the first quarter of 2012.

The state has $144 million in federal dollars available for Broadband Technology Opportunities Program for Round 1 and Round 2, $40 million available in a private match, $7.7 million available from MCNC Endowment, and $24 million is available from the Golden Leaf Foundation. The funding is being used to expand the North Carolina Research and Education Network and is expected to be completed by July 2012.

In 2011, Blue Cross and Blue Shield of North Carolina (BCBSNC) working with the North Carolina HIE and Allscripts launched the “North Carolina Program to Advance Technology for Health” (NC PATH). This program was created to equip 750 North Carolina independent physicians including over 150 physicians in 39 free clinics with Allscripts EHR software to connect healthcare providers across the state through the North Carolina exchange.

For in-network providers, BCBSNC will cover 85 percent of the software, maintenance costs, and the NC HIE connectivity and membership fee for a period of 5 years while the provider is responsible for the remaining 15 percent.

The NC Area Health Education Center’s Regional Extension Centers (NC AHEC REC) program at the University of North Carolina, Chapel Hill received an award for $13.6 million over 2 years and presently has enrolled over 3700 primary care providers. The NC REC was designated one of five vanguard states by ONC.

The North Carolina Beacon Community Grant operating with the lead agency Southern Piedmont Community Care Plan, is working with funding of $15.9 million. The overall goal is to leverage Community Care of North Carolina’s patient-centered medical home model, health IT, and innovative interventions to improve care coordination, encourage patients to be involved in their medical care, and to improve health outcomes.

The Cabarrus Health Alliance has scanned all of their medical records to prepare for EMR implementation. They have implemented a child health module and have incorporated a new evidence-based program “Bright Futures” into their EMR.

The Rowan County Health and the Stanly County Health Departments are also upgrading their EMR software and scanning medical records in preparation for EMR implementation. The next phase is to develop a public health portal to view demographic and community health data.

The lead agency for telehealth is the North Carolina Telehealth Network which was awarded a federal grant of $12.1 million through the FCC Rural Healthcare Pilot Program. They were also awarded $125K in one time state dollars in 2008 from the North Carolina Division of Public Health for the initial development for telehealth.

So far, the NC Telehealth Network has been successful in building up broadband telehealth capacity particularly in rural and underserved communities in the state. Phase 1 has completed telehealth connectivity to virtually all public health sites and free clinics in North Carolina. Phase 2 will focus on small public and non-profit hospitals in cooperation with the North Carolina Hospital Association.

In the field of pediatrics, Community Care of North Carolina is working with CMS and the American Academy of Pediatrics on developing and evaluating a Pediatric EHR model. North Carolina and Pennsylvania are the only two states selected for this pilot grant program.

The CHIPRA Category-D Pediatric EHR Consultant has been meeting with vendors, practices, and stakeholders since late August 2011 to introduce the Pediatric Electronic Health Record model. The state is evaluating the model among smaller independent healthcare providers and across a variety of EHR vendors. So far four vendors have conducted Pediatric content-specific product demonstrations for the project team.

The evaluation design phase in this grant project is well underway and five areas of quality improvement have been selected to be the primary focus and include obesity, oral health, developmental and behavioral health, early periodic screening, diagnosis and treatment, and asthma.

Go to to view the complete quarterly legislative report distributed January 1, 2012.

Genetic/Genomic Testing Creates Jobs

Driven by rapid innovation made possible in large part by the mapping of the human genome, genetic and genomic clinical laboratory testing generates 116,000 U.S. jobs and contributes $16.5 billion annually to the U.S. economy, according to a new report by the Battelle Memorial Institute.

The report titled “The Economic and Functional Impacts of Genetic and Genomic Clinical Laboratory Testing in the United States” was sponsored by the American Clinical Laboratory Association, and their educational arm “Results for Life.” Because this industry sector is still in the early stages of development, much future growth is expected.

It was found that the industry sector’s ability to innovate and produce cutting-edge genetic testing services and products supports about 44,000 direct jobs and generates another 73,000 jobs in key supplier industries such as real estate, food services, and wholesale trade businesses, as the result of consumer spending by laboratory employees. Together, the genetic and genomic laboratory testing sector-related workforce received nearly $6 billion in wages and benefits in 2009. It also generated $657 million in estimated state and local tax revenue and nearly $1.2 billion in federal taxes in 2009.

“The fact that genetic and genomic testing has created 116,000 jobs and $6 billion in personal income for U.S. workers in the middle of one of the country’s worst recessions should be noted by U.S. policy leaders. This industry is one of America’s true economic success stories.” said Alan Mertz, ACLA President. “It is also important to recognize that a significant amount of that amount is coming from the small innovative start-up labs throughout the U.S.”

Battelle reports that comparatively high levels of wages and salaries are provided within the industry, along with sound benefits packages. It was found that the annual average personal income of a worker in this sector was about $57,000 in 2009 which is a significant wage premium as compared to roughly $45,000 in the overall U.S. economy.

In addition to fueling the economy, innovative genetic tests are enabling a revolution in medical care and genetic testing by identifying the genetic nature of a disease or condition that enables physicians to better target treatments. Significant improvement is occurring as a result in a range of conditions such as childhood leukemia, HIV, heart disease, cervical cancer, blood clotting, melanoma, and colorectal cancer.

For example, physicians use these clinical laboratory genetic tests to target cancer therapies to an individual’s unique genetic fingerprint, which has improved survival rates in many types of cancer. Genetic tests are used to diagnose certain genetic diseases, such as cystic fibrosis in babies, so treatment can begin early and minimize the disease’s impact. Genetic tests are also used to improve patient safety by preventing underdosing, overdosing, or misdosing medications which can cost more than $100 billion annually in human suffering.

“This report provides a much clearer understanding of the real-world impact in terms of jobs, economic growth, and health cost savings and in terms of rapid innovation in genetic and genomic testing” said Mertz. “This information can help guide strategic economic development and regulatory efforts at both the state and national levels as decision makers look to nurture high growth economic sectors.”

To view the report, go to or to

AHRQ Seeks Survey Participants

The Agency for Healthcare Research and Quality (AHRQ) seeks input from researchers and implementers who have experience using the AHRQ Health IT Survey Compendium. The Compendium is a tool for health IT researchers and implementers looking for Health IT related surveys to help support their implementation and evaluation needs.

If you are a health IT researcher or implementer with prior experience using the Compendium and you are interested in participating in this AHRQ research effort, please email Westat at or call Westat toll-free at 888-789-8869 but you will need to contact Westat by February, 2, 2012 to schedule a call.

Westat will then contact you for some additional information. If you are selected to participate, Westat will schedule time with you and then send you a confirmation in advance. Your participation will include participating in an online interview and will take approximately 60 to 90 minutes of your time and does not require any travel. No advance preparation is required and you will receive a payment of $75 to thank you for your time.

Tuesday, January 17, 2012

Modernizing Lifeline Program

FCC Chairman Genachowski is proposing changes to eliminate waste, fraud, abuse, and sees the need to modernize the Universal Services Fund’s “Lifeline” program so that all Americans can have access to basic communications services. As the Chairman has stated “Lifeline” a vitally important program for over the past 20 years has helped tens of millions of low income Americans afford basic telephone service.

According to the FCC, the Lifeline program is faced with a number of problems. Some carriers are providing Lifeline services to individuals that already have Lifeline service from another carrier. Currently, there is no database of recipients that carriers can check against before signing up a new customer.

The FCC has received reports that some unscrupulous carriers are abusing the program by supporting consumers who did not sign up for Lifeline by mailing them phones already set up for the service, or signing people up for Lifeline who aren’t eligible for the program. Finally the program is outdated and only focuses on phone service and not the internet.

The proposed reforms are projected to save the program up to $2 billion over the next few years:

• Eliminate waste, fraud, and abuse by creating a National Lifeline Accountability Database to prevent multiple carriers from receiving support for the same subscriber
• Set a budget for Lifeline while acknowledging that the size of the program should fluctuate as the economy improves or worsens
• Establish national eligibility criteria to ensure low income consumers access to Lifeline service who meet the federal standards for participation in the program
• Conduct independent audits every two years on every carrier that receives more than a specified annual amount of support

Lifeline needs to be modernized from just a telephone service to being able to support broadband. To accomplish these goals, the FCC is going to establish a Broadband Adoption Pilot Program to determine how Lifeline can be used to increase broadband adoption among Lifeline-eligible consumers. Starting this year, the program will solicit applications from broadband providers and select a number of projects to fund.

The Commission will discuss Lifeline issues at a meeting scheduled to be held in Washington D.C. on January 31, 2012 and will consider the many changes and reforms needed to modernize the program to meet the needs of the consumers.

Monitoring Health on the Move

Ford, Microsoft Corp, and Healthrageous announced at the Digital Health Summit, that they plan to work together to develop connected devices to help people monitor and maintain health and wellness while in their cars. Since trends show that people are spending more time in their cars, researchers will examine how to extend health management into the personal vehicle in a nonintrusive way while people are on the move.

“With the tremendous growth in mobile healthcare solutions, Ford is dedicated to understanding the value of connecting to health and wellness-related services while driving,” said Gary Strumolo, Manager of Infotainment, Interiors, Health and Wellness at Ford Research and Innovation.

As Strumolo explained “Our connectivity platform Ford SYNC provides easy voice-controlled access to mobile devices such as smartphones and tablets and it makes sense to research areas that are important to our customers. Customer research and societal trends suggest that there is a strong business case for Ford to explore opportunities in health and wellness technology.”

A prototype system being developed by BlueMetal Architects is leveraging Ford SYNC® technology, Microsoft HealthVault, Windows Azure, and the interactive services Healthrageous provides in conjunction with compatible biometric measurement devices.

The prototype system would capture biometric and vehicle data as the basis for real-time health and wellness advice and monitoring. The driver can provide voice inputs plus other details on their health routine such as the number of glasses of water consumed during the day or what pills they take.

The data would then be uploaded into the HealthVault cloud, at which point, the data would be transferred to Windows Azure. Then the information would be processed with other health data to create graphical reports that drivers can access after leaving the vehicle.

Since last year, medical and healthcare was the third-fastest growing category of smartphone apps, with more than 17,000 available for download. By 2015, this market is expected to reach $392 million according to a new Frost and Sullivan report and 500 million people are expected to use mobile healthcare apps. As Strumolo explained, “These trends point to a natural role for the automobile in the emerging digital health and wellness field.”

For more details, email Alan Hall at, Mike Werner at or Emily Rosen at

Companies Receive Funding

The Maryland Technology Development Corporation (TEDCO) awarded 12 Maryland researchers $485,000 through their University Technology Development Fund (UTDF) and TechStart programs. The aim of the UTDF program is to help researchers develop and assess the commercial viability of new technological inventions, test prototypes, and optimize principle research designs.

So far, since 2001, 95 projects have been completed and 43 have been licensed or optioned to private companies with 35 of these companies located in Maryland. Of these licensees, 29 were startup companies in the state, 13 received follow-on funding through TEDCO’s Maryland Technology Transfer and Commercialization Fund program, and 7 through TEDCO’s TechStart program.

Of the $485,000 awarded, researchers from Johns Hopkins Applied Physics Laboratory, Johns Hopkins University, Salisbury University, and Towson University received up to $50,000 each in UTDF funding. The University of Maryland Baltimore, University of Maryland College Park and JHU, each received up to $15,000 in funding from TEDCO’s TechStart program. Five startup companies were launched as a result of the funding and include BOSS Medical, CervoCheck, Clear Guide Medical, Lifelong Technologies, and Neximmune.

A.J Khanna M.D., JHU Associate Professor of Orthopedic Surgery and Biomedical Engineering was awarded $50,000 to develop a minimally-invasive bone tissue harvesting device to be able to collect of more bone tissue, provide safer autograft, and reduce pain. The resulting technology is the core for the startup company BOSS Medical LLC.

Robert H. Allen, PhD, JHU Associate Research Professor of Gynecology and Obstetrics, received $50,000 to develop a technology to enable obstetricians to more accurately diagnose early preterm labor, prescribe interventions to prolong the pregnancy, and to improve fetal development. This device by bypassing the maternal abdomen to measure contractions in the cervix and vagina enables a more accurate diagnosis. The startup company CervoCheck, LLC resulted from the development of the device.

Emad Boctor, PhD, JHU Assistant Professor of Radiology received $50,000 to develop a needle tracking and intervention guidance device using ultrasound imaging. This enables needle-guided interventions to be done without the need for expensive, cumbersome, and external tracking devices currently used. This device will allow the physician or ultrasound expert to find small or deep tumors which cannot yet be easily spotted by ultrasound. This technology is the core for the startup company Clear Guide Medical, LLC.

Angelia Crawford entrepreneur and graduate of the ACTIVATE program, UMB Robert O’Toole, M.D, Assistant Professor of Orthopedics, and Nancy Cowger, M.D, Office of Technology Licensing at UMB were awarded $8,000 from Tech Start to develop the Step Activity Monitor (SAM) a walking aid. SAM provides data on the patients’ physical activity to physicians. LifeLong Technologies, LLC was formed around the technology.

Mathias Oelke, PhD, JHU Assistant Professor of Pathology, Kenneth Carter, PhD, entrepreneur, and Daniel Potvin PhD Senior Licensing Associate received $15,000 from TechStart to develop a technology to destroy tumor cells. The technology developed is an easy-to-assemble system where different immunological signals can be attached to a bead or smaller quantum dot and activate Natural Killer T-cells (NKT) that can stimulate cells outside the body in culture and also be injected into patients. The startup company Neximmune, Inc. was formed around the technology.

Other technologies under development include the development of a therapeutic technology known as a mimetic peptide to treat cancer. This technology showing promise in inhibiting metastatic breast cancer and other breast cancers that are not responding to current treatments, is being researched by Aleksander Popel, PhD at JHU.

An award was also made to a JHU researcher Brendan Canning PhD to further develop a treatment to limit coughing. The ongoing research has discovered cough receptors that play an essential role in regulating the cough reflex and a group of compounds have been discovered that are more effective in selectively targeting these receptors.

In addition, JHU Researcher Clifford Weiss M.D. is working on a device to make dialysis more effective. His team has designed a device to access naturally high blood flows in the leg, as opposed to the artificially created ones in the arm that cause stenosis. This subcutaneous device provides two ports for access to the femoral vein and a third port for controlling a valve which closes access to the vein when the patient is not in dialysis.

For more information, go to or

New Telehealth Alliance Formed

MedApps, Inc., a mobile telehealth innovator is aligning with MedMinder a company helping chronically ill seniors and those with disabilities maintain their independence. The Alliance is going to improve the ability to deliver connected and remote medication management. Both companies have led the way in their respective areas of expertise within the telehealth market by providing affordable, easy to use, patient-centered remote monitoring solutions.

According to Kent Dicks, Founder and CEO MedApps, “The challenge with any prescribed therapy for patient care is compliance whether that means a patient is taking their blood pressure or glucose readings on a daily basis or taking their medication when they are supposed to so that the caregiver can effectively manage their conditions.”

MedMinder offers their smart cellular pillbox referred to as “Maya” complete with innovative features to enable medication management. Maya can track the dosage activity of patients, deliver optional medication reminders or alerts if the medication is not taken within an assigned timeframe, or report if an incorrect medication compartment is inadvertently accessed.

MedMinder not only keeps detailed records of patient medication activities but also can provide access to reports for the user, the family, and caregivers via the internet, email, and by text notification. MedMinder’s capabilities with MedApps supply of consistent near-real time biometric data will be able to deliver a coordinated solution for medication management.

“We are very excited about partnering with MedApps and integrating into their remote health monitoring platform,” said MedMinder Founder and CEO Eran Shavelsky.

In addition, MedApps Cloud Care™ enables health information delivery to allow a variety of manufactured devices to be integrated into a remote monitoring program very quickly with a minimum of coordination time. CloudCare is the first in the telehealth field to deliver “Plug & Play” platform.

For more information, go to or go to

Texas Upgrading Systems

The state of Texas hired Public Consulting Group (PCG) a privately held consulting firm, to conduct a comprehensive analysis of their public behavioral health system as required by Texas 2011 legislature. PGC will conduct a comprehensive study of the current behavioral health system and provide short and long term recommendations to upgrade the system. The main purpose is to provide future direction on behavioral health services in the state.

To accomplish the study, the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS) are currently holding six public stakeholder forums conducted by PCG that started in December 2011 and continuing through January. Stakeholders are providing feedback on topics such as access to services, service delivery models, current services available, general strengths and weaknesses of the system, and funding issues.

One of the key topics under discussion includes the integration and coordination of care in the state. The people in Texas people want to see better coordinated care between physical, mental health, and substance abuse issues. Issues under discussion include barriers to receiving coordinated care within the current service delivery system and what strategies are needed by the state to achieve high quality and efficient coordinated care.

In-depth discussions are focusing on the various service delivery models in the state. Texas is a large state where behavioral health services are provided through various service delivery models across the state through mental health authorities, substance abuse providers, and NorthSTAR. To make it more complicated, Medicaid benefits are managed both through a traditional Medicaid Fee for Service model and numerous Medicaid managed care programs.

The stakeholders ideas and thoughts will be reviewed and PCG will do an in-depth review of the financial structure of the current behavioral health system to understand the current and existing sources of funding to pay for the services. In addition, PCG will look at other states and how their behavioral health systems operate in order to identify potential options on how Texas can improve their system.

Information from the initial discussions at the forum will be analyzed thoroughly and a comprehensive report will be made to DSHS. At this point, PCG will work on the second phase of the analysis to provide recommendations on how to effectively improve access, service utilization, patient outcomes, and system efficiencies, and how to accomplish these goals with the funding available now and in the future.

According to the Texas HHSC newsletter, ‘InTouch”, the state is embarking on a modernization project to upgrade the state’s eligibility system to meet the needs of the future and to provide the software and hardware that the local offices will need to implement the system.

The first step is to obtain feedback on the project and then develop ideas for improvements based on best practices from other states and from within HHSC. The second step will be to undergo further scrutiny by the HHSC staff and the third step will be to try out the new processes and technology tools in a nonproduction environment. These steps are needed to make sure that the project’s vision actually plays out successfully in high volume use often incurred in eligibility offices.

To keep up with the needs of eligibility offices, the network infrastructure will be built around state-of-the-art hardware and software capable of running multiple virtual server processes simultaneously. This means that if one data-serving process goes down or needs to be serviced, the work can temporarily be shifted to others without affecting the ability to work.

Survey Shows Benefits for HIT

Doctors that are routine users of health IT obtained significant more benefits in healthcare delivery, according to a new Accenture online survey of 3,700 doctors across eight countries. These countries included the U.S. Australia, Canada, England, France, Germany, Singapore, and Spain. Five hundred physicians were interviewed per country and 200 physicians were interviewed in Singapore between August and September 2011.

Global findings show that doctors agree that HIT improves clinical data by 70.9 percent, coordination of care by 69.1 percent, and reduces medical errors by 66 percent. In general, doctors in Singapore and Spain perceive a more positive impact compared to their counterparts in the U.S. and Australia.

Specifically, U.S. physicians rate the benefits of EMRs and HIEs lower than their international colleagues, and the U.S has the lowest number of doctors (45 percent) who think health IT will improve diagnostic decisions as compared to 61 percent globally. Only 47 percent of U.S. doctors reported that healthcare technology has improved the quality of their treatment decisions as compared to 61 percent globally.

The survey showed an age divide and a statistically significant contrast in attitudes among doctors above or below 50 years of age. The study found that doctors under 50 are more likely to believe that health IT has a positive impact across a wide range or perceived benefits. But more than 72 percent of doctors under 50 think EMRs and HIEs will improve care coordination across settings and service boundaries and 73 percent believe that these technologies will offer better access to quality data for clinical research.

Accenture is a global management consulting technology services and outsourcing company. For more survey information, call Jenn Francis Accenture Health at +1-630-338-6426, or email

Resource Center Events Coming

The Mid-Atlantic Telemedicine Resource Center Summit in conjunction with the Virginia Telehealth Network is presenting a premier event on March 15-16, 2011 at the University of Virginia’s Darden School of Business. Leading telehealth resources plus experts and programs throughout the mid-Atlantic region and the nation will be on hand for presentations and discussions.

There will be opportunities to hear from national leaders on telehealth policy and resources, to explore a broad range of innovative new technologies and approaches to telehealth, to formulate strategies to remove barriers to application, and to collaborate with experts in a broad number of areas.

Featured keynote speakers are:

• Marilyn Travenner, Acting Administrator for CMS
• Aneesh Chopra, Assistant to the President & Chief Technology Officer and Associate Director for Technology within the Office of Science & Technology Policy

Go to to register and for more details, email, or Ladi Carr at, or call Eric Swensen at (434) 924-5770.

The Northwest Regional Telehealth Resource Center will present a Conference on March 19-20 in Billings Montana. Several keynote speakers will be featured such as Glen Hiemstra, Founder of and the Founder and Curator of, Ron Rabou with expertise on how to improve communication skills to achieve better relationships, Peter Yellowlees, M.D. Professor of Clinical Psychiatry at UC Davis Health System, and Steve Bahmer, a former award-winning journalist, leader of a technology company, and founder of his own public affairs company.

One free registration will be given away for the Conference which will run through January 25th. For more details, go to the NRTRC blog post “NRTRC Telemedicine Conference Giveaway”. For more details on the Conference, go to

Tuesday, January 10, 2012

Updated 2012 Health Technology Report Released

Bloch Consulting Group’s Federal Health Technology Report has just been revised for 2012 and is available for download at

The report, “Activities in Telemedicine Telehealth and Health Technology” contains key details on Federal government activities in telemedicine, telehealth, eHealth, health technology and related areas at 24 cabinet level and independent federal agencies.

The download also includes “Selling to HHS,” a guide to navigating and taking advantage of many relevant programs at HHS.

“The growing use of health information technology is becoming the routine way to deliver healthcare in the U.S. and other parts of the world” according to Editor Carolyn Bloch. “To keep up with Federal activities, it is essential to understand not just what funding may be available, but also current and future innovative federal movements and policy changes.”

The 260-page edition of the “Activities in Telemedicine Telehealth and Health Technology” contains information on how government agencies are organized, describes ongoing activities relevant to the field, and points out numerous grant and contract programs useful for ongoing business development.

The 45 page report “Selling to HHS” specifically helps individuals and companies market their technology products and services, secure grants, and locate good possibilities for funding within this agency. This report is included free with all orders for the 2012 Federal Activities report.

The reports are available as digital downloads in PDF format. More information is available at the Bloch Consulting Group web site at

Handheld Can Save Lives

Researchers at the Army Medical Research and Materiel Command at Fort Detrick Maryland are successfully working on a handheld telemedicine device referred to as “TEMPUS-Pro” in the article “The Business Side of Saving Lives” authored by Jeff Soares, a Communications Specialist with USAMRMC. The handheld device is an advanced compact telemedicine system that can be used on combat casualties happening in forward areas.

The “TEMPUS-Pro” resulted from a collaboration formed with TATRC, MC4, Defense Health Information Management Systems, Army Aero-Medical Research Laboratory, Army Institute of Surgical Research, Army Medical Materiel Agency, Air Force Medical Evaluation Support Activity, and the Joint Forces Command Surgeon’s Office.

Three devices incorporated into one handheld device is able to provide real-time audio and video capability plus the device houses a transcription feature to use when voice free input is available. The handheld allows for immediate communication, pre-hospital monitoring of patient vital signs and telemetry data, and is able to receive instructions from other medical providers.

The device is designed to be lightweight, mobile, rugged, and can be used with tactical communication radio networks supporting internet protocol-based transmission. This enables signals to be sent digitally over both classified and non-classified systems.

According to Dr. Gary Gilbert, Chief of the Knowledge Engineering Group for USAMRMC’s TATRC, “The patient’s medical data is always with the patient and goes with the patient everywhere.”

Medics can also quickly assess severe injuries and send real-time images along with live telemetry data, plus the Tactical Combat Casualty Card (TCCC) to experienced surgeons offsite for instructions. The physician mentor can talk with medics over the built-in voice-over IP capability. With ultrasound and laryngoscope capabilities in the works, use of the device will lead to more accurate diagnoses and treatment.

Personnel can transfer data from one device to another, from the ground to the helicopter, to the hospital, and can transmit information via radio or tactical internet in advance of the patient’s arrival at the next stop in the evacuation. The patient’s vital records can be exchanged wirelessly between various systems and eventually inserted into the patient’s permanent medical record.

The “TEMPUS-Pro” is requiring the military to upgrade the current limited capability to transmit data digitally between air and ground units. “The military’s helicopters currently do not all have compatible high tech radio systems necessary to transmit information digitally from helicopters to the ground, Gilbert says. “One of the biggest challenges is to get the TEMPUS-Pro integrated properly to be used in the medevac helicopter.”

Currently, the device is awaiting approval under the Department of Defense Information Assurance Certification and Accreditation Process. However, about 25 units have been distributed to various Special Operations commands for trial use and so far the results have been positive.

The “TEMPUS-Pro” has been selected for the Army’s Network Integration Evaluation exercise to be held at Fort Bliss Texas beginning April 2012. The device will be field tested for two months to determine its operational effectiveness within Infantry Brigade Combat Teams. Also, the device will be tested in a Marine Corps Warfighting Lab Limited Objective Experiment scheduled for August 2012. Gilbert believes that these tow rigorous tests should help to validate the applicability and usefulness of the handheld device.

Artificial Pancreas Advancing

Advancing the development and use of an artificial pancreas, developing anti-obesity drugs, and exploring immune-based diabetes treatments will spearhead the Decade of Discovery’s research programs in coming months. Last year, the Minnesota Partnership for Biotechnology and Medical Genomics launched the “Decade of Discovery” to conquer diabetes.

The goal is to optimally treat and ultimately cure Type 1 and Type 2 diabetes through a multi-sector, coordinated initiative that will draw on Minnesota’s expertise in research, care delivery and public health. The Decade of Discovery along with leaders from the University of Minnesota and Mayo Clinic announced awards totaling $1.86 million in state funding for three projects under the auspices of the Minnesota Partnership.

Advancing the artificial pancreas is one of the research projects. The artificial pancreas works by combining a continuous glucose monitor and an insulin pump complete with sophisticated computer software to provide automatically the right amount of insulin at the right time.

Funding for $500,000 was awarded for a project called “The Chip” to explore and develop a specialized electronic chip that will improve glucose monitoring and provide a critical component to the artificial pancreas being developed by Mayo Clinic.

The chip will be a new type of sensor to transmit data wirelessly and be able to function in more locations in the body than current sensors. It may also last longer than current sensors and because it is made from grapheme may also be useful in detecting other diabetes factors such as lactate or ketone molecules. Based on a device concept invented at the University of Minnesota, the new sensor should be more reliable, stable, accurate, and make the artificial pancreas possible.

The other two research projects awarded will do research to develop an anti-obesity drug but this means that the researchers will need to discover new molecular targets for the drugs. The other research project will target insulin-specific T cells in an effective way to cure Type 1 diabetes in mice. In the coming year, the research team will test and validate mouse models containing human diabetes cells against various factors.

Another research project is ongoing with Boston University and Massachusetts General Hospital (MGH) to find the cure for Type 1 diabetes and make automated blood glucose control a reality. So far, engineers from Boston University have develop a closed-loop artificial pancreas blood glucose control system that uses frequent measurements of blood glucose concentration along with subcutaneous delivery of both rapid-acting insulin and glucagon as directed by a computer algorithm.

Previous artificial pancreas designs did not include the capability to administer glucagon. The artificial endocrine pancreas automatically makes a new decision about insulin and glucagon dosing every five minutes. The system is being tested in people with Type 1 diabetes at MGH with results recently published in “Science Translational Medicine”.

JDRF, researchers, clinicians, policymakers, and patients have called on the FDA to advance the development of an artificial pancreas. Also, over 100,000 people in the diabetes community signed JDRF’s petition which urged the FDA to adopt clear guidance. In addition, leading clinical organizations specializing in diabetes care are urging FDA to ensure that the development of an artificial pancreas is not delayed by unnecessary regulatory roadblocks.

On the regulatory front, on December 1, 2011, FDA issued draft guidance designed to help investigators and manufacturers as they develop and seek approval for artificial pancreas device systems to treat Type 1 diabetes. To facilitate development of the device, the draft guidance provides flexible recommendations for design and testing that meets statutory requirements for safety and effectiveness. When final, the guidance will help manufacturers and investigators assemble submissions for clinical trials as well as product approval submissions.

DOD Funds Brain Studies

The Department of Defense awarded BrainScope® Company, a Bethesda Maryland medical neurotechnology company, a $7.5 million contract to use their BrainScope technology to help medical teams effectively treat head injuries in the emergency department.

BrainScope’s Ahead™ M-100 is a handheld non-invasive non-radiation emitting medical device under development to use at the point-of-care to aid in triage or use for patients where TBI is suspected. The device capable of assessing structural brain injuries and impairment from TBI and concussions, and can rapidly assess brain injuries based on patterns identified in brain electrical activity.

The company also received $250,000 in funds through the Maryland Department of Business and Economic Development made through the Maryland Venture Fund. This came about because earlier this year, the state was awarded $23 million in federal funding to invest in businesses and to disburse funds through existing state finance programs that included the Maryland Venture Fund.

The company will use this funding to develop and conduct clinical trials for Ahead™ M-100. In addition, the company also participated in MEDICA 2011 in Germany with the help of a DBED MD Export grant for $5,000.

In another DOD funding effort, researchers at the University of Southern California’s Institute for Creative Technologies, (ICT), New York-Presbyterian Hospital/Weill Cornell Medical Center, and Emory University School of Medicine were awarded an $11 million, four year grant from the Department of Defense to test different ways to treat PTSD including the use of virtual-reality exposure therapy developed at ICT.

The study will involve 300 military and civilian personnel who have been diagnosed with PTSD that occurred after their service in the Iraq and Afghanistan wars. The researchers will look at personal and genetic factors that may impact an individual’s chances of developing PTSD as well the individual’s future response to therapy.

JoAnn Difede, Director of the Program for Anxiety and Traumatic Stress Studies at New York-Presbyterian/Weill Cornell reports, “Combat-related PTSD is notoriously difficult to treat. Our study will conduct a large-scale head-to-head investigation of virtual reality as compared to tradition exposure treatment for PTSD. This could answer decisively which intervention is most effective, and for whom.”

Patients using virtual reality will use a headset with goggles and earphones as the therapist controls the digital scenes. Sensory cues will be added such as chair vibrations that simulate an explosion.

Difede began using virtual reality with burn unit patients in the 1990s and in 2001, she did research at the University of Washington which resulted in the creation of the Virtual World Trade Center System that was used to treat 9/11 survivors.

For more information email or visit or for information about the study sites email Brittany Mello at

Technologies at Harvard

To repair damage and defects within a heart, doctors currently use stopped-heart and open-chest surgeries. These procedures are highly invasive and incur a significant risk to the patient from neurological impairment to possible death. The “Motion Compensating Catheter for Beating Heart Surgery” (#3719) a device developed at Harvard, now enables surgery to be performed within a heart while it is beating with the same accuracy as in open-chest surgeries.

The technology is a fast motion compensating mechanical device using image guidance and a sophisticated software package that is able to anticipate and react to the rapid movement of the cardiac tissue. The device can either be a handheld tool or it can be a standard cardiac catheter, enabling the surgeon to perform very delicate surgeries such as mitral valve repair without the need for heart stopping techniques. The technology takes advantage of real-time 3-D ultrasound images and a Radon transform-based algorithm for processing.

In another technology developed at Harvard “A Second Skin Pressure Sensor for Large Area, Form-fitting Wearable Applications” (#3788) a flexible form-fitting pressure sensor capable of registering location and intensity of pressure acts as a “second-skin” to create a range of never before possible body monitoring applications. The sensors can improve motion for use in physical therapy and long term healing, can be used in wearable sensors, in peripheral input devices, special effects hardware, and for battle field monitoring.

The sensors can be built into a new class of “smart” orthotic braces to give real-time feedback based on need. When used as a peripheral input device, these sensors can provide body movement data that can be translated into commands.

Both available technologies have U.S. Utility Patent Applications pending.

For additional information on Harvard Case #3719 go to and for Harvard Case #3788, go to or contact Sam Liss, Director of Business Development at (617) 495-4371.

Rural Healthcare Grants Available

The Colorado Rural Health Care Grant Council requests applications for the fifth cycle of their grant program. The grant program is designed to help expand access to healthcare for rural residents and to help improve the health infrastructure and primary care services in the state.

The grant program, a collaborative effort between the State of Colorado and UnitedHealthcare will end up providing a total of $7.5 million to healthcare organizations in the state starting in 2008 and end in 2012. For 2012, the Council will award up to $1 million with the maximum award to be $50,000 per applicant. The program is administered by the Colorado Rural Health Center.

Organizations located outside of the state’s urbanized areas that provide outpatient primary care services that includes medical, oral, and mental health services are eligible to apply. Grants will fund projects to support the rural health infrastructure and strengthen the capacity of rural entities to enable adequate outpatient primary care services to be provided not only now but in the future.

The Intent to Apply forms are encouraged to be submitted by January 13, 2014 with applications due February 15, 2012. For more information, go to or contact Shelly Collings at (800) 851-6782 or by email at

Saturday, January 7, 2012

FDA's Recent Actions

Recently, FDA approved a medical device that can support the weakened hearts of children with heart failure so they will live until a donor for a heart transplant can be found. The mechanical pulsatile cardiac assist device called the EXCOR Pediatric System made by Berlin Heart comes in graduated sizes to fit children from newborns to teens.

Heart failure in children is much less common than in adults. Heart transplantation offers effective relief from symptoms, however, there are far fewer pediatric-sized donor hearts available for transplantation than for adults. For infants, the average waiting time for a donor heart is 119 days. Overall, a reported 12 to 17 percent of children and 23 percent of infants die while on the waiting list for a heart transplant.

The EXCOR was designated as a Humanitarian Use Device by the Office of Orphan Products Development at FDA. This designation is made for medical devices intended to benefit patients in the treatment or diagnosis of a disease or condition that affects fewer than 4,000 individuals in the U.S. annually. FDA’s Orphan Products Grant Program supported the U.S. clinical trials for the EXCOR Pediatric System with grants of $400,000 per year for three years.

In another FDA action, FDA now allows the marketing of the first hand-held device intended to aid in the detection of life-threatening bleeding in the skull called intracranial hematomas using near-infrared spectroscopy. The device called the “Infrascanner Model 1000” manufactured by InfraScan Inc. of Philadelphia, can help healthcare providers identify patients with critical head injuries who need an immediate brain imaging study. Intracranial hematomas occur when blood from a ruptured blood vessel collects within the brain or between the skull and the brain.

The scanner directs near-infrared light which is a wavelength of light that can penetrate tissue and bone into the skull. Blood from intracranial hematomas absorb light differently than from other areas of the brain. The scanner is able to detect differences in light absorption and then transmit this information wirelessly to a display on a hand-held computer.

By comparing the optical density from a series of scans for specific areas on both sides of the skull, a trained healthcare provider can use the information provided by the device, in conjunction with other clinical information to determine the likelihood of an intracranial hematoma and the need for further diagnostic procedures such as a CT scan.

“As a result, this portable device can offer emergency room physicians a non-invasive mechanism to aid in assessing whether an immediate CT scan is needed”, according to Christy Foreman, Director of the Office of Device Evaluation at FDA’s Center for Devices and Radiological Health.

NASA Selects 300 SBIR Projects

NASA selected 300 small business proposals to negotiate for possible contract awards through NASA’s SBIR and STTR programs. The SBIR program selected 260 proposals for a combined value of $44 million to negotiate for Phase I feasibility study contracts. In addition, the STTR program selected 40 proposals with a combined value of $5 million to negotiate for Phase I contracts.

Ionu Biosystems in Somerville Massachusetts proposed an SBIR project (11-1X13.01-9659) to develop a fluorescent smart phone blood analyzer that can measure important physiological concentrations from a drop of blood. The approach is to develop fluorescent optode sensors to detect the concentration of the components of basic metabolic and blood gas panels.

Using wireless optode sensors removes the need for wired connection of the sensors, sample preprocessing, and microfluidics for sample handling. Fluorescence emission from the sensors will be directly measured by the built-in phone camera and the data process that can occur on the phone itself.

This smartphone will present commercial applications for NASA to enable NASA to self- monitor key physiological parameters during long flight missions and enable non NASA applications for a fluorescence-based smart phone blood diagnostics device. This technology will also be useful in communities since the device can be used in rural settings, for home health monitoring, and used in developing countries.

For more information, contact John Dubach at (617) 460-4003.

CFD Research Corporation located in Huntsville Alabama proposed STTR project (11-1T1.02-9940) to develop a novel miniaturized point-of-care (POC) device to diagnose disease pathogens. The device after development will be compact, lightweight, fully integrated, automated, highly cost effective, and power efficient.

In its final phase of development, the sensor will be integrated with a compact handheld instrument for data collection, analysis and processing, and will interface with existing NASA space instrumentation to use for both terrestrial and microgravity environments.

The device in a non NASA commercial application could provide a new type of electrochemical sensor or diagnostic technology and provide no-cell culturing based pathogen detection for a variety of applications in healthcare, life sciences, in hospital settings, and for monitoring.

The researchers will work to develop in-situ analytical tools for the preparation, detection, and analysis of low level pathogens obtained from biological fluid and or water samples. Also, the device may also be used in drug discovery, to study human diseases, to do clinical and preclinical diagnosis, as well as be used in the areas of cellular biology, microbiology, and homeland security.

For more information contact Jianjun Wei at (256) 327 0672.

Go to then click on “SBIR 2011 Phase 1 Selection Announcements dated 11/29/ view the research proposal abstracts.