Wednesday, February 29, 2012

Developing Space/Earth Medicine

The “Computer Assisted Medical Diagnosis and Surgery System” (CAMDASS) developed by the European Space Agency (ESA) provides just-in-time medical expertise to astronauts. All the astronaut needs to do is put on a stereo head-mounted display complete with 3D guidance to be able to diagnose problems.

To do an ultrasound examination, an ultrasound device is linked with CAMDASS and with the patient’s body registered to the camera. Then the display is calibrated to each wearer’s vision. Next, 3D augmented reality cue cards are displayed in the headset to guide the wearer. This is accomplished by matching points on a virtual human and the registered patient. The wearer can see the ultrasound images and can use speech recognition to allow hands-free control.

The use of CAMDASS right now is focused on ultrasound examinations, but in principle could guide other procedures. Ultrasound is leading the way because it is a versatile and effective medical diagnostic tool and is already available on the International Space Station.

The prototype has been tested for usability at Saint-Pierre University Hospital in Brussels, Belgium with medical and nursing students, Belgium Red Cross, and paramedic staff. It is thought that once CAMDASS is completely tested, it might also be used as part of a telemedicine system to provide remote medical assistance via satellites and could be deployed as a self-sufficient tool for emergency responders and eventually used in space.

The research was funded by ESA’s Basic Technology Research Programme with the prototype developed by a consortium led by Space Applications Service NV in Belgium with support from the Technical University of Munich and DKFZ German Cancer Research Centre.

In another NASA research effort as described in an article published by NASA’s Lunarscience Institute, important research developments are happening that involve NASA biocapsules. The researchers at the Space Biosciences Division at NASA Ames have been searching for more medical technology that could be effectively used by astronauts.

Researchers working on the biocapsules now under development are looking for ways to effectively deliver doses of medicine one time, over days, and even over years while astronauts are in space and enable the astronauts to be treated in space without even knowing that the treatment was happening.

For example, one of the potential uses for biocapsules would be to treat massive blasts of radiation while astronauts are in space. The biocapsule could be implanted under the astronaut’s skin and could work without the astronauts even knowing there was a health risk coming from excessive amounts of radiation suddenly blasted out in space.

This isn’t science fiction, since we already use a hormone G-CSF to treat cancer patients who are receiving radiation treatments. So it was a small jump to put these cells in a capsule. Without using G-CSF, an astronaut’s immune system might not recover if exposed to massive doses of radiation.

However, NASA’s biocapsule also has important medical applications on Earth. One of the main targets for the biocapsule is to treat diabetes and could be especially important for those patients that need insulin. To be effective, the capsule could contain pancreatic islet cells from animals or contain engineered cells designed to behave like pancreatic islet cells with both glucose-sensing and insulin secretion functions.

Patients with low-insulin requirements might be able to benefit from implantation of a single capsule containing perhaps a million to 10 million cells. Patients with higher insulin requirements might require implantation of more than one capsule. The biocapsules would be able to work automatically regardless if the person is awake or not.

Another application for biocapsules on Earth would be to treat cancer especially brain cancer. A biocapsule implanted directly into a tumor bed could deliver very high doses of chemotherapy right to the area where it is needed and then side effects could possibly be reduced.

Scientists also think that biocapsules could have important applications in gene therapy. Some children are born missing a gene or are born with a defective gene. As a result, they can’t make a needed protein as in the case of hemophilia where patients are missing an important blood coagulation protein. The biocapsule could be used to implant cells that are engineered to release the missing protein and spare patients the need to receive periodic injections.

Animal trials are scheduled to begin this year and the next, and human trials using biocapsules could begin shortly after. According to Dr.Loftus, the inventor of the NASA Biocapsule and holder of the patent, biocapsules could be implanted in astronauts on the International Space Station within this decade and he thinks that we could realistically see widespread usage on Earth within 10 to 15 years.

State to Improve Health Outcomes

In January, Louisiana’s Governor Bobby Jindal submitted the state’s FY 2013 budget to the legislature where improving healthcare outcomes will play a big part. The healthcare budget is proposed at $8.96 billion, up from the existing operating budget amount of $8.28 billion.

According to the Governor’s budget, this fiscal year represents a monumental shift in healthcare in Louisiana. With the full implementation of BAYOU HEALTH and the Louisiana Behavioral Health Partnership, the state is embracing a new approach to both physical and behavioral healthcare focusing on outcomes, streamlining delivery and payment systems, saving critical dollars, and dramatically improving access to care.

Under BAYOU HEALTH, which will be fully implemented by the start of FY 2013, the state is transitioning away from the fee-for-service model and going towards models based on medical homes for most Medicaid beneficiaries. As a result, BAYOU HEALTH estimates a savings of $135.9 million in the Medicaid program.

According to the Governor, FY 2013 represents a new way to provide behavioral healthcare for 50,000 Louisiana children and 100,000 adults. The Louisiana Behavioral Health Partnership includes using the Coordinated System of Care to streamline the state’s approach to delivering and financing behavioral health services.

Under the Partnership, the state has contracted with a third party to serve as a single point of entry for people in need of behavioral healthcare services. Previously, services have been fragmented and funded through several different mechanisms with some services falling under Medicaid, while others were paid for strictly with State General Funds or with Federal block grants.

The FY 2013 budget request includes several strategies to deal with cost containment. The budget includes cost containment measures such as:

• $1 million to expedite the inclusion of waiver recipients into BAYOU HEALTH
• $1.2 million to coordinate non-waiver services
• $3 million for using a managed care approach for long term personal care services
• $1.5 million to transition the pharmacy program from using the Average Wholesale Price to Average Acquisition Costs
• $3.2 million to restructure payments to hospitals to the Medicare-like reimbursement system
• $6 million to change the reimbursement methodology for nursing homes to base reimbursements on the acuity of Medicaid patients instead of the entire home population.

As the Governor reports, Medicare costs continue to balloon out of proportion to state budgets and revenues. Medicaid expenditures have increased by about 40 percent with an average rate of growth annually of nearly 7 percent with increases to continue to grow in the coming years.

Because of the continuing growth anticipated, DHH will implement an overall two percent reduction in the Medicaid private provider program. The Department will be working closely with each provider type in Medicaid to identify how to achieve that reduction. That same two percent reduction in the private provider program will also be applied to the managed care companies for both BAYOU HEALTH and the Louisiana Behavioral Health Partnership.

The Greater New Orleans Community Health Connections (GNOCHC) initiative funded through a special waiver in Medicaid uses block grant funds to help in hurricane recovery programs. The Governor pointed out that GNOCHC clinics represent a gold standard for the primary care medical home model for the state. Originally funded by a three year $100 million grant after Hurricane Katrina, DHH applied for and received permission to allow the clinics to draw down from the Disproportionate Share Hospital (DSH) dollars normally used for hospitals to care for the indigent.

In addition, the proposed FY 2013 budget will help small and rural communities with the $1.4 million in State General Funds included in the FY 2013 budget. There would be funds for 16 new Federally Qualified Health Centers and Rural Health Clinics plus about $1.7 million in State General Funds to annualize funding for 22 centers enrolling in FY 2012.

Developing the Rural Workforce

Mary Wakefield PhD, R.N., Administrator of HRSA, said, “HIT has the potential to improve the quality, access, and efficiency of healthcare delivery especially in our nation’s rural areas.” To meet the need of the rural HIT workforce, a Memorandum of Understanding (MOU) was initiated between HRSA and the Department of Labor to develop job training programs.

According to Wakefield, “This MOU will help ease the challenges of geographic isolation and staff shortages faced by rural communities and help move us toward our mutual goal of HIT workforce development.”

The Assistant Secretary for Employment and Training Administration at DOL, Jane Oates said, “There is a real need to expand the rural health IT workforce and the MOU will help to ensure that job training programs are quickly and effectively put in place to address this need.”

The two agencies will work to connect community colleges and technical colleges and provide rural communities with the materials and resources needed to conduct HIT training to increase the workforce needed in rural hospitals and clinics. The Bureau of Labor Statistics estimates that the needed HIT workforce will increase by 20 percent by 2016.

The White House Rural Council recommends making HHS loans available to more than 1,300 Critical Access Hospitals to use to recruit additional staff and to help purchase software and hardware to implement health IT.

Other recommendations made by the Council were to take decisive steps to dramatically increase the purchase of biobased products which will create jobs and innovation where biobased products are grown and manufactured.

The Council also recommends that the “Rural Jobs Accelerator”, a national competition should provide about $25 million for projects to promote innovation-fueled regional job creation. The competition will combine funding from the USDA’s Economic Development Administration, Delta Regional Authority, and the Appalachia Regional Commission.

In addition, on February 22nd, Secretary of Labor Hilda L. Solis announced that $183 million in grants will be awarded to 43 private partnerships with 15 of those organizations involved in healthcare. The funding was made available through the second round of funding under the H-1B Technical Skills Training Grant Competition.

The grants will provide education, training, and job placement assistance related to high growth fields in which employers are currently using the H-1B nonimmigrant visa program to hire foreign workers. The grants will provide significant investments in such fields as information technology, advanced manufacturing, and healthcare.

VUMC Launches Genotyping

According to the “Reporter” Vanderbilt University’s weekly newspaper, word is spreading to providers in pilot clinics that they should perform prospective genetic testing on certain patients. When a drug doesn’t work for a patient, or when a patient experiences side effects but receives little benefit then further genetic testing could possibly find solutions and avoid adverse drug events.

Certain common genetic variants or genotypes have been found to change the odds for certain drug responses especially with the development of personalized medicine. Soon, personalized medicine will require checking genotypes to ensure patients get the right drug at the right dose from the very start. Across the healthcare system when clinical genotyping is done at all, it is typically limited to a single gene-drug interaction. Looking ahead, Vanderbilt is mounting prospective, wide spectrum genotyping.

A single test, known as PREDICT or PDX test, is able to look at 184 common genetic variants collectively implicated in a host of known and suspected gene-drug interactions. For now, the university provides PREDICT/PDX at no cost to patients. Approximately 4,300 patients have been tested and it is expected that another 6,000 will be tested by June.

The gene-drug interactions that are currently listed for testing involve the cholesterol lowering drug simvastatin (Zocor) and the anti-clotting drug clopidogrel (Plavix). Other gene-drug interactions now being considered for testing involve the anticoagulant warfarin, the cancer drug tamoxifen, and two immunosuppressives.

“This isn’t about any one medicine. If we test prospectively, we can avoid a range of therapeutic delays and mishaps”, said Jim Jirjis, MD, Assistant Chief Medical Officer and the physician lead for the implementation of PREDICT.

Personalized medicine conducted at VUMC is possible since PREDICT can scan electronic records to forecast each patient’s risk over a three year horizon after receiving listed drugs. When the risk surpasses a threshold, the patient’s provider receives an automated alert through StarPanel (Vanderbilt’s EMR application) suggesting a PREDICT/PDX order.

The StarPanel patient summary displays the results but only those results that are of concern on listed drugs. The remaining results are stored for later use as more drugs become listed for testing. As test results become available, providers will then be able to write electronic prescriptions. Should there be a problem an alert will be issued if the genotype suggests an alternate dose or drug.

States Introducing Telemedicine Bills

There are several states that have introduced bills specifically related to telemedicine in the current 2012 legislature session. These states include Maryland, Virginia, Tennessee, Michigan, Connecticut, Hawaii, and Arizona.

Several bills introduced in the Maryland legislature are:

• SB 817, would require reimbursement to licensed healthcare providers if they are providing telemedicine services
• SB781 and HB 1149 require insurers, non-profit health services plans and health maintenance organizations to provide same coverage for healthcare services done whether in person or by telemedicine
• HB 1399 involves hospitals and the issue of credentialing and privileging

Bills HJR 171 and HJR 119 were introduced in the Virginia legislature to establish a joint subcommittee to examine if telemedicine is used—then would telemedicine reduce costs.

In Tennessee, House Joint Resolution 58 was introduced by Representative Tony Shipley to encourage the implementation and use of telemedicine in the state.

The resolution specifically wants to expand the use of telemedicine to:

• Improve access to medical services by patients in all regions of the state
• Improve patient choices and experience in interacting with healthcare services
• Promote competitive healthcare delivery options
• Improve quality and efficiency
• Enable physicians and their staff to extend their reach to help patients in the state

Other state bills introduced include:

• Bills SB 3103 and HB 3719 introduced in Tennessee would require a report to be produced on the good and bad effects of telemedicine being used in the state

• Bills HB 5421 and HB 5408 introduced in Michigan would prohibit insurance companies from denying coverage for telemedicine services

• Hawaiian bill HB 1708 would authorize the emergency exam of a patient by telemedicine in remote areas of the state when an emergency situation requires hospitalization in a psychiatric facility

• Bills HB 2666 and SB 1414 were introduced in Arizona to deal with health insurance reimbursement issues involving telemedicine

Saturday, February 25, 2012

HRSA Seeks Grant Applications

HRSA is soliciting applications for the “Telehealth Resource Center Grant Program” (TRCGP) to support Telehealth Resource Centers (TRC). The TRCs provide technical assistance to healthcare organizations, healthcare networks, and healthcare providers to help organizations implement cost-effective telehealth programs to better serve rural and medically underserved areas and populations.

The Office for the Advancement of Telehealth (OAT) within HRSA wants every state to be covered by a TRC. The funding will help five Regional TRCs (RTRC) use telehealth for clinical care in the RTRC communities and regions.

The grant applications are due April 20, 2012 with the program to provide funding during federal fiscal years 2012-2016. About $1,625,000 is expected to be available annually to fund the five RTRCs at a level of $325,000 for a four-year project period.

OAT expects the TRCs to use the grant funds to:

• Provide technical assistance, training, and support
• Disseminate information and research findings related to telehealth services
• Promote effective collaboration among telehealth resource centers
• Conduct evaluations to determine the best use for telehealth technologies to meet healthcare needs
• Promote the integration of the technologies used in clinical information systems with other telehealth technologies
• Foster the use of telehealth technologies to provide healthcare information and education for healthcare providers and consumers in a more effective manner

This funding will support two National TRCs (NTRCs) to work with the RTRCs. About $600,000 is expected to be available annually to fund the two NTRCs at a level of up to $300,000 each year for a four-year project period.

One National TRC will focus on providing specialized technical assistance in telehealth technology. The other National TRC will focus on policy issues that deal with physician and nurse licensure, credentialing and privileging, Medicare and Medicaid reimbursement, and private insurance payment policies.

Applicants applying for the grant funding should have expertise in telehealth services including telehomecare services, mHealth, and the use of handheld technologies

Eligible applicants can include Native American tribal organizations, non-profits, faith-based, community-based, and tribal non-profit organizations.

For more information, go to or email Monica M. Cowan, Public Health Analyst, at or call (301) 443-0076.

Oregon's Plans for CCOs

The 2011 Oregon legislature created Coordinated Care Organizations (CCO) through House Bill 3650 requiring the Oregon Health Authority (OHA) to develop a proposal for CCOs. To help create the Implementation Proposal over the months, more than 1,200 Oregonians provided input through eight community meetings that were held in the state and another 133 people met in four targeted work groups to make recommendations on how to implement CCOs in local communities.

The Oregon Health Policy Board (OHPB) a nine member citizen board serving as the policy-making and oversight body for OHA held a meeting January 24, 2012 to approve the final CCO Implementation Proposal. On February 1, 2012, the proposal was delivered to the legislature.

The next order of business is for the state legislature to approve the proposal and if approved, the state will apply for the required permissions and waivers needed from CMS. In the March to June 2012 framework, OHA implementation planning will take place and should have the first CCOs certified and enrolling members by July 2012.

The vision is that a CCO in a community would be responsible for coordinating all of the mental, physical, and dental care for Oregon Health Plan (Medicaid) members through collaborative relationships. The legislation provides for flexibility to set CCOs up in a way that will work best locally because the delivery of healthcare needs may differ from community to community.

A third party analysis found that by implementing CCOs, Oregon could save a significant portion of projected Medicaid costs in the short and long term. Savings would be more than one billion total funds within three years and more than $3.1 billion total fund expenditures over the next five years.

The CCO model would offer local control, focus on prevention, provide for community health workers, establish patient-centered primary care homes, have one point of accountability, integrate physical and behavioral health with a primary care provider working with mental health professionals to reduce administrative overhead, operate on a global budget, and use Electronic Health Records.

In general under the proposal, local providers would have the means and incentives to work together for the population they serve. There would be more flexibility for preventive care and chronic disease management. The CCOs would manage a global budget and if performance standards were met, providers could share in the savings.

The OHPB requested that the Oregon Health Information Technology Oversight Council (HITOC) provide advice on what CCOs will need electronically to operate efficiently:

• CCOs will need to help providers adopt meaningful use of EHRs

• Facilitate the exchange of information utilizing HIEs and insure that every provider is ether registered with a statewide or local direct-enabled health information service provider

• CCOs will need to leverage HIT tools to transform from a volume-based delivery system to a value-based system.

• CCOs need to assess provider performance, effectiveness, cost-efficiency of treatment, look at quality reporting, and provide for not only for HIT but also for telehealth, and mobile devices

The next legislative steps in 2012 are to vote on a proposal to allow OHA and the Department of Consumer and Business Services to share information, so that CCOs will not have to submit financial reports to both agencies, to continue current protections that prohibit discrimination of providers based solely on their license type in the CCO environment, and require OHA to report quarterly on the implementation of CCOs through 2017.

Go to to view the final CCO Implementation Proposal that was submitted.

Arkansas Revising 3 RFPs

The Arkansas Department of Human Services (DHS) responsible for administering the state’s Medicaid program is working with their Division of Medical Services (DMS) to redefine systems and business processes for the Arkansas Medicaid Program.

In 2011, DHS pursued the procurement for the Medicaid Management Information Systems (MMIS) and associated professional services through a multi-contract and multi-vendor approach. But due to industry responses and lessons learned from the procurement, DHS canceled the 2011 MMIS procurements and now has restarted the procurement process.

The plans are for DHS during the second quarter of 2012, to release three RFPs. The first RFP to be released will be the “Arkansas Medicaid Enterprise (AME) Core System and Services” response. The contractor will need to delivery components and the associated Medicaid operations professional services.

The second procurement will be the “AME Pharmacy System and Services” The contractor will need to deliver components for point of sale, pharmacy benefits management, and for the associated Medicaid pharmacy services.

The third RFP to be released will be for the “AME Data Warehouse” The contractor will need to deliver services for a Decision Support System, MARS, SURS, and for program integrity capabilities. In order to implement the AME, the DMS will need to procure new IT to replace the 25 year old MMIS, to modernize the business processes, and procure more effective professional services.

The target start date for all contracts is December 2012. Targets for final implementation will be in the 2015-2016 timeframe. So far, the information provided is tentative and may undergo changes prior to the actual release of the three RFPs. DMS welcomes written comments and questions on the procurement.

For more information, email Susan Rojas at Go to to read the revised procurement strategy.

Data Mining Expertise Sought

FDA on February 21st issued a “Sources Sought Notice/Request for Information” (RFI) to find organizations with the ability to data mine structured data from the National Library of Medicine’s (NLM) MEDLINE to detect potential drug-adverse event associations.

FDA is looking for an automated and fully auditable program capable of quantitative signal detection where drug-event pairs that occur disproportionately higher than expected frequency are identified. They also are looking for a system that has “drill-down” capability to identify and access original resource materials and able to provide links to other relevant scientific electronic databases.

FDA issued the “Sources Sought Notice/RFI” to hear from qualified small businesses for information but FDA welcomes solutions from all interested parties.

Responses are due March 07, 2012 for the RFI “Systematic Data Mining of the Medical Literature: a Novel Analytic Tool for quantitative Drug-Adverse Event Safety Signal Detection” (FDA-SOL-12-1234567).

For more information, go to For questions, email Christine Rynkiewicz at

Further Developing Tech

The Army seeks a commercial and/or cooperative development partner for a rapid clotting technology to use in a variety of emergency and surgical situations. New technology applied to clotting could be used by first responders, emergency room professionals, and surgeons.

Hemorrhage is one of the most common causes of death among people who die prior to reaching an emergency room or patients that die in the operating room. Research has demonstrated the individual effectiveness of recombinant “factor VIIa” and “fibrinogen” in clotting. VIIa plays a key role in activating the blood coagulation process and fibrinogen provides the raw materials needed to make an effective clot.

The Army has patented the combination of recombinant “factor VIIa” and “fibrinogen” for stemming blood loss and restoring hemostasis. The combination is administered intravenously and circulates safely through the body to the site of injury. The approach would be especially useful for treating multiple wounds and internal bleeding.

Advantages to using this approach to treating clotting would mean that trauma could be treated in the field or on the way to the hospital, components could be stored for years in dry form or for months in a wet form, it’s easy to use and reconstitutes quickly, can be administered via IV, and is useful in difficult cases to help control bleeding in hard-to-reach injuries.

The Air Force has developed a realistic training simulator to use for Negative Pressure Wound Therapy (NPWT) that incorporates bleeding, fluid extraction, pulse points. It can be used to represent various wound types and depths such as bed sores, diabetic ulcers, and blast/high energy trauma on different anatomic locations.

A need exists for improved NPWT training and simulation as current NPWT training devices offer limited physiological realism and functionality. FDA has issued an advisory on deaths and injuries associated with NPWT over a two year period. FDA reports that adequate training is needed as the first potential remedy especially for home and long-term care facility users where most deaths occur.

So far, a prototype of an Air Force’s trainer has been constructed with commercial off-the-shelf components. Final designs and configurations for the trainer are flexible and can be determined by the commercial developer. The trainer can be developed as a standalone task trainer or engineered for use with high fidelity simulators. The prototype trainer is built and tested and now the Air Force is looking for potential for R &D collaboration. The U.S patent application is available for license.

For more information on both opportunities, email Darin D. Oelkers at or call (406) 994-7723 or email Dan Swanson at or call (406) 994-7736.

Collaborative Projects on the Rise

On February 17th, the Navy Surgeon General, Vice Adm. Matthew Nathan called for enhanced collaboration among the services and other federal healthcare agencies at the annual Tri-Service Medical Information Management Symposium (TMIMS) held in Las Vegas.

Speaking to an audience of more than 1,000 military and civilian healthcare professionals, Nathan believes that by effectively coalescing medical resources, the military will enhance healthcare access, wellness, and provide the continuity of care to service members, their families, and veterans.

According to Verlin Harlan, Chief Information Officer for the U.S. Navy Bureau of Medicine and Surgery, the Navy is working with sister services to explore ways to modernize the military’s healthcare network. Collaborative efforts are now being undertaken to improve bandwidth and to provide for other updates on and off the battlefield.

In an effort to have in-depth discussions on what the Navy is trying to accomplish, the Navy invited Major General (Dr) Byron C. Hepburn, the Commander of the Air Force’s 59th Medical Wing to tour the Tri-service Research Laboratory hosted by the Naval Medical Research Unit at their San Antonio Laboratory. At this joint meeting, the Navy briefed General Hepburn on new surgical devices and discussed the Navy’s wide array of biomedical research.

In an Army collaborative effort, the Army’s Africa’s first “Medical Readiness and Training Exercise” of the year, known as MEDRETE 12-1, medical personnel traveled to Zanzibar, Tanzania in January. In February, the Army doctors performed a suture-less cataract surgical technique to provide medical treatment to local citizens.

Medical personnel included military specialists and civilians who came from the Womack Army Medical Center in Fort Bragg, N.C., the Madigan Army Medical Center in Joint Base Lewis-McCord Washington, the Joint Base Elmendor-Richardson Hospital, in Alaska, and Caserma Ederie in Vicenza, Italy.

The surgical techniques known as “Extracapsular Cataract Extraction” an inexpensive and low tech procedure takes only 20 minutes for a person blinded by cataracts to regain their eyesight. This project involved the collaboration of not only the U.S. medical team, but also Ministry of Health Officials from Zanzibar and the Tanzania People’s Defense Force.

In the university sector, the University of Pennsylvania has established a collaborative research effort with the Walter Reed National Military Medical Center. This relationship was formed when Congress appropriated $32 million to develop technology for proton therapy.

Ten percent of the money is going to Walter Reed to do research and development and the remainder of the funding will go to the Roberts Proton Therapy Center a cancer radiation facility housed within Penn Medicine. Projects will include how to design and improve proton therapy, how to improve scanning techniques to deliver radiation, how chemo and proton therapy can be combined in a beneficial way, and how proton therapy can be used to improve surgical outcomes.

Also, the funding will also be used to provide for the Joint Military Civilian Proton Radiotherapy Center established to provide oversight and management for research will be transformed into a center so that all military healthcare beneficiaries diagnosed with cancer can receive proton radiotherapy treatment as prescribed at Walter Reed.

Tuesday, February 21, 2012

VA's FY 2013 IT Plans

The Veterans Administration operates one of the largest consolidated IT organizations supporting over 300,000 VA employees and about 10 million veterans and family members. The information technology 2013 budget proposal includes $3.3 billion for IT which is a $216 million increase over the current budget.

In 2011, DOD and the VA agreed to build the joint Integrated Electronic Health Record (iEHR) and to upgrade EHRs for all veterans to a single common platform. The iEHR FY 2013 budget request is for $169 million.

In FY 2013, plans are to deliver an iEHR Pharmacy Solution, Identity Management Orders Services, Consults and Referrals, Immunizations, and continue the VistA Open Source Custodial Agent at $5 million per year.

In FY 2011, the VA led the way to cloud computing. So far, the VA has successfully implemented a large scale, cloud program in the Post 9/11 GI Bill IT System. In addition, the VA has aggressively adopted the Data Center Consolidation concept to increase systems reliability, security, and to reduce costs.

So that the VA and other agencies can move forward with cloud computing, GSA recently released the Concept of Operations” (CONOPS) document. The plan is for the Federal Risk and Authorization Management Program referred to as FedRAMP to make it possible to initiate new cloud certification programs.

The Office of Telehealth Services, within the VHA’s Office of Patient Care Services has implemented a large national telehealth program within VHA. The goal is to help improve and provide teleconsultations, teleretinal imaging, telemedicine, and telehealth to more rural areas.

To aggressively help veterans in rural areas, Representative Kathleen Hochul (D-NY), on February 14th introduced the “Veterans Telehealth & Telemedicine Improvement Act”. The legislation if passed would improve and expand the VA’s telehealth initiative and further provide veterans in rural areas with easier access to medical care.

The VA’s Office of IT (OIT) in their Acquisition Strategy & Business Relations Office has formed a strategic partnership with the VA’s Technology Acquisition Center to do the following.

• Provide acquisition program management oversight
• Serve as industry liaison
• Provide customer interface support
• Disseminate department-wide IT acquisition policies and procedures
• Monitor OIT federal interagency agreements
• Lead strategic sourcing initiatives

OIT is working across government agencies to unite buying power, provide for integration, consolidate requirements, and implement strategic sourcing initiatives. OIT’s activities also include managing the “Transformation Twenty-One Technology” (T4) contract.

OIT is taking part in GSAs Federal Strategic Sourcing Initiative to provide access to common procurement opportunities that can offer greater discounts, offer business intelligence, and best practice solutions. In addition, OIT is consolidating contracts and creating enterprise licensing agreements to improve the acquisition process.

The VA’s new Health Informatics Initiative (hi2) with a budget request of $8 million will work with the VHA’s transition from a medical model of care to a patient-centered model of care and help to build a sustainable collaborative relationship between VHA and OIT.

The hi2 initiative will work to establish cross-cutting health informatics tools. The schedule for hi2 deliverables will be to deliver products throughout each year for over a period of three years. The Health Informatics team will coordinate with the Virtual Lifetime Electronic Record (VLER), iEHR, and work with teams centered on developing new models of care for the VA.

The goal for the hi2 initiative is to work on internal well coordinated collaborations that will:

• Support rapid product development and delivery methods
• Integrate health informatics and IT in the delivery of healthcare IT products by using a succession plan to transition the Computerized Patient Record System to the next generation of browser-based EHRs
• Build health informatics capacity and develop the health informatics workforce

AVIVA is the VA’s next generation web-based EHR. In FY 2011 two AVIVA software modules were developed with the first AVIVA pilot site launched. Since then, the 3rd and 4th AVIVA software modules have been developed, the first AVIVA prototype module for the system facing interface were delivered, and the Intranet Portal strategy was designed. The FY 2013 budget request includes plans to deploy AVIVA modules to VA medical centers and develop additional modules for the AVIVA framework.

To address the concept of innovation, in 2011, the VA established the VA Innovation Initiative (VAi2) to draw expertise from individuals in government or from outside the government to obtain new ideas to produce innovative solutions to help veterans access services. The VAi2 initiative in FY 2012-2013 will continue implementing projects selected in previous competitions through pilot testing.

In 2012, the VAi2 initiative brought roughly 120 projects into their portfolio which range in size from doctor-lead process improvements costing only a few thousand dollars to multi-million dollar innovations. In addition to continuing to manage and support the VAi2 portfolio, new competitions both internal and external will be announced for 2012 and will be open to industry leaders, start-ups, and non-profits.

Developments in Broadband

To support the President’s National Wireless Initiative, the Department of Commerce’s FY 2013 budget request proposes to establish a program to develop a nationwide interoperable public safety broadband network in the 700MHz band.

Today, the 10 megahertz of dedicated spectrum allocated to public safety in the 700 MHz band for broadband communications provides more than the required capacity for day-to-day communications. However, for the worst emergencies, even access to another 10 MHz of spectrum is insufficient. Therefore, priority access and roaming on the 700 MHz commercial networks is critical to providing adequate capacity in extreme situations.

So far, according to the Department of Commerce’s FY 2013 budget release, $2 million would be allotted to the Public Safety Communications Research program now being conducted by NIST with the National Telecommunications and Information Administration (NTIA).

The demonstration has created a 700 MHz Public Safety Broadband Demonstration Network to help manufacturers have a site to deploy their systems, to help evaluate systems in a multi-vendor environment, and to stimulate integration opportunities for commercial service providers.

On February 17th, the establishment of a nationwide interoperable public safety broadband network was included in the House of Representatives “Middle Class Tax Relief and Job Creation Act of 2011” and passed. The bill has provisions to ensure that public safety broadband network research, development, and standards work would be conducted by NIST.

This legislation enables NIST to work with the telecommunications industry and the public safety community to help spur the development of cutting-edge wireless technologies for first responders.

The Department of Commerce’s FY 2013 budget request would establish a “State and Local Implementation Grant Program” to be administered by NTIA. Grants would to go to states to use to assist state, regional, tribal, and local jurisdictions to identify, plan and implement the most efficient and effective ways to use and integrate the infrastructure, equipment and other architecture associated with the network.

The grant program would begin in FY 2013 and would be administered over ten years with the total cost of $200 million to the federal government. The program would be fully offset by proceeds from spectrum incentive auctions to be conducted by the FCC.

In other news, NTIA has announced that the “National Broadband Map” has a new feature to make it easier to use the map while using a mobile device. The new feature allows anyone on the go using a mobile phone and the GPS system to more easily search broadband availability, summarize and rank data, and view a map of community anchor institutions.

Users of the mobile browser version of the National Broadband Map can swipe across panels of information and access additional information by sliding the footer panel up. A convenient sharing panel is also available at the top of each page. Traditional search is supported and the results are presented in a new format for mobile devices.

Telehealth to Help IBD Patients

Research on medication adherence in pediatric Inflammatory Bowel Disease (IBD) has demonstrated that pediatric patients do not adhere to their medication regime from rates that range from 50 to 88 percent of the time.

This data is alarming since the risk of relapse in IBD is 5.5 times more for patients that do not take their medications properly than for those patients that adhere to the medication schedule. In addition, the annual costs of healthcare for IBD patients that do not adhere to their medication schedule are 12.5 percent higher and cost the U.S. healthcare system $100 to $300 billion more.

Factors that relate to the problem are lack of knowledge about IBD, the medications that can be used for treatment, organizational barriers, and not addressing the behavioral problems found in adolescents and sometimes their families.

Current studies demonstrate the feasibility of providing family-based behavioral intervention which is viewed favorably by patients and families and results in higher medication adherence. Individually tailored behavioral treatments are advantageous because of the ability to analyze and target specific behaviors that are preventing adherence to medications.

However, only a limited subgroup of patients are able to receive this type of treatment due to a lack of available trained providers and in addition, the long distances between patients and their treatment facility can make it difficult for patients to attend the necessary weekly treatment sessions.

The current study in this field is being funded by the National Institute of Child Health and Human Development (NICHD) and is taking place at the Cincinnati Children’s Hospital Medical Center. The Medical Center is working with 194 patients (11-18) and their families via a randomized controlled clinical trial.

The study is examining how telehealth can be used to provide behavioral treatment to improve medication adherence but also studying how to improve the quality of life for children with IBD. The study is also targeting a clinically relevant sample of patients who demonstrate substantial resistant to taking their medications and how it may be affecting their health outcomes.

The study may impact public health by providing an evidence base that shows how an individually tailored behavioral treatment to support taking medications may reduce healthcare disparities for families that have limited access to services.

The grant study “Telehealth Enchancement of Adherence to Medication in Pediatric IBD” (R01HD06717-01A1) was initiated in 2011 with the final year to be 2016.

For more information, email Kevin Hommel at the Division of Behavioral Medicine and Clinical Psychology at the Cincinnati Children’s Hospital Medical at or call (513) 803-0407.

U.S Leads in Adopting HIT

Accenture has released findings obtained from the year-long study “Connected Health: The Drive to Integrated Healthcare Delivery” that examined the impact of technology across eight country health systems. The health study among the largest ever conducted found that the U.S. is a leader in adopting healthcare IT.

The study included Australia, Canada, England, France, Germany, Singapore, Spain, and the U.S. with results showing that the U.S is one of the few countries where healthcare IT penetration is nearly equal among primary physicians and specialists.

The study’s findings are the result of more than 160 interviews with health leaders including government officials, clinicians, health information specialists, academics, and analysts with a total of 3,700 physicians interviewed across the eight countries.

Among the findings:

• More patients in the U.S can access health records electronically than in most of the other countries

• The U.S. health system has more than double the percentage of doctors that provide patients with electronic access to their own medical information when compared to their international counterparts (8 percent is the global average as compared to U.S average of 17 percent

• More U.S. doctors send prescriptions electronically to pharmacies than anywhere else in the world. More than half of U.S. primary doctors (54 percent) studied regularly use e-prescribing to send prescriptions to pharmacies electronically when compared to just 20 percent internationally.

• U.S. doctors increasingly share patient data outside their organization to improve disease management with 44 percent of specialists and 39 percent of primary doctors and do this on a regular basis

• U.S doctors use HIEs for e-prescribing, computerized physician order entry, and for e-referrals

• The majority of U.S. physicians (59 percent) enter patient notes electronically during and after appointments

• Independent physicians were significantly less likely to make use of HIE capabilities as compared to physicians who are employed or aligned with larger health systems

“What is encouraging about the U.S. findings is that primary doctors and specialists are on pretty equal footing for healthcare IT adoption,” said Mark Knickrehm, who leads Accenture’s global healthcare business. “This balance and equality between the sectors is helping to speed the integration of care delivery across the U.S. healthcare system.”

For more details on the study, go to

Spotlight on Telehealth

The first Mid-Atlantic Telemedicine Resource Center Summit in conjunction with the Virginia Telehealth Network is presenting a premier event March 15-16, 2012 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.

Prominent keynote speakers include Delaware Secretary of Health Rita Landgraf, Virginia Secretary of Health Bill Hazel, FCC Commissioner Robert McDowell, Marilyn Travenner, Acting Administrator for CMS, Aneesh Chopra, Former Assistant to the President & Chief Technology Officer and Former Associate Director for Technology within the Office of Science & Technology Policy, Sherilyn Pruitt, Director, HRSA, Office for the Advancement of Telehealth, William Warmpler, Former VA Senator and Executive Director for the New College Institute, and Karen Rheuban, MD, Director for the University of Virginia’s Center for Telehealth.

Some of the other speakers include Eric Aldrich MD, Associate Professor of Neurology at Johns Hopkins, Gary Capistrant, Director of Policy ATA, Mohit Kaushal, MD, Executive Vice President at West Wireless Health Institute, Joe Tracy, Vice President for Telehealth at Lehigh Valley, and Rob Sprang, Director for Kentucky TeleCare. For more details on the agenda and additional speakers, go to

There will be sessions and panels on reimbursement, addressing public policies, telestroke, telemental health, federal funding opportunities, innovation, and much more.

Go to to register. The fee is just $395. For more details email, Ladi Carr at or call Eric Swensen at (434) 924-5770.

In Montana, the Northwest Regional Telehealth Resource Center will present a Conference on March 19-20 in Billings. 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.

In addition, the administrative tract will interest anyone who is in charge of a telemedicine network at any level. Tammy Arndt’s session “Anatomy of a Telemedicine Agreement” will center on business agreements for telehealth. Paloma Costa and Carolyn McCornac will talk about the FCC program and the competitive bidding rules for the Rural Health Care program.

A special session Telemedicine 101 has just been added with Jeff Shuckra Network Engineer at the Utah Telehealth Network as the presenter. At this session, Jeff will review the infrastructure of telehealth by examining the basic types of video conferencing equipment, look at different types of networks and their equipment, and discuss the best practices for securing telehealth

It is still affordable to attend the Conference since the registration is now only $185. If three or more people from one organization attend, then a 10 percent discount will be applied. The only rule that applies to this offer is that all of the registrations must be purchased at the same time. For more details, contact, and for more details on the Conference, go to

Tuesday, February 14, 2012

HHS Budget News

According to the FY 2013 HHS budget request document released February 13th, there is a reduction in discretionary funding for ongoing activities and legislative proposals that would save an estimated $350.2 billion over 10 years. The budget request totals $940.9 billion in outlays and proposes $76.7 billion in discretionary budget authority.

The FY 2013 budget request for the HHS Office of the National Coordinator for Health Information Technology (ONC) is $66 million which is $5 million above FY 2012. The budget includes $7.8 million, an increase of $2 million to allow ONC to work with healthcare and community organizations so that best practices can be shared and to encourage the adoption and meaningful use of health IT. In addition, the funding will continue the support of Regional Extension Centers and other HHS priority programs such as the National Quality Strategy.

The FY 2013 budget request includes $12 million for work on standards and interoperability. ONC supports developing standards and specifications for health IT, implementing standards, developing and maintaining certification criteria and the process, and works to coordinate efforts involving health information exchanges.

The budget request includes $5 million to assure that policies and practices are in place to keep health information private and secure. Key efforts include the evaluation and policy development of privacy and security protections for electronic health information in the evolving nationwide network.

CMS and ONC are working to expand access to care through increased adoption and meaningful use of EHRs. HHS aims to increase the number of eligible providers who receive an incentive payment from the Medicare and Medicaid EHR Incentive Programs for the successful adoption or meaningful use of EHR technology from 80,000 in FY 2012 to 140,000 by the end of FY 2013. As of January 2012, nearly 60,000 REC-assisted providers had implemented EHRs with e-prescribing and quality reporting capabilities and over 5,000 of these providers have achieved meaningful use.

The FY 2013 budget request includes $26 million, the same as FY 2012 for the AHRQ health IT research portfolio. This investment includes $19 million to support approximately 56 research grants to generate evidence that demonstrates the most effective and efficient use of health IT.

In addition, AHRQ would receive $7 million to support contract activities related to synthesizing and disseminating evidence on the meaningful use of health IT. Funds will also be used to develop the tools and resources for various stakeholders to be able to implement best practices.

HRSA’s FY 2013 budget request includes $8.4 billion which is a net increase of $228 million above FY 2012. The FY 2013 includes $122 million for targeted rural health programs. This investment includes $56 million to continue collaborative models to improve healthcare access and quality. The budget request provides $26 million to continue funding for all continuing rural Hospital Flexibility grants, $20 million for research, technical assistance, and policy development. Also included is $12 million to expand access to quality care through telecommunications which is the same amount as in FY 2012.

The Center for Medicare and Medicaid Innovation is addressing patient safety, coordination of care among multiple providers, and enhanced primary care. The Affordable Care Act appropriated $10 billion to support the Center’s activities from FY 2011 to FY 2019.

Through the HHS Health Care Innovation Challenge, the Innovation Center will award up to $1 billion in grants to providers, payers, local governments, and other partners. Recipients will be selected based on their proposals to implement or expand compelling new models to improve care and reduce costs. CMS anticipates making awards in the spring or 2012.

The “Partnership for Patients” program is a collaborative effort by CMS with more than 7,000 stakeholders including over 3,000 hospitals to help improve patient safety. The Partnership has set a target for reducing hospital-acquired conditions by 40 percent by 2013 and to reduce hospital readmissions by 20 percent over the same time period. In December 2011, the Innovation Center awarded $218 million to 26 regional hospital engagement networks to help support the Partnership’s goals.

The Innovation Center has partnered with the Medicare-Medicaid Coordination Office. Specifically, the Medicare-Medicaid Coordination Office awarded contracts up to $1 million to 15 states to design person-centered approaches to coordinating care across primary, acute, and behavioral health and long term services for Medicare-Medicaid enrollees.

The Medicare-Medicaid Coordination Office will have demonstrations to focus on reducing preventable inpatient hospitalizations among long-term residents of nursing facilities that are often eligible for both Medicare and Medicaid. CMS will begin accepting applications for this demonstration in 2012. links to health insurance plans and puts the information in one place to make it easier for consumers and small businesses to learn about and compare insurance options. Of the approximately 6.6 million visitors to the web site in its first year, about 2 million used the Insurance finder tool.

The budget requests $864 million to establish state-based insurance marketplaces called Exchanges. In 2011, 28 states and the District of Columbia received over $438 million in Establishment Grants to begin building their exchanges. Additional grants will be awarded in FY 2012 and may be renewed through January 1, 2015. After their initial establishment, exchanges will be self-funded through user fees or otherwise generate funding to support their operations.

The CDC FY 2013 budget request includes $197 million for Health Surveillance and Statistics, an increase of $23 million over FY 2012. In FY 2013, CDC will use the resources to obtain and use statistics to understand health problems, identify risk factors, support state electronic birth and death records implementation, guide programs and policy, and monitor the impact of health reform. Policy makers, researchers, and the public rely on data from these surveys to support decision making and research on health.

The NIH FY 2013 budget requests $30.9 billion which is the same level as in FY 2012. In FY 2013, NIH estimates that it will support a total of 35,888 research project grants, including 9,415 new and competing awards.

NIH is accelerating discovery by using technology. Investigators are better able to benefit from basic research discoveries by using advanced technologies such as DNA sequencing, microarray technology, nanotechnology, new imaging modalities, and computational biology. In FY 2013, NIH plans to support further development and application of these advanced technologies.

In FY 2013, NIH will continue to implement the National Center for Advancing Translational Sciences (NCATS) to re-engineer the process of translating scientific discoveries into new medical products. A total of $639 million is proposed for NCATS in FY 2013, including $50 million for the Cures Acceleration Network.

HIEs Progress and Challenges

“Health Information Exchanges have made progress but challenges and barriers still exist in dealing with this complex issue,” according to Darrell West Vice President and Director of Governance Studies and Founding Director of the Center for Technology Innovation at Brookings. On February 8th, he moderated a panel discussion on the issues surrounding the implementation of health information exchanges.

Claudia Williams, Director State Health Information Exchanges in the Office of the National Coordinator reports that there is good news and bad news on exchanges but in either case, exchanges are ready to take off.

According to Williams, progress is taking place with increases in meaningful use, doubling of
e-prescribing, conversations with consumers, developing consumer portals, and looking at innovative plans and ideas for payment reforms. There is a great interest in exchanges, however, dialogue and conversation needs to take place on developing workable business models so that costs are lower. The answer may be to knit together existing HIEs in order to reduce the cost of exchanges.

“This country needs to move towards accountable coordinated care but we won’t be able to get there unless health exchanges are established”, according to Janet Marchibroda, Chair, Health Information Technology Initiative at the Bipartisan Policy Center.” Further work needs to be done on governance, payment issues, further work on standards, adoption, and dealing with issues on the ownership of medical information, privacy, security, and workforce issues.”

AHRQ has and is still playing a role in doing evidence-based research on HIEs. Initially, AHRQ funded demonstrations in different states and made an initial investment. The states that were funded years ago are now serving as models, according to Jon White MD, Director for the Health IT Portfolio at AHRQ. He said, “Establishing HIEs is harder than people thought it would be because it is not just about equipment but most importantly exchanges are about people”.

John Piescik, Strategy Program Manager at the MITRE Corporation reviewed made an important contribution by examining relevant MITRE research. His team looked at ways to enable large scale organizational changes to take place across organizational boundaries.

Also, on February 8th, Allan Friedman a Fellow in Governance Studies and Research Director of the Center for Technology Innovation at Brookings, along with Darrell West released the paper “Health Information Exchanges and Megachange.”

Specific state experiences were researched in the states of Indiana, Massachusetts, New York, Tennessee and California. The authors summed up the progress in these states related to exchanges and found a wide range of approaches, tactics, and outcomes. In general, Indiana and Massachusetts have made significant progress, New York has made moderate progress, and Tennessee and California have made limited progress implementing HIEs.

The paper also discusses the challenges and lessons learned for developing and operating HIEs. One issue is how to deal with the funding uncertainty at the state and federal levels in order to maintain support over time. The paper points out that some states have made efforts to find alternative revenue sources.

Another issues concerns federal health policy as to whether it should just be centered on state-level exchanges. However, some observers are questioning this approach. Marc Overhage, Chief Medical Informatics Officer at Siemens and previously the President of the Indiana HIE, maintains that the state may be the wrong unit to move HIEs. So in some respects, disagreements over federal policies have stymied progress on HIEs.

The authors also see the need for varied approaches since no one approach will work in every place. Each state has to identify its own strengths and build their HIE in a way that will work in their state and location.

Go to to view a podcast of the event. To download the paper, go to

Addressing Clinical Trials

The Austen Bioinnovation Institute in Akron (ABIA) has created a “Center for Clinical Trials and Product Development” (CCTPD) to capitalize on the opportunities available from clinical trials that can possibly advance and move biomedical product development forward. ABIA is working collaboratively with Akron Children’s Hospital, Akron General Health System, Northeast Ohio Medical University, Summa Health System, and the University of Akron.

CCTPD will work to create innovative solutions so that researchers will be able to take product development to the stage where the product can then be assessed for commercial potential. After this stage, early stage product development will result along with clinical trials, the product will move forward to market approval, and then on to simulation training.

Dr. Stan McDermott a 30 year pharmaceutical development and clinical research industry who is leading CCTPD, wants to see the new center provide ABIA partnerships and biomedical companies with expertise in medical device and biopharmaceutical development. The goal is to provide a single stop full service support system for product development and regulatory approval so that products will speed to the marketplace.

As for the Federal sector, NIH has just created a new website “NIH Clinical Research Trials and You” at to help people learn more about clinical trials, why they matter, and how to participate.

The website has information on:

• The basics of clinical trial participation
• First hand experiences and stories from actual clinical trial volunteers
• Explanations, and information from researchers
• Links to help search for a trial or to enroll in a research matching program

In addition, healthcare professionals can read about evidence-based strategies for talking with patients, print audience-tested posters to help promote trials in clinics and offices, and find other educational materials.

Developing Countries & mHealth

As reported in the NIH Fogarty International Center’s recent newsletter, a public health challenge facing developing countries is to provide safe breast milk to infants born to HIV-positive mothers. The problem is very severe in Sub-Saharan Africa, where studies have shown that around 40 percent of babies have become infected with the virus as a result of mother-to-child transmission during breastfeeding.

Rohit Chaudhri, a computer science expert from the University of Washington has designed a mobile health intervention to help mothers, caretakers, and health workers in South Africa produce greater quantities of safe milk.

Pasteurization is known to deactivate HIV and other contaminants in breast milk and can be done at home by HIV-positive mothers. However, the process must be monitored to ensure that essential nutrients are not destroyed when heating the milk. Collaborating with the international health organization PATH, and two South African institutions, Chaudhri has developed a monitoring system that pairs a food-grade temperature probe with an android mobile phone.

Just before hitting the high temperature point, the phone beeps twice to alert the user that the milk is almost heated, at that time, the message on the screen changes and the phone beeps continuously until the jar is removed. The message onscreen then indicates that the milk is cooling. The phone is also able to send data to a server to be reviewed. Chaudhri and his colleagues will carry out a field trial in 2012 at the neonatal ward at King Edward VIII Hospital in Durban.

In Peru, mobile health tools are being used to manage diabetes since this country has two million diabetics with almost half of them unaware of their diagnosis. A study was done at a public hospital in Lima with 17 diabetic patients enrolled using C@reNet an mHealth tool capable of sending text messages related to individual risk factors, provide drug intake reminders, provide lab test results, and able to update medical appointments.

This is the first mHealth tool used to address the comprehensive care of diabetics or it could be used for other chronic patients in Peru. It is one of the first types of mHealth technology to be used in Latin America. The C@reNet project was funded by the Universidad Peruvian government and implemented by Universidad Peruana Cayetano Heredia in partnership with the company Voxiva.

States Sharing Electronic Info

Eight states representing over a third of the U.S. population has taken a huge step to share EHRs across state lines according to NYEeNEWS. Until recently, the ability to expand the usage of EHRS has been limited by the incompatibility of many different systems. A variety of custom interfaces used between records and HIEs has made it difficult to share information across systems.

But recently a workgroup of eight states and 22 vendors were able to determine common specifications by releasing a set of technical specifications able to link their regional medical networks to healthcare providers.

The healthcare providers are able to send and receive individual patient records with other healthcare providers inter and intrastate and able to search for and retrieve patient records across disparate healthcare systems.

The workgroup was formed by the New York eHealth Collaborative (NYeC). The common guidelines were created by organizations the federal government has designated to promote EHR in California, Colorado, Maryland, Massachusetts, New Jersey, New York, Oregon, and Vermont.

The states were joined by 13 EHR vendors including Allscripts, Cerner, eClinicalWorks, eMDs, ePocrates, Dr. First, First Medical Solutions, GE, Greenway, McKesson, NextGen, Sage, and Siemens. They were also joined by 9 HIE vendors that included Axolotl, dbMotion, GE, ICA, InterSystems, MedAllies, Medicity, Mirth, and Misys Open Source Solutions.

Collectively, the group is hoping to see the widespread adoption and market preference for the products that employ their specifications and they have plans to launch a pilot program.

Saturday, February 11, 2012

New Telemedicine Cart Available

LifeBot is presenting their new “Virtual Ambulance Telemedicine Crash Cart System” at HIMSS 12, February 20-23 in Las Vegas along with Hewlett Packard. The “Virtual Ambulance” cart design is multi-versatile and is not only able to handle routine day-to-day procedures but also able to manage unexpected emergencies.

The system features a flashing light system to clear the hallways similar to the way an ambulance clears the street. The cart is the very first Emergency Crash Cart with telemedicine, in other words, the telemedicine cart is a virtual ambulance that may be easily deployed facility-wide.

LifeBot mobile telemedicine carts are the first and only carts designed to transmit live voice video and full patient physiological data. This data is usually acquired by complete physiological monitoring systems that are connected directly to the patient. Physicians when using the LifeBot Slate tablet or Desktop PCs have remote control of the pan, tilt, plus zoom cameras next to the patient.

The same week as HIMSS 12, LifeBot is displaying one of the original DREAMS™ Project Digital Ambulances at the “Gathering of Eagles” meeting to be held in Dallas, Texas February 24-25, 2012. LifeBot acquired the exclusive world-wide rights to key telemedicine technologies including DREAMS™, a $14 million research project that built the first Digital Telemedicine Ambulances. The DREAMS project was the brain child of Texas surgeon Dr. James “Red” Duke, Jr. and was funded by TATRC and the U.S. Army Medical Research and Material Command.

LifeBot CEO Roger Health said, “Entire states and nations internationally want to use these advanced systems now to save lives, reduce workloads, reduce risks, and reduce healthcare costs. So far, most of the technology has focused on “Community Paramedicine” and the delivery of primary care using mobile telemedicine. Now, both the cart and ambulance systems have merged to form one uniform comprehensive system to meet both clinical and pre-hospital needs.”

For more information, go to

NIST Announces Pilot Projects

NIST’s new $10 million competition will help to accelerate the progress needed to improve systems for interoperable trusted online credentials that go beyond using simple IDs and passwords. The competition managed by the NIST National Program Office for the National Strategy for Trusted Identities in Cyberspace (NSTIC) is a White House initiative that will work collaboratively with the private sector, advocacy groups, public sector agencies, and others to improve the privacy, security, and convenience of online transactions.

NSTIC will address the challenges through a user-centric “Identity Ecosystem” that will operate as an online environment where individuals and organizations will be able to trust each other because they follow agreed upon standards to obtain and authenticate digital identities and the digital identities of devices.

Today, the challenges in cyberspace are to:

• Make certain that people, organizations, and businesses are who they say they are online
• Deal with the dozens of different usernames and passwords used
• Not to disclose sensitive information

There are several barriers that prevent identity solutions from being widely deployed in the marketplace. These include the need for technical standards, clarification concerning liabilities when something goes wrong, no common standards for privacy protection and data reuse, and issues with ease of use for some strong authentication technologies. NIST seeks proposals that address some or all of these challenges and barriers.

NIST anticipates funding five to eight pilot projects for up to two years in the range of approximately $1,250,000 million to $2,000,000 million per year. To apply for funding, proposers must be institutions of higher education, hospitals, non-profit organizations, commercial organizations, or state, local, or Indian tribal governments. An eligible organization may work individually, work as a sub-contractor, or work on contracts with others in a project proposal.

The deadline for proposals is March 7, 2012. On February 15, 2012, NIST will host a proposer’s conference at the Department of Commerce in Washington D.C. The conference will offer guidance on preparing proposals, explain criteria to be used in making awards, and answer questions.

The proposer conference will include a live web cast at and participants will also be able to ask questions through Twitter and be able to tweet using hashtag, #NSTIC. To pre-register for the web cast, go to

The proposal for the “NSTIC Pilot Grant Program (2012-NIST-NSTIC-01) is available at For more details, email Dr. Barbara Cuthill at

Addressing Cardiovascular Defects

A miniature battery-free, wireless cardiac implant device is being developed by a University of Michigan research team led by Martin Bocks, MD and the Ann Arbor company Integrated Sensing Systems, Inc (ISSYS). The university researchers and ISSYS received a $1.5 million grant from NIH’s National Heart Lung and Blood Institute (NHLBI).

The funding is going to be used to complete the final preclinical testing required before seeking approval from FDA under the Humanitarian Device Exemption pathway. The grant funding will help test a device that will reduce the need for invasive cardiac catheterization procedures. The research team has been working on this device for three years and anticipates that it will be used in infants and children.

Bocks a Pediatric Cardiologist with the University’s Congenital Heart Center and the university’s C.S Mott Children’s Hospital, reports that the device has the potential to greatly improve the care that we provide to complex patients and will provide researchers with unprecedented opportunities to learn more about their unique physiology.

The wireless device is to be implanted within a heart chamber. Once the device is implanted, doctors can measure pressure inside the heart while the patient is being seen in the outpatient clinic without having to do a heart catheterization. In the future, this monitoring may be performed remotely or patients can be monitored from the home.

The device would stay in place permanently and would be used in patients with functional single ventricle conditions, such as hypoplastic left heart syndrome but could be used in other forms to treat pediatric and adult heart disease in the future.

Researchers are hopeful that the device will go to market by 2013. According to Nader Najafi, PhD, ISSYS President and CEO and the project’s technical principal investigator, “The pediatric medical device field represents unique commercialization challenges due to its small size and stringent requirements.

For more information, go to or contact Margarita Wagerson at the University of Michigan at

The University of Minnesota is looking into licensing possibilities for a device developed to treat cardiovascular defects. A septal defect is a type of congenital heart defect that allows blood flow between the atria or ventricles. Current closure devices generally contain metallic features to provide shape support. These devices can erode into surrounding tissue and corrode over the 70 year potential lifetime of the device.

Newer devices include self-centering features to reduce the potential for residual leaks and can provide complete occlusion of the defect. However, due to the presence of metallic wires, these devices are bulky and can cause unintended flow disruptions.

A solution for the problem is to use a non-metallic closure device. The ideal solution for cardiovascular defects is to use a temporary device that can be resorbed by the body and replaced with native tissues.

A device has been developed that can completely occlude defects, and be retrieved back to the catheter in the event of sub-optimal deployment. The device is designed to be bioresorbable and does not have metallic components. This simplifies the manufacturing of the device and allows the device to degrade over time and then be replaced by natural fibrous tissue in the body. For more information on this device, go to or call (612) 624-0550.

Washington State HIE News

Washington State’s HIE “OneHealthPort” works with participating organizations representing a community of trading partners making preparations to exchange transactions. As organizations join the HIE, they are added to the list so that the trading partners and others interested in joining the HIE know who is participating and what transactions are being prepared to exchange.
Although the HIE supports the secure exchange of many common electronic health information transactions, there are many other uses for the HIE that trading partners are beginning to explore. For example, several clinics are looking to the HIE as a method to facilitate referrals in their community through the use of a community referral form and the CCD.

Other organizations are considering the OneHealthPort HIE as a ready infrastructure that can be used to support sharing information and reports for ACOs. The HIE also encourages trading partners to reach out to members in their medical community to begin to share ideas about transactions or ways to use the HIE to open other possibilities.

The HIE helps to find trading partners by providing an Entity Level Provider Directory. As the trading partner community grows, the HIE is also going to host a Practitioner Level Provider Directory in 2012.

Also in 2012, the HIE will host a Washington State Entity Level Provider Directory. This entity level directory will list any organization wishing to post on the HIE or HIO to describe their interest in participating and to describe what transactions they are ready to send and receive. This directory will include routing addresses and technical contact information for each entity.

Currently, OneHealthPort, the Washington State health Care Authority’s (Medicaid) EHR Incentive Program, and the Washington & Idaho Regional Extension Center (WIREC) are working together to finalize a proposed service for eligible professionals and hospitals to test and provide validation reporting for meaningful use requirements through the HIE.

The HIE has plans to expand beyond the state and is working with the state HIE’s of Alaska and Idaho, and with the Beacon Community of the Inland Northwest (BCIN) to prepare a policy and technical connectivity agreement for HIE-to-HIE exchange. Policy documents and technical connectivity processes resulting from the work with Alaska, Idaho, and the Beacon Community will be shared. There will be several opportunities to roll out an HIE-to-HIE connection using the agreed upon technical approach.

OneHealthPort is also working with a larger group of Western states and working with the Office of the National Coordinator to address HIE-to-HIE connections where NwHIN Direct tools are being used.

The National Renal Administrators Association (NRAA) is participating in a pilot to go through the end of March which is sponsored by CMS through the NwHIN to access the quality of patient care. The pilot will submit quality data reports containing clinical data for end stage renal dialysis patients to CMS from fourteen renal dialysis facilities across the country.

The NRAA contracted with the HIE in 2011 to obtain NwHIN exchange participation approval and to provide the technical infrastructure for this pilot. The HIE will continue to work with the NRAA for the national production that is expected to go live in 2012.

For more information, go to

MIT Developing Photonic Chips

There has been enormous progress made in recent years to develop photonic chips that use light beams instead of electrons to carry out computational tasks. Now, researchers at MIT with funding from the National Science Foundation (NSF) have filled in a crucial piece of the puzzle to enable the creation of photonic chips on standard silicon material to form the basis for most of today’s electronics.

Development of the technology would greatly boost the speed of data-transmission systems for two reasons. First, light travels much faster than electrons and secondly, while wires can only carry a single electronic data stream, optical computing enables multiple beams of light carrying separate streams of data to pass through a single optical fiber or circuit without interference. “This may be the next generation in terms of speed for communications systems, reports Caroline Ross, the Toyota Professor of Materials Science and Engineering at MIT.

In many of today’s communication systems, data travels through light beams transmitted through optical fibers. Once the optical signal arrives at its destination, it is converted to electronic form, then goes through electronic circuits, and then is converted back to light using a laser. Development of the new device could eliminate those extra electronic conversion steps, allowing the light signal to be processed directly.

“The new component is a diode for light,” says Ross and the co-author of a paper reporting on the new device that was published online November 13th in “Nature Photonics”. According to Ross, it is analogous to an electronic diode, a device that allows an electric current to flow in one direction but blocks it from going the other way. In this case, it creates a one way street for light rather than electricity.

“The whole system could be made using standard microchip manufacturing machinery” said Ross. “This would make it easier to commercialize than a system based on different materials.” She points out that there is a huge infrastructure for silicon processing and the process used is well known. This means that the chip can be developed without worrying about new fabrication techniques.”

IOM to Examine Telehealth

An Institute of Medicine (IOM) panel is going to examine how the use of telehealth technology can fit into the U.S. healthcare system. The panel to be chaired by Karen Rheuban, M.D, Professor of Pediatrics and Medical Director of the University of Virginia Office of Telemedicine, will discuss the potential for telehealth to serve geographically isolated individuals to extend the reach of scarce resources.

Topics to be discussed include:

The increasing role that policies have played to promote or delay the use of telehealth and the consumer acceptance of telehealth

Discussion on the current evidence base for telehealth including available data and gaps in data

Discussions on how technological developments including mhealth, electronic ICUs, remote monitoring, social networking, and wearable devices in conjunction with the push for EHRs is changing the delivery of healthcare in rural and urban environments

Discussions on what actions HHS can undertake to further the use of telehealth to improve healthcare outcomes while controlling costs in the current healthcare environment

The proceedings from the meeting will be summarized in a final report. For more information and meeting schedule, contact Samantha Robotham at (202) 334-3822 or email

Tuesday, February 7, 2012

Creating the Public Safety Network

Creation of a next-generation public safety communications network needs to be led by a single non-profit organization according to a report recently released by a NIST Federal Advisory Committee. NIST supports public safety communications and operates a testbed at its Boulder Colorado campus.

The report compiled by NIST’s Visiting Committee on Advanced Technology (VCAT) was discussed at a number of meetings where input was collected from the communications and public safety communities as well as the public.

The network will support voice, video and data transmissions, and ideally be at the disposal of all first responders whether they are medical, emergency, law enforcement, or military personnel if they happen to be the first on the scene where events are taking that are threatening public safety.

Public safety communications reach across many geographical, jurisdictional and technological lines, involving federal, state, and local agencies, as well as private organizations and even volunteers. All of these entities have different procedures, budgets, and existing technologies that must be coordinated to create an effective communications solution for the country.

The report concludes that a public safety communications network should:

• Incorporate commercial technology where appropriate
• Extend commercial technology to achieve robustness
• Provide for backward compatibility or interoperability through standards adopted and developed where feasible and be interoperable with existing and new 911 systems
• Give high priority to cost-effectiveness, ease of use, and affordability
• Take advantage of the internet and other packet-based technologies to support multi-media communications and mobile ad hoc network formation
• Incorporate strong, federated authentication and other security technology to positively identify and authorize personnel and equipment permitted in the system
• Incorporate advanced position location capabilities, including indoor and underground locations
• Make extensive use of open national or international standards and where appropriate open source software
• Adapt to new technologies as they are developed

Go to to view the report.

HHS Announces Two FOAs

The challenge is to integrate mental health at the same time when chronic disease care is being administered. To meet the need, NIH’s National Institute of Mental Health (NIMH) posted a Funding Opportunity Announcement (FOA) February 3, 2012. The FOA seeks research project grant applications to provide cost-effective integrated care interventions for the treatment of patients with co-morbid mental and chronic physical illnesses in low and middle income countries (LMIC).

Researchers will use innovative technologies such as mobile phones and telehealth interventions, along with information systems to help manage people with co-morbid mental and chronic health conditions living in LMICs. Researchers will also test models to be used for resource sharing, communication, case referral, and service planning.

Institutions of higher learning, non-profits, for-profits, state, county local governments, are invited to apply. Funds for the FOA titled “Grand Challenges in Global Mental Health: Integrating Mental Health into Chronic Disease Care Provision in Low and Middle Income Countries” (RFA-MH-13-040) are anticipated to be approximately $2,000,000 in FY 2012 and provide funding for up to four awards.

Go to for more information.

NIH, CDC, FDA, and ACF on January 31st released an FOA seeking SBIR/STTR grant applications from small businesses. The National Institute of Biomedical Imaging and Bioengineering (NIBIB) goals are to improve health by accelerating the application of biomedical technologies.

These are just a few of the specific needs that NIBIB is requesting through their SBIR/STTR FOA:

• Develop software and hardware for telehealth studies with broad applications as well as do early stage development of telehealth technologies, along with research to address usability and implementation issues in remote settings

• Research is needed to develop technology to standardize and incorporate state-of-the-art security protocols for verifying user identities and to preserve patient confidentiality across remote access

• Develop new technologies to collect, store, retrieve, and integrate quantitative data along with large-scale data-driven methods to support data mining, statistical analysis, systems biology, and modeling efforts

• Develop medical devices and implants to enable exploratory research on next generation concepts for diagnostic and therapeutic devices, develop tools for assessing host-implant interactions, perform studies to prevent adverse events, and develop predictive models and methods to assess the useful life of devices

For the SBIR program total funding for awardees may not exceed $150,000 for Phase I awards and $1,000,000 for Phase II awards.

For more information on research topics from NIBIB and other agencies, go to Go to page 4 and click on “PHS 2012-2 SBIR/STTR Program Descriptions and Research Topics for NIH, CDC, FDA, and ACF” For addition information, email Todd Merchak at or call (301) 496-8592.

Washington State News

The Washington State Health Care Authority has selected Deloitte Consulting LLP as the successful vendor to design, develop, and implement the state’s Health Benefit Exchange IT system with a $23 million grant. The Authority will begin contact negotiations and hopes to begin the project with the vendor in February.

A nine member governing board appointed by Governor Gregoire in December will begin to govern the program in March 2012. The Board will oversee ongoing design and development activities and eventually be responsible for the operation of the Exchange. The Board will also provide input on any further legislation needed to move the project forward and also help shape the state’s request for additional federal funding available this year.

The Health Care Authority has also announced that five health plans have been evaluated and are qualified as successful bidders on 2012-2013 contracts that will provide managed care for more than 700,000 Medicaid clients and Basic Health subscribers in the state.

The health plans include Amerigroup, Community Health Plan of Washington, Coordinated Care Corporation, Molina Healthcare of Washington, and UnitedHealthcare Community Plan. Two other health plans that bid on the contracts were Premera and Columbia United Providers. The next step is to finalize the contracts with the successful bidders, a step the Health Care Authority expects to complete by the end of February.

Doug Porter, Director of the Health Care Authority said, “Washington State contracts drew national attention since health plans across the country are eyeing the increased enrollment anticipated by Medicaid programs once national healthcare reform raises eligibility standards, effective January 1, 2014.

Washington State’s Beacon Community of Inland Northwest (BCIN) recently released their 2011 Annual Report with a section on the use of technology in BCIN. According to the report, 48 technical assessments were made at clinics, hospitals, and physician offices around the region.

Some of the specific projects included:

• The Enterprise Master Patient Index containing patient demographic information was evaluated. The Index brings the records into one view allowing the clinical staff to see the full continuum of care for the patient

• Developing interface standards to be used by any facility sending any type of data to the data repository regardless of the system

• Being able to send data electronically between BCIN and the information systems at eleven hospitals and physician offices.

• Developing a disease management tool to allow data from the clinical data repository to flow into a patient’s specific algorithm to help care-coordinators determine the best approach to use

• Completing the full implementations of the technology needed at two clinics and two hospitals

• Developing a technical training program with supporting guidebooks to teach clinic staff how to use needed technical tools

BCIN is in the process of creating a report engine to allow for Business Intelligence Reporting, and is also developing a web-based Patient Portal that will enable patients to become more involved in their care and provide information to their caregivers.

Brain-Controlled Posthetic Arm

A new prosthetic arm operated by a wounded soldier at the Walter Reed National Military Medical Center (WRNMMC) for the first time, enabled the soldier to control the device’s metallic fingers and wrist with his thoughts. The Modular Prosthetic Limb (MPL) was developed as part of a four year research program by the Johns Hopkins University Applied Physics Laboratory, WRNMMC, and the Uniformed Services University of the Health Sciences (USU).

Col. (Dr.) Paul Pasquina, Chief of Orthopedics and Prosthetics at WRNMMC and Director for the Center of Rehabilitation Sciences at USU explained that the limb is controlled by surface electrodes that pick up electric signals generated by the muscles underneath the skin, and then convert those patterns in electrical signals into a robotic function.

With an amputee, the nerves traveling down the spinal cord are still intact, and they’re still connected to some of the muscles in the arm, said Pasquina. “What we are trying to do is pick up the electrical signals of the muscles that still exist in the arm and then interpret and convert these signals to a computer signal that will then drive a robotic limb. For example, when an individual is thinking about closing their hand, muscles will activate and the prosthetic limb will respond accordingly.”

As Cmdr. Jack Tsao, Director, Traumatic Brain Injury Programs for Navy Medicine’s Bureau of Medicine and Surgery explained, before being fitted with the device, amputees must first go through training using the Virtual Integrated Environment (VIE) to record their muscle movements. By collecting the amputees muscle data, the MPL is then individualized for the person using the device.

Engineers are hoping to use electrodes underneath the skin to achieve an electrical signal with much higher fidelity. Researchers are looking to explore other mechanisms to rewire nerves and learn even more about how the body can integrate with computers and computer interface. “The next step in MPL’s development is to incorporate sense of touch and apply this technology to prosthetic legs in the future”, said Tsao.

Navy Seeks Commercial Partner

As reported in FLC Newslink, SPAWAR Systems Center Pacific (SSC Pacific) seeks commercial partners for licensing or collaborative agreements for its rotatable multi-cantilever “Scanning Probe Microscopy” (SPM) head that is able to consolidate several scanning probe tips into a rotating array.

There are over 20 established types of scanning probe microscopes. Currently each microscope requires a separate circuitry box with each one costing $30,000 to $50,000. SSC Pacific has developed a technology that is able to consolidate many circuit boxes into one array that rotates to apply each measurement. Instead of removing a circuit box on the machine and replacing it with another, the user can rotate the scanning probe head and apply the next measurement to the sample.

This technology allows the user to obtain more information about one sample by allowing many different tips to interact with the same measurement site. The system could also save money and materials during production by consolidating circuitry onto one machine.

The growing field SPM is a branch of the field of microscopy and is of benefit to various fields of research operating with microns down to nanometers. SPM has helped advance industries such as solar, data storage, integrated circuits, chemistry, and many medical areas of study like DNA, cell membranes, and bacteria.

For more information, email SPAWAR Systems Center Pacific at

Sunday, February 5, 2012

ATA Highlights Licensing Barriers

The American Telemedicine Association (ATA) hosted a groundbreaking briefing on Capitol Hill to discuss “Physician Licensure Barriers to 21st Century Healthcare”. The briefing initiated by ATA was held to inform Congressional offices, national organizations, and other key stakeholders on the current U.S. state-based licensing systems. According to ATA and other stakeholders, the present licensing system restricts quality modern healthcare.

Opening the event, Bernard Harris Jr. M.D., MBA, President of ATA and President and CEO of Vesalius Ventures said “ATA has been leading the charge in resolving problems associated with state-by-state licensure and regulation of health professionals.” In his career as a medical doctor, Harris had to reply for several separate licenses but all with the same licensing requirements.

Jonathan Linkous, Chief Executive Officer for the American Telemedicine Association, said, “It is time to explore licensure reform nationwide to help increase consumer choice, improve safety, and cut costs for patients across America. What the licensing issue is not about is partisan politics, not about taking state rights away, and not just about telemedicine since licensing is an important issue affecting the entire health and medical community.”

As Linkous pointed out, “The patchwork of state-by-state licensing creates a mire of costly red tape and has become an untenable barrier for both providers and patients. If physicians today want to do telemedical visits with patients in another state, they have to be licensed in both their home state and also in the state where the patient is located.

Also, there is no one model for the way state medical boards approach licensure so it can be very confusing across all 50 states. Resolving this problem will improve patient choice, ensure consumer safety, cut costs, alleviate regional healthcare shortages, and remove barriers to interstate commerce.”

As moderator for the briefing, Susan Dentzer, Editor-In-Chief for Health Affairs a leading peer-reviewed journal is very concerned with the large influx of Medicaid patients anticipated in the future if health reform is in place.

Dealing with children and their heart medical problems, Craig Sable, M.D., Director, Echocardiography and Telemedicine, at Children’s National Medical treats many children remotely in the U.S. but his program also provides remote cardiac services to patients in numerous locations such in Africa.

He reports that heart defects affect 40,000 children a year with 10,000 requiring critical care. It is essential that telemedicine be used so that the doctors at the Children’s National Medical Center can work with doctors in other hospitals. As he commented, he has had problems getting licensed in several states so he could practice telemedicine, but worldwide he is able to set up similar telemedicine programs, cross boundaries, and help children without problems.

Andy Mekelburg, Vice President, Federal Relations, Verizon described the issue from the consumer’s viewpoint. Today, consumers are faced with a boom in apps available to consumers and as a result, their expectations are high in terms of reliability, ease of use, and protection of their privacy.

Verizon has spent billion on the best broadband networks with increased capacity that consumers need and want to use. As he said, “Lack of technology is not a barrier to using telemedicine since the broadband now in place has created the right technological environment so doctors have the capacity to provide telemedicine. However, the present laws and regulations that Verizon and others face are hindering their ability to provide the most effective services possible.”

As a South Dakota resident, Deanna Larson, Vice President for Quality & eCare Initiatives at Avera Health, provides services in multiple states with mostly rural areas requiring multiple state licenses. These multiple licenses are needed as Avera provides e-ICUs, e-pharmacies, and telehealth.

As she explained, “One of the biggest problems that rural areas face is not having enough specialists. There is not enough population in isolated areas to attract specialists that want to work and live in rural communities. As a result, there is the need for residents in these rural and frontier areas to use telemedicine to communicate with specialists in other areas of the country.”

She told the attendees that one of the most formidable problems to getting licensed is to find the 15 to 20 hours needed to fill out the applications as the states won’t accept each other’s forms. Also, after filling out the forms, numerous calls are needed to find out the status of the applications.

Fern Goodhart, Legislative Assistant in the Office of Senator Tom Udall (D-NM), reports that the Senator has been actively exploring issues related to a national physician licensing system to operate with state boards and has plans to issue the legislation in the spring.

Another important need is to have a database operating in real-time with all states having access to information on credentialed telemedicine practitioners. The database would contain claims histories, hospital privileges, and criminal background checks.

To meet the needs of the military, Congressman Glenn ‘GT’ Thompson (R-PA) sponsored the “Servicemembers Telemedicine and E-Health Portability Act” (H.R. 1832) or STEP Act. The passage of this legislation would enable healthcare professionals to provide care crossing state lines, according to the Congressman’s Legislative Assistant Darrell Owns.

For more information, go to or visit