Wednesday, March 28, 2012

Newborns Screened for Disorders

University of Michigan researchers going to use a $2.5 million grant from AHRQ to study how long-term health outcomes and cost-effectiveness applies to newborn screening. The project team will include investigators from a wide range of disciplines who have expertise in evidence synthesis, policy analysis for newborn screening programs, and have clinical expertise.

The study aims to provide comparative effectiveness evidence and cost-effectiveness results for newborn screening to look at medical disorders like Krabbe, Pompe, and Phenylketonuria.

• Krabbe disease is a degenerative disorder that affects the nervous system
• Pompe disease is an inherited disorder that disables the heart and skeletal muscles
• Phenylketonuria (PKU) is an inherited disorder that can cause intellectual and developmental disabilities if not treated.

There are costs and potential harms associated with doing screenings, follow-ups, and treatments therefore, it is important to recognize both the benefits and costs involved in screening newborns. The study’s results could impact lawmakers and their recommendations for the tests given to newborns in terms of potentially harmful disorders. According to study leader Dr. Lisa A.Prosser, PhD, “New technology has made it easier and less expensive to screen newborns for additional disorders.”

Prosser is a core faculty member of the University of Michigan’s Child Health Evaluation and Research (CHEAR) Unit that analyzes the healthcare system in terms of how to finance care for children. Since its inception, the CHEAR Unit has been awarded over $40 million in research grants from federal, state, and foundation sources.

The five year multidisciplinary study will use computer modeling to simulate clinical trials for newborn screening programs. By combining information from primary data collection, systematic reviews, published and unpublished data, and expert opinions; study investigators will be able to project long-term health and economic outcomes for conditions that can be detected by newborn screenings.

The project will also include an advisory committee to include representatives from state and federal agencies, clinical experts, and patient advocacy groups to insure policy relevance and provide recommendations for disseminating research findings.

Connecting More CHCs

The Technology, Health, and Quality (THQLink) was launched last week by the National Association of Community Health Centers (CHC) in partnership with Health Center Controlled Networks (HCCN). The three HCCNs include Health Choice Network of Florida, OCHIN of Oregon, and the Alliance of Chicago.

The partners built THQLink as an infrastructure to enable the Networks along with other safety-net participants to share resources by jointly deploying state-of-the-art health IT. Their objective is to support the efficient and effective use of health IT to achieve “Patient Centered Medical Home” recognition. Also the plan is to implement a robust data aggregation and analytics platform to measure outcomes, share best practices, and improve population health.

Community Health Centers need to address how to deliver healthcare, measure outcomes, and how to effectively share data, but the thinking today is that CHCs also need to address social and economic conditions in the community. In order for the CHCs do this, updating health IT is required to not only effectively deliver health and medical information but also for the CHCs to help communities with other issues such as employment, education, and help to provide social support in the community.

In researching this need, the Institute for Alternative Futures released the study “Community Health Centers Leveraging the Social Determinants of Health” available online at The study discusses how Community Health Centers (CHC) reach beyond clinical care to shape the health of their patients by changing community conditions and performing non-clinical work.

The IAF report describes the patterns across many initiatives and details the recommendations developed at a national workshop of community and public health leaders on how to support and expand these actions.

Some of the recommendations include establishing partnerships and collaborations as a critical need. For example, HRSA should leverage Social Determinants of Health (SDH) in a collaborative setting where CHCs could share information on their success in treating patients with chronic diseases. Patients could create story boards and registries to broadcast and report on how and what information was exchanged to help achieve success.

Also, HRSA’s Bureau of Primary Health Care should make it easier for CHCs to report the nature and the scope of their SDH efforts to the Uniform Data System and to the Electronic Handbook.

Another recommendation wants to see HRSA form and lead a formal interagency group to promote advances and support efforts addressing the SDH within communities. The report recommends that the Federal Interagency Health Equity team and the National Prevention Council work with the National Partnership for Action to end health disparities. Agencies that need to partnership in one way or another include USDA, Department of Commerce, DOD, ED, EPA, HUD, DOJ, DOL, DOT, VA, HHS and the U.S Consumer Product Safety Commission.

In studying the SDH issues in communities, the Robert Wood Johnson Foundation sponsored a poll and found that while most physicians recognize the importance of working with the patient’s community and social conditions, they are still unsure how they should specifically address the societal needs and issues.

To help study and meet SDH needs, the RWJF Community Grants program is in place to address economic and social issues supporting system changes in communities. The RWJF Community Grant program not only sees the need to address employment issues and education, but also realizes that family and social support needs to be addressed in communities.

The Grantees involved in this program are organizations participating in established coalitions or networks spanning multiple sectors and include representatives from business, education, public health, healthcare, community organizations, policy advocates, and foundations.

The RWJF Community Grants program has recently announced up to 20 grants in 2012 will be awarded with grantees receiving awards up to $200,000 each for up to 24 months to use to implement their proposed policy or system change strategy. Non-profit organizations, tribal groups, or state and local agencies are eligible to apply.

An applicant conference call was held March 20th with another applicant conference call scheduled for April 10, 2012. May 2, 2012 is the deadline for brief proposals and July 25, 2012 is the deadline for full proposals.

Go to to view more information. For inquiries email Alexis Brimage-Major, at or call 617-275-2865.

Air Force's Automated Eye Care

The refraction process has not changed for more than 100 years, but some of the tools used to perform refraction have improved with the development of new technology. The Peterson Optometry Clinic at the Peterson Air Force Base located in Colorado has acquired and is using an automated refraction system.

Previously, the ophthalmic technicians in the optometry clinic would collect data on a patients’ vision status and on their current prescriptions and then enter the information into the EHR for the optometrist to use as a starting point for the exam.

Now, the data is automatically transferred to the refraction equipment in the doctor’s exam room. The new system design allows the doctor to be more efficient throughout the refraction process by simply pressing buttons and rapidly assessing which combination of lenses provides the best possible vision for the patient.

The best part is that the doctors can view the contrast between what the patient’s vision is with their current prescription and what their vision will be with their new and improved prescription. Healthcare providers at the clinic are now able to offer patients more comprehensive care by providing immediate feedback about changes in their vision.

The new automated system actually decreases the chances for errors significantly. By automatically transferring data from the technician to the doctor, errors that occur during the transcription of that data are eliminated. This means fewer patients return to the clinic to be rechecked and more appointments are available to other patients.

Tracking Environmental Issues

The CDC currently funds 24 state and local tracking programs to protect people from health threats as part of their National Environmental Public Health Tracking (EPHT) Network. Since the network was launched, public health officials have used state tracking networks to identify trends in increased asthma, higher lead poisoning rates, and to identify people at high-risk of consuming contaminated drinking water.

Vermont was faced with a problem involving the high rate of asthma for individuals in the state. Asthma affects about eleven percent of adults and ten percent of children in the state. Some areas of the state have higher rates of hospital stays and emergency room visits due to asthma, but the reasons remain unknown.

Rutland County has the highest hospital rate of all Vermont counties. The Department of Environmental Conservation’s air monitoring data shows that this county also has the most days per year of air pollution from fine particulate matter. Ozone pollution along with mold and allergens in older housing may also be contributing to the health problem.

The Vermont Tracking Program is partnering with the Department of Health’s CDC-funded Asthma Program to use tracking data to identify trends and patterns in asthma hospitalizations and emergency department visits in the state. Better understanding of asthma triggers could lead to better ways to prevent asthma, lead to fewer hospitalizations and emergency department visits, and help the state to take the most appropriate public health actions.

Connecticut is another state where residents are concerned with asthma especially those residents living in urban areas. The Connecticut Tracking Program was developed as part of the state tracking network just to look at the state’s rate of residents with asthma and includes data from the state asthma program and from hospitals across the state.

Today, thanks to the tracking program, complete user-friendly asthma data for the state is available in one place for the first time. In addition, other health department programs in the state now have access to asthma data that can help them more readily evaluate their asthma prevention and control activities.

In 2012, CDC will be adding new data to their Tracking Network to help further define the health impacts of fine particles in the air, to learn how environmental issues can affect developmental disabilities, and how environmental issues are affecting cancers such as kidney, liver, mesothelioma, and melanomas.

Chip to Help the Brain & Heart

Dr. Hashem Ashrafiuon, a mechanical engineering professor at Villanova University’s College of Engineering and his team are working on a computer chip that could be imbedded in an athlete’s helmet to transmit brain wave data for instant analysis by using software now under development.

The software developed by Ashrafiuon and colleagues from the University of Wisconsin and Brain Computer Interface LLC is able to analyze human brain wave data commonly known as EEG signals. The data is recorded by a single-electrode headset and is able to predict abnormalities in brain activity. This means that information given can significantly improve a concussion diagnosis using an inexpensive portable EEG medical device.

“The software can be used to help not only athletics but according to Ashrafiuon, the software can also be used to diagnose and health problem that affects brain activity. He hopes to be able to monitor brain health in patients with mild TBI, PTSD, Alzheimer’s disease, mild cognitive impairment, and sleep and circadian disorders. At this stage of the research, Ashrafiuon’s team has validated the software in a study performed under a U.S. Army SBIR contract to specifically evaluate software to potentially diagnose PTSD.

The team’s current research findings were presented at the 2011 Alzheimer’s Association International Conference in Paris, France and is expected to be published at several conferences in the spring and fall of 2012. Commercialization of the software is projected for 2014.

In another university research effort at the University of California in Irvine, Ventricular Assist Devices (VAD) medical devices to assist with blood flow from a lower chamber of the heart to the rest of the body, may now be used in patients with Heart Failure (HF) to assist with their cardiac functions. Currently, VADs require direct contact with the blood, and as a result, patients need to be on antirejection and anticoagulation therapies. A VAD not requiring the patient to take additional medication may decrease complications for the patient and would also be cost effective.

Researchers at the UCI have developed a medical device to augment cardiac function during HF. The “Extra Cardiac Ventricular Assist Device” (ECVAD) operates by a different mechanism than the pulsatile or continuous flow designs that are currently used.

With the ECVAD, there is no direct contact between the device and the patient’s blood which decreases the risk of contamination of the blood and eliminates the need for certain drug therapies. In addition, the ECVAD can be implanted using minimally invasive laparoscopic surgery and can be easily removed without tissue damage to the patient.

For more information, email Grace Yee at the UCI Office of Technology Alliances.

Saturday, March 24, 2012

Artificial Pancreas Trial Approved

FDA recently approved the first outpatient artificial pancreas trial in the U.S. that will test a device to be used by individuals with Type 1 diabetes. The hand-held device was created by reconfiguring a standard smart phone capable of automatically monitoring blood sugar levels and providing insulin as needed. It works by combining a continuous glucose monitor and an insulin pump complete with sophisticated computer software that automatically provides the right amount of insulin at the right time.

The development of an artificial pancreas has been one of JDRF’s top priorities and the Foundation in working with NIH’s Special Diabetes Program has funded groundbreaking work in recent years to advance the research and development of the device.

As part of the study, the first outpatient trials used an approach developed by the JDRF- supported Artificial Pancreas Consortium. This international research group worked together with teams from Montpellier University Hospital in France, the Universities of Padova and Pavia in Italy, and the Universities of Virginia in Charlottesville.

The first eight Type 1 diabetes patients participating in outpatient trials in Europe were able to maintain safe blood sugar levels using the artificial pancreas, able to eat a restaurant meal, and able to spend one night at a hotel while using the device.

The approval of the JDRF study follows a major 18 month effort by JDRF and others to ensure a clear and reasonable regulatory pathway for outpatient artificial pancreas studies and ultimately for Artificial Pancreas systems to be approved and made available by the FDA.

In early 2011, JDRF proposed guidance to the FDA based on recommendations from an external expert panel and where over 1000,000 people in the diabetes community signed JDRF’s petition seeking approval from FDA. In addition, the petition was signed by leading clinical organizations as well as over 60 Senators and 250 Representatives. The FDA met the deadline and released the draft guidance for Artificial Pancreas systems in December 2011.

JDRF recently completed an evaluation of the FDA draft guidance for Artificial Pancreas systems and submitted further comments to FDA on March 3rd. JDRF is happy to report that the draft contains many positive elements that will encourage research and development for the artificial pancreas so that the technology will become available in the U.S.

Mobile Health Research

Clinical researchers at the University of Massachusetts Medical School are combining innovative technologies to prevent and treat drug abuse. The researchers studying emerging technologies such as artificial intelligence, smartphone programming, biosensors, and wireless connectivity have designed a device that will detect physiological stressors associated with drug cravings.

According to the preliminary data from the research study published online in the “Journal of Medical Toxicology”, many behavioral interventions used to treat patients are ineffective outside of controlled clinical settings where they are taught. This failure can be attributed to the patient’s inability to recognize biological changes that indicate increased risk of relapse and an inability to change their behaviors to reduce health risks.

Edward Boyer, MD, PhD, Professor of Emergency Medicine and lead author of the study worked with his colleagues at the University of Massachusetts Medical School and MIT to design a mobile device equipped with enabling technologies that will make behavioral interventions to treat substance abusers more effective outside the clinic or office environment.

The device called “iHeal” combines sensors to measure physiological changes and is able to detect trigger points for risky health behaviors such as substance abuse using Smartphone software that will respond with patient-specific interventions.

Individuals with a history of substance abuse and PTSD were asked to wear an “iHeal” sensor band around their wrist to measure the electrical activity of the skin, body motion, skin temperature, and heart rate. This information wirelessly transmits information to a Smartphone where software applications monitor and process the user’s physiological data.

When the software detects an increased stress level, it asks the user to input information on their perceived stress level, drug cravings, and current activities. This information is used to identify in real-time drug cravings and then deliver personalized multi-media interventions precisely at the moment of greatest physiological need.

In another development in Massachusetts, the Worcester Polytechnic Institute (WPI) a research group developing mobile smart applications has established the Healthcare Delivery Institute (HDI). The plan is to bring together engineering, science, and business to help solve problems on delivering high quality healthcare for a growing aging population.

HDI’s areas of expertise will develop mobile and wireless smart applications, study the adoption and impact of health IT systems, model and redesign the way healthcare is delivered, and mine the digital data now generated by systems.

HDI has approximately $4 million in current funding from the National Science Foundation (NSF) and the Veterans Administration’s New England Healthcare System. Last fall, NSF awarded WPI $1.2 million to develop a Smartphone application to help people with advanced diabetes and foot ulcers to better manage their disease. The HDI faculty will work on the four year project in collaboration with diabetes and wound care specialists at UMass Medical School.

For more information on HDI, go to

AHRQ Invites Proposals

The Agency for Healthcare Research and Quality (AHRQ) issued RFP No. 12-10005 on March 19, 2012 entitled “Patient Safety Organization Privacy Protection Center” (PSOPPC). The Patient Safety and Quality Improvement Act of 2005 authorized the creation of Patient Safety Organizations (PSO) to collect, aggregate, and analyze confidential and privileged information regarding the quality and safety of healthcare.

The Patient Safety Act also authorized AHRQ to develop a “Network of Patient Safety Databases” (NPSD) where PSOs can voluntarily contribute non-identifiable patient safety event information. The NPSD is going to report on non-identifiable, aggregated patient safety event information to be included in AHRQ’s Annual National Healthcare Quality Report and in the National Healthcare Disparities Report.

AHRQ established the PSOPPC to assist PSOs and others to make certain that patient safety event information be made non-identifiable prior to sending to the NPSD. The main requirement of this contract is to provide guidance to PSOs with how to use common formats and how to render patient safety event information non-identifiable.

The Contractor selected must maintain the PSOPPC and the information received by the PSOPPC must be handled with extreme care, adhere to high standards of quality control, and be managed efficiently and transparently. Also, the PSOPPC must operate in tight coordination with the NPSD.

The Contractor must also maintain the PSOPPC website and databases, transfer non-identifiable information concerning patient safety events to the NPSD, provide assistance and training to PSOs, and conduct several meetings and conference calls.

A Notice of Intent is due April 12, 2012 with proposals due April 19, 2012. For more information, go to or email Kathryn Carr at or phone 301-427-1151.

Rural Networks Issued RFPs

The FCC supports the Rural Health Care Program (RHCP) and the Rural Health Care Pilot Program (RHCPP) of the Universal Service Fund administered by the Universal Service Administrative Company. Since the first of the year, several RFPs were issued in selected states that included Illinois, Missouri, Nebraska, and New York State. In addition, an RFP was issued by the Southwest Telehealth Access Grid and an RFP was issued by the Virginia Acute Stroke Telehealth Project.

The Illinois Rural HealthNet Consortium (IRHN) was created to deploy high speed networking to rural hospitals, clinics, and mental health facilities to connect to larger facilities to have the ability to deliver telemedicine and telehealth services. The IRHN Consortium includes behavioral and medical health service and higher education organizations, along with existing health, education, and research networks.

When completed, the IRHN will provide virtually instantaneous transfer of diagnostic images for treating cardiology, neurology, and oncology patients. The Network will also provide real-time virtual consults for trauma patients and provide psychiatric services.

The IRHN posted their RFP on January 26, 2012 and again posted an RFP on March 5, 2012 seeking bids to provide services to new locations not previously addressed. For more details, email Pat Schou at or call 815-875-2999.

The University of Missouri/Missouri Telehealth Network (MTN) on January 20, 2012 issued an RFP requesting Recurring Telecom Services. MTN has a 2 gigabit backbone infrastructure on the MOREnet network to connect major underserved population centers in the state. For more details, email Darla Higgins at

The Rural Nebraska Healthcare Network (RNHN) has recently completed a 70 mile fiber optic, privately owned, multi-gigabit Ethernet network connecting 40 hospitals and clinics in the Panhandle. RNHN posted an RFP on February 7, 2012 and an RFP on March 13, 2012, seeking to further connect their fiber network to the internet consistent with the program guidelines of the Rural Healthcare Pilot Program (RHCPP). For more details, email Kent Van Metre at

In New York State, the Adirondack-Champlain Telemedicine Information Network (ACTION) issued an RFP on March 9, 2012 requesting equipment and services. ACTION a regional initiative seeks to provide leased broadband intranet services to support new connections to the existing Network. Bidders will need to provide for a managed switch service over a secure fiber/Ethernet broadband network.

Another RFP was released on March 9, 2012 by the North Country Telemedicine Project (NCTP). This is a regional fiber optic telecommunication telemedicine network connecting 28 participating entities located at sites operating in Jefferson, Lewis, and St. Lawrence Counties in New York and four urban facilities located in Syracuse and Utica.

The Southwest Telehealth Access Grid (SWTAG) is an interstate network of networks serving New Mexico, Arizona, and the Southwest Indian Health Service Telehealth Consortium and associated tribes.

The Winslow Indian Health Care Center (WIHCC) in the region is planning to construct an interconnected broadband network to link providers. WIHCC posted an RFP on February 9, 2012 seeking a 50mbps point-to-point dedicated circuit with Ethernet handoff, preferably non-bonded broadband connectivity to support EHRs. Vendors, suppliers, and service providers are to provide the connectivity and any required edge network electronics and devices. For more information, email

The University of Virginia’s Virginia Acute Stroke Telehealth Project (VAST) sought bidders to respond to their RFP released January 31, 2012 with the contract to be awarded on April 16, 2012. The contract will enable VAST to build their telecommunications backbone so that healthcare providers will be able to use telemedicine and telehealth to support stroke care and health IT. The three health system hubs in the system include the University of Virginia Health System, Culpeper Regional Hospital System and Eastern Shore Rural Health System. For more information, email Michael Warlick at

Go to to view more information.

Computer Tracking Dementia

Ashish Raj, PhD, Assistant Professor of Computer Science in Radiology and his team at Weill Cornell Medical College developed a computer program capable of tracing how different forms of dementia spread within a human brain. They report that their mathematic model can predict where and approximately when an individual patient’s brain will suffer from the spread, neuron to neuron of “prion-like” toxic proteins which they say underlies all forms of dementia.

The research was funded by NIH and the findings have been published in the March 22, 2012 issue of “Neuron”. The results of the study could help patients and their families confirm a diagnosis of dementia and prepare in advance for future cognitive declines over time. In the future, targeted drugs will be available to treat dementia and the findings from this research might help physicians identify suitable brain targets for therapeutic intervention.

“Think of a weather radar system with the capability to show a video of weather patterns in an area over 48 hours”, explained Dr. Raj. “Our computer model when applied to the baseline magnetic resonance imaging scan of an individual brain can similarly produce a future map of degeneration in that person over the next few years or decades.”

“This could allow neurologists to predict what the patient’s neuroanatomic and associated cognitive state will be at any given point in the future. It will be possible to tell when the patient will develop speech impediments such as memory loss, behavioral peculiarities and so on.”

The computational model is the latest and one of the most significant validations of the idea that dementia is caused by proteins that spread through the brain along networks of neurons. It was reported in February that Alzheimer’s disease starts in a particular brain region but spreads further via misfolded toxic “tau” proteins. These studies were done by researchers at Columbia University Medical Center and Massachusetts General Hospital but only focused on Alzheimer’s disease.

According to Dr. Raj, the classic patterns of dementia are well known. This however, is the first computer model to relate brain network properties to patterns and explain them in a deterministic and predictive manner.

The study’s third author is Michael Weiner, M.D, Professor of Radiology at the University of California, San Francisco, and the Principal investigator of the Alzheimer’s disease neuroimaging initiations.

For more information on the study, email Richard Pietzak at

Tuesday, March 20, 2012

Kennedy & Ramstad Speak at NPC

Former Congressmen Patrick Kennedy and Jim Ramstad launched their “Parity Implementation Coalition” at a March 14th National Press Club luncheon to obtain grass root support for more inclusive treatments for individuals with mental illnesses. The immediate plan is to hold events and hearings in a number of cities to garner public support to ensure that mental illness and drug issues will be insured by insurance companies that treat diseases of the brain in the same way as diseases of the body.

Patrick Kennedy recounted that on October 3, 2008 President George W. Bush signed into law the “Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act”. As he explained, “We need to lobby to complete the unfinished work that this Act intended to accomplish.” Both former Congressmen are strongly calling for Congress to act to establish the final rule for the legislation.

Both speakers are passionate concerning the return of our wounded veterans with brain injuries that is costing lives in terms of suicide and high risk behaviors. However, many of the wounded warriors do not seek treatment through the VA because they feel a stigma in having a mental illness.

Patrick Kennedy also reported on his involvement in a new research mission launched in 2011 along with his friend Garen Staflin called “One Mind for Research”. The mission’s goal is to unravel the profound complexities of brain science, to accelerate cures for diseases of the brain, and to eliminate the stigma and discrimination these brain diseases cause.

The organization has spearheaded a broad-based, international coalition of renowned neuroscientists, advocates, policy makers, and others to help define the first global scientific roadmap for curing diseases of the brain within 10 years.

As Kennedy reports “One Mind for Research” is involved in several initiatives including:

• The Disease Network Alliance to focus on TBI and Post Traumatic Stress. The Alliance is operating as a new public-private partnership to bring the best-in-class science, technology, and expertise together to accelerate research and come up with new diagnostics, treatments, and cures. Partners will include international academic and corporate partners along with DOD and NIH

• A Virtual Biorepository Program to operate as an on-line international registry of biorepositories supported by the Neuroscience Information Framework, American Brain Coalition, and NIH

• A Brain Data Exchange Portal to operate as a federated data sharing technology platform created with J&J and to be managed by the International Neuroinformatics Coordinating Facility with 16 member nations

• A Digital Brain Imaging Toolkit to operate in partnership with GE Healthcare to establish new imaging analytics methodology and to form a public-private partnership for PET Ligand development

• The Alzheimer’s Disease & Dementia Leadership Council to operate as a partnership with the New York Academy of Sciences along with citizen representatives to define executable programs able to eliminate barriers to developing cures for Alzheimer’s and other dementias

It was announced by Patrick Kennedy on March 12th, that General Peter W. Chiarelli, U.S Army (Retired) will join One Mind as Chief Executive Officer. Said Chiarelli, “I am honored to join One Mind and look forward to building on the work I did during my time with the Army to draw attention and to initiate support for active duty military personnel and veterans with TBI and post traumatic stress”.

Disability System Needed

The Social Security Administration (SSA) is developing an Occupational Information System (OIS) tailored specifically for their disability programs. In order to work with disability claims, SSA needs information on occupations that exist throughout the nation to determine whether an individual claiming a disability is no longer able to work.

Currently, SSA uses primary sources of information on jobs and job requirements from the Department of Labor (DOL), but from now on, DOL will not be updating their job requirements information. Therefore, SSA is taking steps to develop an Occupational Information System suited specifically for their Social Security disability program.

Several years ago, SSA established their Occupational Information Development Advisory Panel (OIDAP) and on March 22nd 2012, a meeting will be held to advise SSA on how to address the agency’s needs.

In addition, to the advice from OIDAP members, SSA is also consulting with external stakeholders, professionals, and members of the public regarding the best way to do disability evaluations and how to use occupational information to help in their disability programs.

OIDP’s activities in FY 2012 and in FY 2013, OIDP will include:

• Conducting quarterly OIDP meetings
• Collaborating and partnering with DOL and other federal agencies during the research and development phases of the project
• Identifying key OIS design elements
• Recruiting, training, and certifying job analysts to perform data collection
• Developing and pre-testing the prototype work analysis instruments involving job analysis and data collection on occupations
• Developing and testing prototype data collection methods and data management systems
• Developing the “Prototype OIS Data Analysis Plan”
• Developing a study design for a job analysis pilot to test sampling and data collection methods
• Conducting a prototype pilot for OIS data collection and job analysis processes

For more information on the Advisory Committee meeting, email Leola S. Brooks at

Texas Approves HIE Plans

In March, the Texas Health and Human Services Commission (HHSC) and the Texas Health Services Authority (THSA) approved several Business and Operational (B&O) HIE plans located in several regions in the state. These approvals include the Rio Grande Valley HIE (RGV HIE), Southeast Texas Health System (SETHS), the Rio One Health Network, and FirstNet Exchange.

The Rio Grande Valley (RGV) healthcare industry is currently experiencing unprecedented changes and uncertainty due to healthcare reform, the Texas Managed Medicaid rollout will require changes, plus financial pressures are coming from hospitals and physicians to either upgrade or purchase EHR systems to meet Meaningful Use requirements.

The RGV consists of 24 hospitals with 14 of the hospitals adopting IT, four federally funded health centers, and slightly over 1,000 primary care physicians to care for a population of 1.4 million. This population grows at least 10 percent each year when adding the “Winter Texans” and does not include the constant heavy influx of patients from Mexico.

The Valley also faces major health disparities in a population that is among the poorest in the U.S. and is medically underserved. As a result, there are serious medical challenges in the valley. For example, the rate of diabetes in the U.S is about 8 to 9 percent of the adult population but in the Valley, the rate is over 20 percent which can lead to heart disease, renal disease, blindness, and overall disabilities.

The RGV HIE’s Business and Operation Plan addresses the major components for the HIE’s operations including governance, HIE technical model, HIE core services, and the plan for sustainability. The Plan also provides details on RGV HIE’s technology capabilities, implementation approach, and the timeline.

The SETHS is a non-profit corporation equally owned by 9 hospitals whose purpose is to collaborate to create economies of scale and scope in the delivery of healthcare. During the planning phase, objectives were to complete an environmental scan to identify the baseline of work, to identify a supportable and sustainable technology solution, and to determine the business model to use to support technology solutions.

The membership of SETHS predominantly represents smaller healthcare organizations that in many cases provide care to rural populations in southeast Texas. This means that the technical architecture needs to be developed in certain ways.

First, the architecture needed to be implemented using open source technologies not requiring extensive capital investments. Additionally, the architecture does not assume that all HIE participants have uniform or large-scale IT infrastructure available.

This means that as with most HIEs, the members of SETHS have chosen a variety of technologies to store electronic health data. Instead of forcing them to upgrade their systems to support a uniform information exchange capability, it is permissible to retrieve health data wherever the information is available.

The Rio One Network is a non-profit corporation established to develop a HIE organization in Hidalgo and Starr counties in compliance with state and federal standards. The network’s goal is to create a regional network of physicians, hospitals, pharmacies, and laboratories intent on exchanging health information.

The HIE is collaborating with the Hidalgo County Health Department to provide resources such as immunizations registries and other public health surveillance systems. The plan is to link with the network technology currently in use at the county government that is helping the enrolled indigent care population.

Members of the community and healthcare providers have been meeting to discuss the importance of developing a “Local Health Information Exchange” in the region. Not only have the features and benefits of a local HIE been discussed, but discussions on the software connectivity process, federal and state requirements for an HIE, grant requirements, and sustainability for the program have also been taking place.

The Rio One Network is actively identifying all pharmacies and laboratories that want to participate in the network. They are identifying the pharmacies and laboratories participating in e-prescribing and laboratories that are presently delivering results electronically.

Meetings have been held with the Independent Pharmacies Association to engage more pharmacists to participate in the local HIE plus independent laboratories have been approached in an effort to have them also participate. Ongoing discussions are being held with laboratory directors, managers, and their personnel.

To insure that active input is maintained, both the pharmacy and laboratory industry have representatives on the Rio One Board of Directors. The Board and Cerner are working with individual pharmacies and laboratories to insure a smooth transition to the Network in 2012.

FirstNet Exchange was formed in 1996 by the East Texas Medical Center (ETMC) Regional Healthcare System as a regional HIE. It started by connecting ETMC hospitals and physicians, but grew to provide a data exchange for numerous East Texas providers.

Today, the Exchange includes 15 hospitals and over 600 physicians and spans 21 counties with data on over one million patients. In the long term, the plans are to use the THSA local HIE Grant program funds to develop and implement a clinical information exchange to meet requirements in 37 counties of East Texas and then to integrate the exchange into the HIE platform.

FirstNet Exchange is working with their partners to provide connectivity services. In cases where current partners cannot offer connectivity services, the Exchange will identify other telecommunications companies or cable/cellular providers able to help develop a viable option.

For more information, go to

Sensor Identifies Tumors

A tactile imaging sensor developed by Temple University engineers is able to give doctors important early information on lesions or tumors. A key part of a patient’s physical exam is performed through touch but the doctor can only obtain so much information. Temple University researchers have now created a prototype device to cost around $500 that has the capability to emulate human tactile sensation.

As Chang-Hee Won, Director of the Control Sensor, Network, and Perception Laboratory at Temple’s College of Engineering and one of the developers of the device explained, “Human hands have this amazing ability to touch something and to tell if it is soft or hard, wet, or even warmth. We are trying to emulate this tactile sensation with a device that will actually quantify this by giving us the mechanical properties of what we are feeling.”

Won explained that the tactile imaging sensor could aid doctors when they feel lesions lumps or tumors while doing physical exams on patients by detecting the size and shape of the lesion or tumor as well as its elasticity and mobility and also be able to characterize the mechanical properties of the irregularity.

When the doctor feels an irregularity while giving a patient a physical exam, the doctor can then place the sensor against the skin where the irregularity was felt with the portable tactile imaging sensor attached to any desktop or laptop computer.

The sensor uses the total internal reflection principle, which keeps the injected light within the elastomer cube unless an intrusion from a lesion or tumor changes the contour of the elastomer’s surface. At that time, the light will reflect out of the cube. The sensor’s camera will then capture the lesion or tumor images caused by the reflected light, process the image using a novel algorithm, and then calculate the lesion’s mechanical properties.

According to Won, studies have shown that cancerous lesions and tumors tend to be larger, more irregular in shape and have harder elasticity. With the information obtained by the new sensor device, it is anticipated that doctors will be able to determine the probability being either malignant or benign.

Resource to Profile Medications

NIH and Eli Lilly and Company are developing a publicly available resource to profile the effects of thousands of approved and investigational medicines. The NIH newly established National Center for Advancing Translational Sciences (NCATS) and Lilly Research Laboratories are collaborating to screen the NCATS Pharmaceutical Collection of 3,800 approved and investigational medicines a comprehensive publicly available database at by using Lilly’s “Phenotypic Drug Discovery (PD2) panel.

The PD2 assay panel part of Lilly’s Open Innovation Drug Discovery platform at consists of sophisticated human disease pathway-related assays relevant to cardiovascular diseases, cancer and endocrine disorders. These testing systems are designed to reveal novel mechanisms or pathway activities of drugs.

Comprehensive knowledge of the biological profiles of these medicines and molecules may enable biomedical researchers to better predict treatment outcomes, improve drug development, and lead to more specific and effective approaches.

The screening will take place over the next 12 to 18 months with results to be made available. For example if an approved medicine is found to be a possible treatment for a new disease indication then a partnership with the organization that owns the chemical compound could be formed to pursue additional studies.

These might include clinical trials required for marketing approval by the FDA. Alternatively, medicines with activity in the PD2 assays might serve as starting points for additional chemistry research efforts to produce new medicines.

“This innovative collaboration with Lilly is exactly the type of partnership that NCATS is eager to foster with many other groups from industry, government, and academia,” said NCATS Acting Director Thomas R. Insel, M.D. “Working together, we can make drug development pipelines more productive.”

Telemedicine Revolution is Here

Integrating telemedicine technology within the hospital and clinical environment could make the difference between success and failure in the coming months. Telemedicine to create your competitive advantage and increases your market share. For this reason, whether you are a novice or expert you will want to go to the 17th Annual ATA 2012 International Meeting & Exposition from April 29 to May 1st to be held in San Jose, California.

Top global thought leaders and visionaries will deliver their insight on how telemedicine technologies are reshaping healthcare and technology and what steps to take to achieve an advantage over others in this competitive field.

Keynote speakers leading the discussion include:

• Steve Wozniak Co-Founder Apple Computer, Inventor of the World’s First Personal Computer, Cult Icon & Self-Confessed Computer Geek

• Bernard A. Harris, Jr., M.D., MBA, President ATA, President and CEO Vesalius Ventures

• James “Butch” Rosser, MD, FACS, Professor of Surgery, Morehouse School of Medicine

• Stuart Ferguson, PhD., President Elect ATA, Chief Information Officer, Alaska Native Tribal Health Consortium

• Ed Brown M.D., Vice President ATA, Chief Executive Officer, Ontario Telemedicine Network

Everyone wants to gain a competitive edge. Clinics and hospitals are looking for a competitive edge over the health provider down the street and want to reduce their cost of doing business—not tomorrow but right now. Businesses are looking to lower the cost of insurance plans and ways to keep workers with chronic disease healthy and on the job.

Smart marketers know they have an edge when they are able to showcase clinical tools using technology to cut costs without cutting services. ATA 2012 will enable attendees to network with 4500 clinicians, researchers, administrators, entrepreneurs, IT specialists, engineers, and companies eager to find out how to obtain these results.

The ATA 2012 Premier Peer-Reviewed Telehealth Educational Program will be based on the latest research and presentations will relate to specialty areas within the telemedicine field. This year, the educational program has been built around 5 macro focus areas such as Business, Finance & Economics, Model Programs & Best Practices, Scientific Research, Outcomes & Evidence, Innovative Applications, and Public Policy.

Just a sample of the not-to-miss critical and informative sessions that will address:

• Global Telemedicine Issues
• Rural Hospitals and Tele ICUs
• Mobile Health Innovation for Disease Management
• Integrating Home Collected Data into the VA EMR System
• Telemental issues facing the General and Military Population
• The State of Mobile Apps
• Using Innovative Telemedicine in Military Settings
• How Medicare –Medicaid Applications apply to Telemedicine
• How Emergency & Trauma Care can better use Telemedicine

At this important venue, ATA 2012 will hold the world’s largest Telehealth Exhibition. The ATA Expo Hall will house the biggest tradeshow ever held in this field anticipated to be over 20 percent larger than last year. Attendees can see and handle thousands of the latest telemedicine technologies from over 250 product and service vendors.

Get a jumpstart on ATA 2012 by attending the Pre-Meeting Professional Development Certificate Courses starting April 28th focusing on an array of administrative clinical and all the technical aspects of telemedicine.

To register and see the ATA 2012 schedule in detail, go to

Saturday, March 17, 2012

FCC Commissioner Delivers Remarks

FCC Commissioner Honorable Robert M. McDowell discussed FCC’s successes and issues with rural healthcare. As a keynote speaker at the First Annual Mid-Atlantic Telehealth Resource Center Summit held in conjunction with the Virginia Telehealth Network at the University of Virginia’s Darden School of Business, he stressed the fact that even though the FCC’s rural health care program is the smallest Universal Services Fund (USF) program its effects have been impressive.

The program has enabled the healthcare community to improve and expand healthcare to patients in extremely remote parts of our country. As McDowell said, “Initially, the program was defined as a pilot or experiment but the program has provided the FCC with an excellent opportunity to learn what works best and what does not work.”

He reported that the FCC was able to learn a great deal in July of 2010, when the FCC asked for public comments on a number of reform proposals regarding the rural health care initiative. The Commission not only garnered valuable information from the comments received but the FCC learned a tremendous amount from participants in the pilot program.

He said, “We have also learned that one of the most valuable benefits of the program is the ability of healthcare providers to work together to create statewide and regional networks that can spark a virtuous cycle of investment, expansion, and opportunity.”

By providing broadband deployment to remote areas, rural healthcare centers are now well positioned to serve as hubs for new economic growth, job development, educational opportunities, and much more. Such partnerships promote efficiencies in the system.

McDowell told the attendees that he would like to see a comprehensive reform of all the USF spending programs completed at the same time as well as reforming the contribution or the taxing side of the ledger.

He summed up by saying, “As part of the implementation of the FCC National Broadband Plan, the Commission has already reformed some of the other USF programs on a piecemeal basis. The Commission will continue to work towards completing all of its reform efforts, including reform of the rural healthcare program as quickly as possible.

CMS Announces New Demo

Currently, Medicaid does not reimburse psychiatric institutions for services provided to Medicaid enrollees aged 21 to 64. This restriction is known as Medicaid’s Institutions for Mental Diseases or IMD exclusion. CMS has announced that the Medicaid Emergency Psychiatric Demonstration established under the Affordable Care Act will test whether Medicaid beneficiaries who are experiencing a psychiatric emergency can get more immediate and appropriate care when IMDs receive Medicaid reimbursement.

Due to the IMD exclusion, many Medicaid enrollees with acute psychiatric needs, such as those expressing suicidal or homicidal thoughts are diverted to general hospital emergency departments which often lack the resources or expertise to care for these patients.

For the Medicaid beneficiary this may result first in a delay in treatment and then when treatment is provided, inadequate care. General hospitals may delay the provision of care until a bed becomes available or inappropriately assign them to medical beds.

The CMS Innovation Center will provide up to $75 million in federal Medicaid matching funds over three years to Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, West Virginia, and the District of Columbia. With the funding, the Medicaid Emergency Psychiatric Demonstration will enable private psychiatric hospitals to receive Medicaid reimbursement for emergency care to be provided to Medicaid enrollees aged 21 to 64 who have an acute need for treatment.

The demonstration will test whether Medicaid reimbursement to treat psychiatric emergencies, described as suicidal or homicidal thoughts or gestures, in IMD settings will enable states to increase the quality of care for people experiencing mental illness at lower costs and will also test whether such expanded coverage reduces the burden on general acute care hospital emergency departments.

Last August, all State Medicaid Program Directors were invited to submit proposals to receive funds for their state for the demonstration. States needed to specify how they would track patients and monitor stabilization and ensure proper patient discharge planning as required by the law.

CMS is working collaboratively with private non-profit organizations and across HHS to develop this demonstration. Partners included the American Association of Psychiatric Health Systems, and within HHS, The Office of the Assistant Secretary for Planning & Evaluation, and the Substance Abuse and Mental Health Services Administration.

Go to for more information.

NH Posts RFP to Transform System

The State of New Hampshire’s Department of Health and Human Services (DHHS) has issued an RFP for their “Service Delivery Transformation-Data Repository Project”. The state is faced with the fact that a number of databases within DHHS have little to no capacity to integrate financial analysis data across the Department.

The problem is that although the state’s Medicaid Management Information System (MMIS) makes it possible to track, monitor, and analyze medical costs and utilization data, the state has little or no ability to completely track data in the area of human services. Medicaid costs analysis can be conducted only after tedious and time consuming data mining is done from at least four data sources within a number of Departmental programs.

DHHS is unable to obtain human services data on factors such as, vendor outcomes, population/client utilization of vendor services, similar or complimentary services across programs, or information to determine the return on investment for primary, secondary, and tertiary prevention services.

The Department wants to see the design of a new service delivery model of care that bridges client services gaps and fully integrates its non-Medicaid specific programs and services that lie within the human service area.

The project will be conducted in cooperation with the New Hampshire Department of Information Technology (DoIT) since DoIT coordinates statewide information technology activities.

The contract will be a firm fixed price not to exceed $1,000,000. The (RFP 2013-005) was issued March 8, 2012, proposals are due April 19, 2012, and there will be a vendor teleconference on March 26th.

Go to to view the RFP. For more information, email Grant Beckman at or call 603-271-9393.

NHGRI Intends to Post FOA

The National Human Genome Research Institute (NHGRI) is planning to publish Funding Opportunity Announcement (NOT-HG-12-011) seeking collaborative genomic medicine pilot demonstration projects. The objective is to design a pilot that will demonstrate the methods needed to obtain and use an individual patient’s genomic findings to make decisions concerning their clinical care.

Researchers want to be able to screen for highly penetrant germline mutations to identify genetically at-risk individuals and then integrate this patient-reported family history information into the electronic medical record to provide appropriate clinical decision support.

NHGRI is looking for research designed to apply phamacogenomic information to use to select drugs and doses, and to be able to use an individual patient’s whole exome or genome sequence data for diagnosis or treatment.

This notice is being provided to allow potential applicants sufficient time to develop meaningful collaborations and responsive projects. Applications are not being solicited at this time. The Funding Opportunity Announcement is expected to be posted in summer 2012 with an expected receipt date in fall 2012.

Go to for more information.

Maine HIT Strategy to Share Info

Recently, the State of Maine and HealthInfoNet received a $600,000 contract to help support electronic sharing of health records among behavioral health providers and general medical providers in the state. Under the contract, HealthInfoNet will build the technical infrastructure needed to facilitate secure EHR sharing. This will include connecting behavioral health providers to the statewide HIE and developing a secure provider only email service.

The contract was funded by the Substance Abuse and Mental Health Services Administration, HRSA, and the Center for Integrated Health Solutions (CIHS). Maine was one of only five states to be selected for funding along with Kentucky, Illinois, Oklahoma, and Rhode Island.

The contract will provide 25 behavioral healthcare organizations and 200 individual Maine providers with new ways to securely share medical records including the use of the HIE to share behavioral health issues and information on general medical care.

By the end of 2011, the state of Maine’s HealthInfoNet had 32 hospitals, representing 90 percent of the state’s inpatient and emergency room utilization, 58 ambulatory practices and five FQHCs participating in Maine’s clinical data exchange. Approximately 1,080,000 patients are enrolled. This number continues to grow as more hospitals and provider organizations join the HIE.

As Maine began initiating their statewide HIT strategy, it became evident that greater attention needed to be devoted to coordinating emerging clinical information systems within the mental health and substance abuse provider community.

Until a recent legal change, behavioral health provider organizations were unable to participate in the state HIE. Legislation passed by the Maine State Legislature in 2011, will now allow patients to choose if they want to share records created by their psychiatrist with their primary care doctor or others via HealthInfoNet’s system.

“True healthcare integration and coordination won’t work unless relevant clinical information can be shared in a secure manner across behavioral health and physical health sectors” according to John Edwards, PHD, a statewide behavioral health IT taskforce member.

Senators Introduce Legislation

On March 15th Senators Jeff Merkley (D-OR), Charles Grassley (R-IA), Michael Bennet (D-CO), and Herb Kohl (D-WI) introduced the bipartisan “Ensuring Safe Medical Devices for Patients Act.” The bill would give the FDA the tools it needs to improve oversight of medical devices. Defective medical devices have been associated with thousands of deaths in recent years.

Safety problems and recalls of certain medical devices including metal-on-metal hips, surgical mesh, and implantable programmable infusion pumps have called into question whether the FDA and its Center for Devices and Radiologic Health (CDRH) have the tools needed to protect patients and keep harmful devices off the market.

According to Grassley, the post-market surveillance work of the FDA needs to be empowered to use the important and valuable information about drugs and devices as the information becomes available when millions of people start using the drugs as compared to what is known before a drug or device goes on the market.

The legislation would require FDA to issue a final Unique Device Identifier (UDI) rule by the end of 2012 requiring implantable devices to carry a unique numerical identifier so products can be tracked through the distribution chain and also once they are being used with patients. The UDI program was created nearly five years ago but FDA has not implemented it.

Also, the legislation would add medical devices to the Sentinel post-marketing surveillance initiative launched in 2008. Sentinel is a national integrated, electronic system that currently monitors prescription drug safety after FDA approval once the drugs are being marketed to patients.

Tuesday, March 13, 2012

Fighting Fraud, Waste, & Abuse

To address the issues surrounding fraud, waste, and abuse in healthcare, the “Alliance for Health Reform” with the support of Centene Corporation sponsored a Capitol Hill briefing on March 5th. The briefing focused on the efforts that Medicaid, Medicare, and the private sector have or will need to put in place to find solutions to deal with this massive problem. For example, just recently, a Texas doctor and five accomplices were arrested and accused of billing Medicare and Medicaid for $375 million over six years as reported in “USA Today”.

In February 2012, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius released the annual “Health Care Fraud and Abuse Control Program” report showing that the government’s healthcare fraud prevention and enforcement efforts have recovered nearly $4.1 billion in taxpayer dollars in FY 2011.

Ed Howard of the Alliance and the briefing’s co-moderator along with Glen Schuster, CMO for the Centene Corporation, introduced Peter Budetti, Deputy Administrator for Program Integrity at CMS. He discussed how the National Fraud Prevention Program implemented in 2011 is able to monitor 4.5 million claims each day using a variety of analytic models.

As Budetti explained, CMS has taken a number of actions. For example, alerts are generated and consolidated around providers and then prioritized based on risks with results available to the CMS Center for Program Integrity (CPI) and to law enforcement partners.

The fraud prevention program is making it easier for honest providers to enroll in Medicare. Very often the process has been slow, cumbersome, and unreliable. Enrollment improvements have taken place and today there is a two-thirds reduction in time to enroll, online enrollment is available, and all enrollees are in the same system which helps to keep all the information up-to-date.

In addition, the enrollment screening process has improved. Today, fraudulent providers and suppliers can be subjected to extensive, risk-based screening through the new Automated Provider Screening (APS) system implemented by CMS in December 2011.

This is accomplished because now medical identities are checked against the compromised numbers database, addresses are checked against valid location databases, and the system is able to check revocations, exclusions, and felony convictions. At this point, CMS can deny suspected individual claims, revoke providers for improper practices, and can work with law enforcement before, during, and after case development.

Additionally, APS can regularly re-screen all information on a provider enrollment application for continue accuracy and able to provide a unified screening process to ensure that all Medicare providers are screened with the same degree of rigor.

Jim Frogue, Founder of the government relations firm FrogueClark, mentioned several pieces of legislation recently introduced in Congress. The “Fighting Fraud and Abuse to Save Taxpayer Dollars” or referred to as the FAST Act was introduced by Senators Carper and Coburn with a similar bill introduced in the House by Congressmen Peter Roskam and John Carney.

Also, the “Medicare Data Access for Transparency and Accountability Act” (Medicare DATA Act) was introduced by Senators Grassley and Wyden. The “Medicare Common Access Card Act of 2011” was introduced by Senators Wyden and Kirk to use the smart card technology currently used in the armed services in the Medicare system.

Looking at the problem from the state viewpoint, Doug Porter, Medicaid Director for the Health Care Authority in the State of Washington presented an update. So far, states are strongly committed to preventing fraud, waste, and abuse but at the same time, states most ensure that all the resources used will produce a positive return on investment.

Fortunately states are becoming more sophisticated in data mining, deploying the technology that is needed, and additionally, states are working to meet the new requirements and cooperating with federal efforts. He also recommends that federal efforts should do what states can’t or don’t do and support states through better funding which means that states need to be able to apply for grants.

William A. Hazel Jr. M.D., Secretary of Health and Human Resources in the Commonwealth of Virginia explained how his state is working on the problem. Virginia conducts extensive prepayment reviews and performs post payment data mining and audits resulting in over 1000 providers being reviewed over the past two fiscal years. The results show over $40 million has been identified as potential overpayments.

Presenting Centene’s preventative approach, Glen Schuster discussed how Centene is using HIT effectively to minimize and prevent fraud and abuse by providing providers with support, sharing information through care coordination, and participating with other Managed Care Organizations in other states.

Schuster reports how one successful Centene program called Centelligence™ decreased trends in doctor shopping for a group of patients overusing narcotics. So far, this program’s successful efforts have shown a 95 percent decrease overusing drugs in South Carolina, 80 percent decrease in Ohio, 90 percent decrease in Florida, and 95 percent decrease in Georgia.

For more information, go to

Researching Network Partners

HRSA’s directory “The Network Guide” last updated February 2012 contains information on 40 Health Center Networks plus helpful tips on how to engage directly with potential network partners. It has proven useful for HRSA grantees, safety net providers, and other healthcare organizations to help find information to better manage their programs. The guide is a collaborative project between HRSA and the National Association of Community Health Centers.

The guide with 25 tables of data provides information on EHRs, quality reporting and incentive programs, membership options, existing member organizations, registries, data warehouses, PHRs, electronic mobile health applications, HIEs, central IT and administrative function support, and accreditation programs.

For example, the Network Guide” provided invaluable information to the White Peak Community Health Center (WPCHC) a large community health center using EHRs to serve residents in rural Eastern Montana. The Center has successfully adopted EHRs, e-prescribes, effectively, uses clinical decision support and other HIT functionalities, and is actively exchanging data electronically with the local hospital.

However, WPCHC concluded that they wouldn’t be able to financially sustain these programs over time using their current general revenue. In addition, the health center’s governance board wanted to obtain Patient Centered Medical Home (PCMH) recognition.

To help address sustainability, WPCHC realized that partnering with a network could help them share resources and achieve savings. To begin the search for a partnership opportunity, WPCHC consulted the Network Guide and their 25 tables loaded with information to begin the search for a network. They needed to partner with a national network since Montana does not have any active networks in just the state.

The next step was to use the Network Guide to identify networks that could work with their current EHR vendor and be able to continue the same EHR maintenance schedule that the Center needs. Lastly, they needed to identify networks that could and would work with members on PCMH accreditation.

A strategy was developed after the research was completed. At that point, the WPCHC leadership went to the Board with a proposed sustainability strategy that WPCHC should join a national network to support their long term sustainability and at the same time, WPCHC would be able to achieve PCMH accreditation.

In another instance, the New York Village Health Network (NYVHN) a designated HCCN helping members implement EHRs was quickly starting to expand their service offerings by developing mobile applications to support telehealth.

NYVHN hosts patient portals and has established online communities to engage patients and as a result, the network has collected and houses various types of data for its members. This information flows in from multiple sources and has been categorized into several buckets within the NYVHN data warehouse.

NYVHN found that they needed additional help so that members could receive additional assistance to analyze health outcomes data and feedback received from patients. This meant that the network needed to expand its data analytic services but did not know where to begin given the network’s limited data analytic expertise and resources.

By using the information in the Network Guide, NYVHN was able to identify colleagues that could help with hosting data warehouses, provide data analysis, support services, and identify networks. This assistance from partnering colleagues can help to support clients with administrative data for quality measurement, reporting, and decision-making. In addition NYVHN is also trying to reach out to networks to help clients use benchmarking techniques and develop comparative analysis to meet industry best practices.

For more information, go to

Reducing Health Disparities

NIH posted a Funding Opportunity Announcement (RFA-EB-12-001) on March 9, 2012 seeking SBIR grant applications to develop medical technologies aimed at reducing disparities in healthcare access and health outcomes. Responsive applicants must be involved in collaborations with underserved populations and/or collaborate with clinics in an underserved community.

The award funding is estimated to be $2.2 million. Budgets will be awarded up to $200,000 total costs per year for Phase 1 and up to $400,000 total costs per year for Phase II may be requested.

Appropriate medical technologies need to be effective, affordable, culturally acceptable, and deliverable to those people in need. Some of the appropriate medical technologies are:

• Telehealth and telemedicine technologies for remote diagnosis and monitoring and able to link up to academic tertiary-oriented health centers with community-based primary care homes.
• Sensors for point-of-care diagnosis
• Devices for in-home monitoring
• Mobile, portable, diagnostic, and therapeutic systems
• Devices that integrate diagnosis and treatment
• Devices that can operate in low-resource environments
• Non-invasive technologies for diagnosis and treatment
• Integrated, automated systems to assess or monitor a specific condition
• Diagnostics or treatments that do not require special training

The National Institute of Mental Health (NIMH) is looking to develop or translate technologies that would help to reduce disparities in care for individuals with autism spectrum disorders, severe mental illness, individuals that are suicide risks, and for the prevention, detection, and treatment of HIV/AIDS.

Only U.S. small business concerns are eligible to apply with less than 500 employees. The letter of Intent is due April 21, 2012 and August 21, 2012 with the applications due May 21, 2012 and September 2012.

Go to to view the FOA.

First Responder Network Coming

As the result of the new legislation “The Middle Class Tax Relief and Job Creation Act of 2012” signed into law on February 22, 2012, a new “First Responder Network Authority” (FirstNet) has been created within NTIA. The plan is to build a broadband network for police, firefighters, emergency medical service professionals, and other public safety officials.

NIST is also involved as the agency will be supporting research for the advanced wireless communications system. The Act allocates up to $300 million to NIST dependent on the funds received from future spectrum auctions.

Too often in critical communication situations, the data exchange between law enforcement and public safety agencies is hampered by equipment incompatibilities and lack of standards. NIST intends to use a combination of in-house research, competitive grants, and transfers to other federal agencies to:

• Document public safety requirements and drive the adoption of those requirements into appropriate standards
• Develop the capability for communications between currently deployed public safety narrow band systems and the future nationwide broadband network
• Establish a roadmap to capture and address public safety’s needs beyond what can be provided by the current generation of broadband technology and work towards technological progress in that direction

Go to for more information on public safety communications research.

AHCA Selected for Pilot

CMS selected Florida’s Agency for Health Care Administration (AHCA) as the only state to pilot the latest version of the Medicaid Information Technology Architecture (MITA) initiative. Known as MITA 3.0, this initiative has new guidelines that require state Medicaid agencies such as the state’s Agency for Health Care Administration (AHCA) to conduct a State Self-Assessment (SSA) of the Medicaid program to evaluate how to control costs and measure care outcomes.

To complete the SSA, AHCA must perform an analysis of how Florida currently administers the business aspects of the Medicaid program. AHCA must look at how they enroll service providers, analyze and assess how Medicaid information is processed, and closely analyze and assess the technology that is used to process current Medicaid information.

As part of the SSA, AHCA will develop a roadmap to plan for enhancements, upgrades, or replacements to the Florida Medicaid Management Information System (FMMIS), which is the main information system used for Medicaid enrollment and to process claims.

MITA 3.0 will use score cards to judge the level of complexity involving informational and technical aspects of the Florida program. Levels of complexity can range from a basic level of compliance to levels where complete automation has been implemented or to where systems are ready to exchange data.

CMS selected AHCA to pilot MITA 3.0 as a test to see how well a state can conduct the SSA using the new guidelines. The Agency will provide feedback to the CMS regional office in Atlanta on their experience in completing the SSA and on using the new MITA 3.0 guidelines. The MITA 3.0 project began January 2012 and will conclude by the end of June 2012.

Saturday, March 10, 2012

DOD Reviewing MHS Changes

Last June, Deputy Secretary of Defense Aston B. Carter established an internal task force to review the governance of the Military Health System (MHS) and to suggest changes if needed. The Deputy Secretary of Defense, Chairman of the Joint Chiefs of Staff, the Military Department Secretaries and Service Chiefs, and other senior officials at DOD reviewed the work of the task force and examined the suggested changes for the existing governance of MHS.

On March 2, 2012, the Deputy Secretary submitted the report to Congress describing how DOD plans to integrate health operations within the Military Health System (MHS). The report was required by Section 716 of the National Defense Authorization Act for 2012.

The report outlines three proposed reforms affecting the governance structure of the MHS with the goal to make the health system more effective and produce savings. TRICARE benefits and access to care will not be affected by these changes.

According to the report, the first reform would establish a Defense Health Agency (DHA) to absorb the functions of the TRICARE Management Activity. In addition, the DHA would assume responsibility for shared services, functions, and activities in the MHS. This would include but be limited to the TRICARE Health Plan, pharmacy programs, medical education and training, medical research and development, health information technology, facility planning, public health, medical logistics, acquisition, budget and resource management, plus other common business and clinical processes.

The second reform would be to appoint market managers for multi-service medical markets with authority to create and sustain a cost-effective, coordinated, and high-quality healthcare system in multi-service medical markets.

Specifically, the market managers would have the authority to allocate the budget for the market, direct the adoption of common clinical and business functions for the market, and direct the workload and workforce between or among the medical treatment facilities in the market.

The third reform would be to transfer the responsibility for running military treatment facilities within the National Capital Region such as the Walter Reed National Military Medical Center and Fort Belvoir Community Hospital to a subordinate organization within the Defense Health Agency to succeed the Joint Task Force of the National Capital Region Medical (JTF-CapMed).

To view the report, go to

Redesigning the Delivery System

The Aspen Institute released their new report “Reinventing Health Care: The Barriers to Innovation” at a March 2nd briefing held at the Kaiser Family Foundation in Washington D.C. The event explored the existing barriers present in today’s healthcare system, new models and changes along with strategies to use, and more ways to promote EHR usage among providers.

The report is an initiative of the Aspen Institute Health Innovation Project produced in partnership with WellPoint. The project is a collaborative effort where experts such as physicians, health plan leaders, policy makers, healthcare researchers, and patients are working together to create a delivery system that is coherent, cost effective, and safe.

Keynoter Sam Nussbaum, MD., Wellpoint, Inc’s Chief Medical Officer opening the event, said, “The U.S. has been successful and leads in research and development and has made unprecedented advances in medical technology. Our advances have resulted in today’s many new treatments and pharmaceuticals now available working to improve the health and healthcare in this country.”

As he further explained, “The U.S. however, faces challenges and ranks near the bottom as compared to other countries in terms of improving public health, dealing with escalating costs for patient care, reducing costs for specialty drugs, and providing access to services especially for the country’s aging population and people with chronic diseases.”

Dr. Nussbaum suggests that innovation needs to play an important role to deal with the challenges evident in the present healthcare system. For example, one prominent issue affecting the present health system is the current and anticipated lack of primary care physicians available to treat patients in this country. As Nussbaum suggests primary care doctors need to get paid more, they need to get paid for coordinating care, and should be included in shared savings plans.

Another vital issue involves improving the quality of patient care and safety. As Nussbaum explained, “WellPoint is able to address this issue with their “Quality-in-Sights Hospital Incentive Program” (Q-HIP) that uses a scorecard to measure the extent to which hospitals implement process improvements and works to reduce HAIs and adverse health outcomes.”

In another move to improve the consistency and quality of healthcare for Californians, a few years ago, WellPoint launched their “Patient Safety First “a $6 million collaboration between Anthem Blue Cross, California regional hospital associations, and the National Health Foundation to improve the consistency and quality of healthcare in the state.

Results show that the initiative has helped save lives by working to prevent sepsis-related deaths, ventilator associated pneumonia, central line blood stream infections, and catheter associated urinary tract infections.

Susan Dentzer, Editor-in-Chief, at Health Affairs moderated a panel to specifically discuss the various barriers to innovation and how to promote the innovations as published in the Aspen report. The panelists included Basit Chaudhry, MD, PHD Medical Scientist at IBM Research, Joseph Hutter, MD, Fellow at the Institute for Health Care Delivery Research, Practicing Physician Intermountain Healthcare, and Daniel L. Newton, PhD Director, Behavioral Economics, Clinical Strategy, and Innovation at WellPoint Inc.

A second panel tackled engaging consumers in the issues facing the current healthcare system. The panelists included Carole Roan Gresenz, PhD, Senior Economist, Director, Economics, Finance, and Organization Program at RAND Health, Anjali Jain MD. Managing Consultant and Researcher for The Lewin Group, Lewis Mattison Staff Vice President, FutureVentures, WellPoint, Inc., and Brent Parton, Director, Health Programs for SHOUT America.

To view the Aspen Institute’s report “Reinventing Health Care: The Barriers to Innovation” online, go to For other inquiries contact, Franmaire Kennedy, PhD, Acting Director of the Health, Biomedical Science and Society Program within the Aspen Institute at (202) 736-5827.

Empowering Breast Cancer Patients

Breast cancer patients report that providers often fail to understand their psychosocial,communication needs, and information skills needed to manage their illness. This is necessary since breast cancer patients very often have to deal with major life changes and potential emotional problems that often accompany these changes.

The internet is becoming an important source of information for breast cancer patients, but unfortunately very few web-based educational interventions integrate personal information from an EMR and also provide educational psychosocial support content concerning breast cancer treatment decision-making and care management.

Dr. Kuang- Yi Wen PhD, Assistant Professor in Cancer Prevention and Control Program at the Fox Chase Cancer Center in Philadelphia is studying how quality improvement initiatives to promote patient-center care within ambulatory settings can be based and designed on using health information and communication technology. AHRQ is providing the grant funding for this research that started in 2011 with the study to continue until 2016.

Eventually, the goal is to provide breast cancer patients with all of the resources available today through health information and help these patients integrate these resources into their personal medical records. This will help women easily obtain information on their own diagnosis and treatment and have the knowledge on how to best manage their individual care.

The randomized controlled trial now taking place at the Fox Chase Cancer is studying 120 breast cancer patients to assess the feasibility and the potential impact of using the “MyHealthPortal” with early stage breast cancer patients. The research is planned to provide a user-centered portal design that will gain the acceptance with both the targeted audience and healthcare providers.

The research study will include surveys to assess existing portal users satisfaction level, identify breast cancer patients information needs, and explore breast cancer clinicians attitudes and expectations regarding the implementation of a patient portal. The findings of this research will provide preliminary data to support a future proposal to study the efficacy and costs effectiveness of the “MyHealthPortal” system but this will be done in a larger study.

For more information, email Kuang-Yi Wen at

System Monitors Movement Disorders

Great Lakes Neuro Technologies received an allowance of patent claims from the U.S Patent Office for their “Movement Disorder Monitoring System and Method”. This system is able to make quantitative assessments of motor symptoms associated with movement disorders. When used for telemedicine applications, physicians will be able to use a web interface to track symptom responses and fluctuations.

The system uses wireless patient-worn motion sensors to assess tremor, bradykinesia, rigidity, and dyskinesias associated with diseases like Parkinson’s and essential tremor. This medical technology has applications for both in-clinic and home-based patient care, optimizing programming for deep brain stimulation, and to provide quantitative endpoints to determine the efficacy of clinical trials.

“The allowance of our patent claims continues a successful commercialization path for our Parkinson’s assessment systems intended to help physicians maximize therapeutic benefits and ultimately improve patient quality of life,” says Joseph P. Giuffrida, PhD, President of Great Lakes Neuro Technologies.

The company has been actively involved in developing and manufacturing technologies to standardize, automate, and remotely capture patient assessments in the movement disorders market. The National Institute of Neurological Disorders and Stroke and the National Institute on Aging have provided continued support for these technologies.

The company is continuing to build their intellectual property portfolio and is covering new applications arising from several on-going clinical studies. “We have a broad range of patent applications in the pipeline and expect this to be the first patent of many to cover our product base for movement disorder technologies,” says Brian Kolkowski, PhD, Executive Vice President and General Counsel. “In addition, this U.S. patent represents a first step as we plan to continue with international filings to protect our technology portfolio to support our growth in international markets”

The company located in Ohio, has been working to commercialize their Kinesia and Kinesia Home View medical technology platforms since 2003. The company serves the research, education, and medical communities, and seeks to help diverse populations improve their access to medical technologies to positively impact their quality of life.

For more information, go to or email Amelia Earhart, Marketing Manager at or call (216) 446-2431 or mobile (619-808-8637. To find more information on Kinesia go to and for Kinesia Home View, go to

Implantable Sensors Developed

A new implantable wireless sensor developed at Rensselaer Polytechnic Institute is able to transmit data from the site of a recent orthopedic surgery. Usually, after an orthopedic procedure, surgeons usually rely on x-rays or MRIs to monitor the progress of their patient’s recovery.

The new sensors can give surgeons detailed real-time information from the actual surgery site. This in-vivo data could lead to more accurate assessments of a patient’s recovery or provide better insight into potential complications.

The wireless sensor measures only 4 millimeters in diameter and 500 microns thick. It doesn’t need a battery or external power and requires no electronics within the body. Instead the sensor is powered by an external device used to capture the sensor data.

The sensors look like small coils of wire and are attached to commonly-used orthopedic musculoskeletal implants such as rods, plates, or prostheses. Once implanted in the in-vivo environment, the sensor can monitor and transmit data about the load, strain, pressure, or temperature of the healing surgery site. The sensor is scalable, tunable, and easy to configure so that it may be incorporated into many different types of implantable orthopedic devices.

One key benefit of the new technology is the possibility of more accurate assessments by physicians to know when recovering patients are able to return to work without a risk of further injury. “Having a stream of real-time in-vivo data should help physicians better decide when a patient has recovered and is ready to return to work”, said Rensselaer faculty researcher Eric Ledet.

Ledet and his research team have filed for patent protection for their new sensor. They currently make each sensor by hand, but the researchers are investigating methods for mass production. Ledet has worked on sensor technology for about five years and has made several presentations on his progress at recent conferences.

Tuesday, March 6, 2012

Board of Directors Appointed

The Department of Veterans Affairs established the “Open Source Electronic Health Record Agent” (OSEHRA) a nonprofit organization to accelerate EHR innovations, to develop open and accessible standards, and to establish a new model for federal software development and procurement.

On March 5th, OSEHRA named three industry leaders to its inaugural Board of Directors:

• The Honorable James Peake, MD., Senior Vice President with CGI Group, Inc. Before joining CGI, Dr. Peake served as the Secretary of Veterans Affairs from 2007-2009. He retired from the Army as a Lieutenant General culminating in serving as Surgeon General of the Army and served as Commander of the Army Medical Command

• Dr. John Halamka, MD, MS, is the CIO of Beth Israel Deaconess Medical Center, Professor at Harvard Medical School, Chairman of the New England Healthcare Exchange Network (NEHEN), and Co-Chair of the National HIT Standards Committee

• Michael O’Neill, Senior Advisor with the Department of Veterans Affairs Innovation Initiative (VAi2). He served as Senior Vice President of Digital ASIC and Communications Products at both AMI Semiconductor and ON Semiconductor and was Vice President of Sales and Marketing at Philsar Semiconductor

In addition, Lieutenant General (Dr.) Charles Green, Surgeon General of the Air force, will service as the DOD liaison to the OSEHRA Board and Dr. Peake will serve as OSEHRA’s Chairman.

The OSEHRA community has grown to include more than 700 users, developers, service providers, and researchers. Seeded by an initial contribution of VA’s VistA EHR software, the community is actively engaged in advancing VistA-based EHRs, supporting joint EHR development between VA and DOD, plus promoting and supporting EHR software and related technology throughout the healthcare industry.

“As we build a strong community focused on healthcare IT innovation, we look to our Board of Directors to reflect the needs of the community and to set priorities that drive our growth,” said OSEHRA CEO Dr. Seong Ki Mun. “The expertise and leadership provided by this inaugural board will be invaluable in both regards.”

For more information, email Seong K. Mun, PhD, President and CEO, at or call (571) 858-3205.

HRSA Soliciting Applications

HRSA’s Maternal and Child Health Bureau posted two funding announcements involving health IT. The first announcement posted February 29th seeks applications for the “National Coordinating Center for the Regional Genetic Services Collaboratives” (HRSA-12-139). The program was established to help provide screening, counseling, and healthcare services to newborns and children having/or at risk for heritable disorders.

One of the primary goals for the solicitation is to develop EMR specifications with the National Library of Medicine (NLM) and various EMR vendors to provide the EMR systems needed to provide the clinical guidelines needed when newborns and children require information for genetic conditions. The specifications must detail requirements and options for the system and the awardee must research the clinical guidelines thoroughly in order to create the most up to date specifications.

The funding will be provided during FY 2012 to 2014. Approximately $1,300,000 is expected to be available annually to fund one awardee with a $200,000 set-aside for further development of data sets to use for follow-up of newborn screenings and to develop data dictionaries for use with EMRs. About $500,000 is budgeted specifically for the National Genetics Education and Consumer Network.

The application due date is March 30, 2012. For more details, go to or email Jill Shuger at

The second HRSA announcement (HRSA-12-147) posted March 1, 2012 solicits applications for the Funding Opportunity “Developing Integrated Maternal and Child Health Information Systems Promoting the Use of Health Information Technology”.

One of the Maternal and Child Health Bureau’s Office of Epidemiology, Policy, and Evaluation (OEPE) primary goals is to build and enhance maternal and child health data capacity at the local, state, and national levels. OEPE is placing emphasis on electronic health information exchange and wants to increase the use of electronic health information technology and exchange as a means to control costs and reduce medical errors.

There are two projects within this funding announcement:

• Project 1 will entail developing requirements for an HIE with an Immunization Information System and HIE entities. This project will have funding during FY 2012 with approximately $300,00 to be available to fund one awardee

• Project 2 involves developing Electronic Vital Records. The purpose is to help states that have not yet implemented a web-based electronic birth records system and also help the states that are in the process of implementing a web-based electronic birth records system. The funding for this project is approximately $150,000 and is expected to be available to fund one awardee

Eligibility requirements are the same for the two funding announcements. State and local governments, nonprofits, for-profits, small businesses are eligible to submit applications.

For more information on HRSA-12-147 with applications due April 2, 2012, go to or email Mary Kay Kenny at

CCA's Briefing on Dual Eligibles

State and federal agencies are aggressively exploring integrated payment and delivery models needed to raise healthcare quality and lower costs for people eligible for both Medicare and Medicaid. The nation’s dual eligibles are overwhelmingly low income, elderly, and among the most costly to treat.

The Care Continuum Alliance (CCA) notes that in Medicare, 21 percent of enrollees are dually eligible but account for 36 percent of spending and in Medicaid, 15 percent are dually eligible and account for 39 percent of spending so it is paramount that the healthcare system needs to provide integrated and coordinated care to really address the cost issues. Although, dual eligibles at the intersection of Medicaid and Medicare, are a relatively small group consisting of 8 or 9 million people.

“Dual eligibles are among the most challenging populations for Medicaid and Medicare, due to the high incidence of multiple chronic conditions, socioeconomic disparities, and limited coordination between the programs,” CCA President and CEO Tracey Moorhead said.

CCA representing more than 200 organizations and individuals has identified core program components necessary for operating comprehensive integrated dual eligible delivery models. These specific issues are discussed in-depth in their just released Policy Paper “Designing and Deploying Core Components of Integrated Dual Eligible Models”.

On March 1, 2012, CCA sponsored a Capitol Hill briefing to discuss the challenges and the solutions to the problem as reported in their Policy Paper. Representative Bill Cassidy (R-LA) opened the briefing commenting that the present system in the U.S provides dual eligibles with very expensive but at the same time, poor care and in addition, payment incentives are pulling the system in all different directions.

As Richard Fredrickson, Vice President for SSI and LTC Programs at Centene Corp, and a speaker at the briefing pointed out, duals are not a homogenous population and are not all eligible for the same level of care. In fact, 75 percent of Nursing Home eligibles live in the community resulting in significant long term savings in Medicaid spending.

Matt Salo, Executive Director, of the National Association of Medicaid Directors who reported that we need to find solutions to providing care to duals since they consume forty percent of Medicaid funds.

Jerome Vaccaro, M.D. President & COO at APS Healthcare is insistent that an integrated transparent system of care and services is an important part of the solution, and Pam Coleman, Senior Vice President for Government Programs at INSPIRIS a provider-based chronic care management company, wants to see coordinated person-centered care so that patients can receive in-home primary care and care management.

The CCA Policy Paper recommends core solutions such as the need for:

• Centralized, comprehensive, and interconnected data
• Health risk assessments and stratification
• Population-specific and personalized care planning
• Care coordination and transitions of care
• Education, training and incentives for patients and providers
• Program evaluation and outcomes toward improvements

To download the policy paper, go to