Tuesday, June 26, 2012

Meeting to Discuss Mobile Devices

NTIA within the Department of Commerce will hold a meeting to discuss how to deal with transparency when companies provide applications and interactive services for mobile devices that handle personal data. NTIA will conduct the meeting for multi-stakeholders on July 12, 2012 in the Washington D.C metro area with the venue to be announced no later than 15 days before the meeting and sooner if possible.  

In March, NTIA requested comments concerning privacy issues with many stakeholders identifying transparency issues associated with mobile apps as a major topic of concern. Mobile apps are socially and economically important, but mobile devices pose distinct consumer privacy challenges, such as disclosing relevant information on a small display. In addition, practices surrounding the disclosure of consumer data privacy practices do not appear to have kept pace with rapid developments in technology and business models.

The issue of mobile app transparency potentially impacts a range of industry participants that includes not only developers of mobile apps but also providers of sophisticated interactive services for mobile devices and mobile app platforms plus others.

The July 12th meeting will be the first in a series of NTIA multi-stakeholder discussions on the topic. The objectives of the meeting will be to work with stakeholders on the format of future meetings.

For more information, email John Verdi at jverdi@ntia.doc.gov or call 202-482-7002.

JHU Establishing Collaborations

The Johns Hopkins University School of Medicine in collaboration with the Johns Hopkins Health System together known as Johns Hopkins Medicine (JHM) was awarded a $19.9 million grant by CMS to improve the quality and efficiency of healthcare delivered to JHM patients. The grant is part of CMS’s $1 billion Healthcare Innovation Challenge, a competitive initiative that seeks to identify and support innovative opportunities to improve care delivery.

According to Edward D. Miller, MD, Dean and CEO of Johns Hopkins Medicine, the Johns Hopkins Community Health Partnership (J-CHIP) recipient of the grant will create a unique Baltimore-based partnership through collaboration with:

·        Centers for Medicare & Medicaid Services
·        State of Maryland and the City of Baltimore
·        JHU to include the university’s schools of medicine, nursing, and public health
·        Johns Hopkins Community Physicians, one of the largest primary care networks in Maryland
·        Johns Hopkins Home Care Group a full service home care provider arm of JHM
·        Johns Hopkins Urban Health Institute established to work on health problems affecting the East Baltimore community
·        Priority Partners a Medicaid managed care organization owned jointly by Johns Hopkins
·        Maryland Community Health a consortium of federally qualified health centers including the Baltimore Medical System
·        Five local skilled nursing facilities

Using transdisciplinary care coordination will reduce unnecessary admissions and readmissions, unnecessary emergency department visits and other expenditures, and costs for care. “Through improved care measures, it is estimated that the J-CHIP program could save Medicare and Medicaid just over $50 million during a three year window.

Johns Hopkins has also signed a Memorandum of Understanding with the Fraunhofer Heinrich Hertz Institute (HHI), a mobile and information technology development leader based in Berlin, Germany. The plan is to jointly research the innovative medical applications of integrated optical sensors.

Under the terms of the agreement, the two entities will study how the technology developed by HHI can be used to detect, diagnose, and treat medical conditions. “This collaboration will leverage both of our organizations best in class abilities to jointly develop new point-of-care clinical tools,” said Frank Menzler, HHI Senior Director in the U.S.

Telepsychiatry Program Saves Money

More than 10,000 telepsychiatry consultations are offered through the South Carolina Department of Mental Health. (DMH) currently provide comprehensive consultations to 23 urban and rural state hospital emergency departments with six additional hospitals being added according to the DMH newsletter, “Mental Health Matters.”

The Telepsychiatry Consultation Program developed by the state DMH requested assistance from The Duke Endowment located in Charlotte North Carolina to develop a statewide telepsychiatry network for all South Carolina hospitals and their operating emergency departments. To date, the program has received more than $6.3 million.

The funding will enable the hospitals to better serve behavioral health patients. The telepsychiatry consultations have increased the quality and timeliness of triage, assessment and initial treatment of patients, reduced the number of individuals and length of stay in emergency departments, and enabled the hospitals to realize financial savings.

In addition, results show:

·        An increase in the number of patients receiving comprehensive assessments
·        Provides for seamless joint consultations
·        Better information available on the substance abuse diagnoses
·        An increase in professional staff able to receive training
·        A reduction in the cost of mental health care

In all cases, the DMH psychiatrists consult with hospital medical professionals, review requested hospital clinical information, consult with patients using the telepsychiatry video system, and summarize their recommendations in the patient’s EMR.  The information in the EMR is then transmitted to the hospital emergency department with a copy of the consultation also sent to the aftercare discharge referral source which is generally the local DMH community mental health center.

Other key partners in addition to the Duke endowment involved in the program include:

  • The South Carolina Hospital Association, a private, not-for-profit organization comprised of 130 institutions and 900 associated members working to develop a uniformed credentialing application to be used by telepsychiatrists
  • South Carolina Department of Health and Human Services which is the state’s Medicaid agency, is partnering to develop a statewide medical health record and working to increase IT infrastructure
  • University of South Carolina School of Medicine and their Department of Neuropsychiatry and Behavioral Science continues to offer advice. Their telepsychiatry program being conducted is in charge of  a large research study funded by NIMH
  • The Department of Psychiatry of the Medical University of South Carolina is providing expertise and clinical office space for telepsychiatrists
  • Department of Psychiatry and Health Behavior at the Medical College of Georgia are sharing lessons learned from their cardiac telemedicine project

It has been found that the telepscychiatry program has resulted in a net medical cost savings of $1,000 per patient per episode of care. This translated to nearly $10,000,000 in savings in just under three years of the program.

NIH Clinical Center Uses New Tool

Too often information systems have not provided the information that executives need in the necessary timeframe and at the level of usability required. To meet the Clinical Center’s (CC) information needs at NIH, the Executive Information System (EIS) was recently launched.

EIS is a work-station based information system that integrates information on key performance indicators and trends affecting their specific institutions. The EIS a new tool available to NIH reports on key CC clinical activity data while giving the institutes and centers much needed information.

Data is populated into the EIS though the Clinical Research Information System (CRIS) and other departmental systems. The customized dashboards in the web-based EIS provide query and reporting capabilities on the hospital’s daily and monthly utilization.

The system offers visual displays of year to date data so users can evaluate trends and compare operational data. The data is not available at a patient level and does not represent hospital charges of reimbursement rates but reflects volume of units according to the industry standard. 

The EIS grew out of the Data Transformation Initiative (DTI), a multi-year project that translated CC activity data into uniform terms and codes used by other academic medical and research centers. With the completion of the DTI and the launch of the EIS clinical activity dashboards, it now means that the institutes and leaders of the NIH centers have access to patient demographic data along with costs for services provided.

“We will be able to benchmark our activities to the industry to evaluate efficiency internally or against other academic medical centers,” said Maria Joyce, CC Chief Financial Officer. “The institutes will be able to understand the total cost of a protocol, which will encourage data-driven decision making, and help the institutes manage their programs more effectively.”

Dr. Tom Fleisher, Chief of the Department of Laboratory Medicine for CC, is looking forward to using the EIS to evaluate data on a longitudinal level. “Having this data accessible will facilitate better understanding of the costs for specific laboratory operations because we can see whether operational changes can translate into cost savings.”

Survey Shows What Patients Want

According to the latest Accenture survey, more than 90 percent of 1,100 U.S patients surveyed want to manage their healthcare with technology but nearly half (46 percent) didn’t know if their health records are available electronically.

“Patients increasingly want access to their personal medical information, anytime, anywhere,” said Kaveh Safavi, MD, JD, who leads Accenture’s North America health industry group. “But they’re not willing to give up the option of face time with their physicians.”

The “Accenture Connected Health Pulse Survey” conducted from March 40 through April 4, 2012, determined the level of access and preferred channels of access to electronic healthcare related information and services, gauged patient perceptions of EHRs, and explored differences in patient perspectives versus physicians as well as between federal health personnel and the general population.

Many patients look to the web for self-service options such as access to personal medical information, to book, change, or cancel appointments, or to request prescription refills. The majority of patients want to take advantage of self-service options such as email and mobile devices.

Interestingly, some geographical differences with patients can affect their desire for online access. The study revealed that patients who primarily live in rural areas are less likely to want their records available online.

The survey was released June 20th at America’s Health Insurance Plans Annual Meeting. For more information, go to http://www.accenture.com/.  

Sunday, June 24, 2012

HHS to Test Two Pilots

Existing prescription drug use data will be available to providers and pharmacists when treating patients in ambulatory and emergency departments through two new pilot programs launched by the Office of the National Coordinator for HIT. The pilot projects to take place in Indiana and Ohio will measure how to expand and improve access to Prescription Drug Monitoring Programs (PDMP).

PDMPs are statewide electronic databases designed to be used as a tool by healthcare providers to identify and intervene in cases of potential prescription drug abuse. The databases collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners.

PDMPs collect a considerable amount of useful information but many states are not using the databases enough. Improving real-time access to the information contained in the PDMPs will provide an incentive to healthcare providers to use the program. So far, 49 states either have legislation authorizing PDMPs or have active programs.

The pilot project in Indiana will demonstrate how emergency department staff can receive a patient’s controlled substance prescription history directly through the Regenstrief Medical Record System, a care management system used by Wishard Health Services, a community health system in Indianapolis and at other hospitals.

The project is a collaborative effort between ONC, Regenstrief, Wishard, the National Association of Boards of Pharmacy, Appriss Inc., and the State of Indiana. In some states, emergency departments are responsible for almost 25 percent of all controlled substance prescriptions.

The Ohio pilot project will test the impact of having a drug risk indicator in the EHR and how that affects clinical decision making. The Ohio project is a collaborative effort with the Springfield Center for Family Medicine, Eagle Software Corporation’s NARxCHECK, the State of Ohio, and MITRE.

“The PDMP pilot projects will help hospital staff identify a patient’s controlled substance history at the point-of-care to better target appropriate treatments and reduce the potential of an overdose or even death,” said Farzad Mostashari, M.D. National Coordinator for Health IT.

The project is funded by SAMSHA within HHS and managed by ONC in collaboration with SAMSHA, CDC and the ONDCP. For more information, go to http://healthit.hhs.gov/

Opening Up Federal Data

Dr. John P. Holdren, Director, Office of Science and Technology Policy (OSTP) within the Executive Office of the President appeared before the June 20th House Committee on Science, Space and Technology hearing on “Examining Priorities and Effectiveness of the Nation’s Science Polices”.

In his statement before the House, he explained how OSTP has worked with OMB, GSA, and other Federal partners to open up Federal government data to the public. Data.gov, the government’s open data site has grown from 47 datasets three years ago to nearly 450,000 datasets today.

The Federal government also has a growing number of websites, including the Open Government Dashboard, Recovery.gov, Usaspending.gov, the IT dashboard, the R&D Dashboard, and Performance.gov to provide details on Federal spending and performance.

Currently, the Administration is building up open data initiatives and the digital government strategy. The goal is to make government and private sector data widely available to the public in machine readable formats that are ready for use by private sector innovators to develop useful apps on mobile platforms.

Dr. Holdren explained how in an effort to move “big data” forward, last March, the Administration announced the “Big Data Research and Development Initiative.” By improving the ability to extract knowledge and insights from large and complex collections of digital data, the initiative promises to help accelerate the pace of discovery in science and engineering and strengthen our national security.

Dr. Holdren told the Committee that OSTP is very involved in developing a neuroscience initiative to advance knowledge in the fundamental understanding of learning, brain development, and brain health and recovery.

Advances in this field will require improved neuroscientific tools, enhanced data, data infrastructure, and necessitate interdisciplinary research efforts. As a result, OSTP has established an interagency working group to coordinate Federal investments in neuroscience research at NIH, NSF, VA, DOD, and other Federal agencies.

The working group will focus on developing clinical treatments for traumatic and acquired brain injuries, better understanding of cognition and learning, and improve the understanding of therapies for Alzheimer’s disease, mental illness, childhood developmental disorders, and other neurological conditions.

DOD's Mobility Device Strategy

DOD has released their mobile device strategy identifying information technology goals and to capitalize on the full potential of mobile devices. The scope of the DOD mobile device user base is significant with more than 250,000 commercial mobile devices and several thousand Apple and android operating systems including pilots.

The strategy focuses on improving three areas critical to mobility such as wireless infrastructure, mobile devices, and mobile applications in order to remain reliable, secure, and flexible enough to keep up with fast changing technology.

“DOD is taking a leadership role in leveraging mobile device technology to improve information sharing, collaboration, and efficiencies,” said Teri Takai, DOD Chief Information Officer. “As today’s DOD personnel become increasingly mobile, a wide variety of devices offer unprecedented opportunities to advance the operational effectiveness of the DOD workforce. This strategy will allow mobile activities across the department to converge towards a common vision and approach.”

The next step is for an implementation plan to follow. This plan will initially support small user populations to assess the efficacy of the strategy. By validating productivity gains, reviewing security architectures, and managing a small segment of users, a business case will be developed to support scaling to an enterprise-wide solution.

Additionally DOD will develop a communication strategy to include outreach via conventional and contemporary methods for addressing the acquisition and cultural challenges associated with enterprise-wide mobile device adoption and deployment. DOD Components will participate in the DOD CIO Commercial Mobile Device Working Group (CMDWG) to share pilot activities, best practices, lessons learned, and efficiencies.

Go to www.defense.gov/news/dodmobilitystrategy.pdf to view the Mobility Device Strategy document. For more information, email Mark Norton at mark.norton@osd.mil.

Australia Making Headway

The Australian Government through their National Health and Medical Research Council (NHMRC) has provided $5 million for research to help prevent and treat chronic illnesses. Monash University and the George Institute for Global Health are administering NHMRC research to study how to deal with chronic illnesses such as hypertension in India’s rural areas and in other developing areas.

High blood pressure is increasing in prevalence in urban regions of developing countries, but little is known about its emergence in more rural regions where 70 percent of the population still lives. The research is focused on three diverse rural regions in India that are at different stages of economic and social transition.

Monash University has been awarded $1,033,805 to find ways to improve the control of hypertension in rural India and how to develop effective treatments.With the planned multi-site study, the research team will examine how the barriers to diagnosing and managing hypertension differ between settings and how gender, socioeconomic deprivation, and education also impact hypertension. The information obtained from the research will enable an intervention program to be developed that is suitable across rural regions.

The researchers at the George Institute with funding for $930,259 are presently evaluating whether an Australian-developed smart phone system will help Indian rural healthcare workers detect and manage hypertension and cardiovascular risk.

The system being studied is modeled on the PC based Health Tracker patient records software used by doctors. The system extracts information from the patient’s health record and then the Health Tracker calculates the patient’s absolute risk of heart attack or stroke and automatically synthesizes recommendations from all relevant guidelines to provide tailored management advice specific to the patient’s circumstances.

Another George Institute research project with $1,067,559 in funding is making efforts to develop two or more blood pressure lowering drugs in a single pill. Providing for simplified treatment programs to increase the use of blood pressure lowering medications would help greatly in rural and developing areas.

There are new collaborative research efforts through a Memorandum of Understanding though Australia’s Agency for Science, Technology, and Research, Biomedical Research Council (A*STAR) and NHMRC. The objective is to promote and encourage research development with researchers from Singapore, and Australia to help fight infectious diseases through integrative technologies. Integrative technology is an area of health and medical research that is rapidly expanding which includes bioinformatics, genomics, and proteomics.

A*STAR and NHMRC are jointly supporting research proposals that use integrative technologies to:

·        Improve surveillance and detection of emerging infectious disease threats
·        Advance diagnostic tools
·        Develop new innovative approaches for vaccine creation and therapeutics
·        Bring together synergistic collaborations and expertise from both countries

To be eligible, proposals must involve a collaboration involving at least one research team from Singapore and Australia.

A*STAR and NHMRC have allocated at total of SGD $4 million and AUD $3.5 million to support up to six research projects for up to three years. Research conducted in Singapore will be funded by A*STAR and research in Australia will be funded by NHMRC.

The applications for this joint grant opened on June 6, 2012 and applications must be submitted by August 8, 2012. For information, email Dr. Willie Koh at A-STAR_NHMRC@a-star.edu.sg.

NHMRC will be announcing a new funding opportunity for their NHMRC Development Grants program. These grants provide funding to support individual researchers or research teams to undertake research at the early proof-of-principle or pre-seed stage. The funding supports the commercial development of a product, process, procedure, or service that if applied would result in improved healthcare, disease prevention, and provide health cost savings. Applicants must have a basic understanding of what is required to move from research to outcomes that can be commercialized.

Applications opened on April 10, 2012 but will be open until July 11, 2012. For more information, email Paul Forsyth at pforsyth@swin.edu.au or John Humann at jhumann@swin.edu.au.

Another opportunity in terms of research that is available through NHMRC’s Partnerships for Better Health Projects would create partnerships among decision makers, policy makers, managers, clinicians, and researchers. The funding supports new opportunities for researchers and policy makers to work together. The next call for applications for the third round is September 26, 2012. For more information, email help@nhmrc.gov.au.

"Ginger.io" Wins 2012 Challenge

Janssen Alzheimer Immunotherapy and Pfizer Inc., together with the Geoffrey Beene Gives Back® Alzheimer’s Initiative announced that Team “Ginger.io” won the Alzheimer’s Challenge for 2012. The team’s ideas support the Challenge objective to develop a simple, cost-effective consistent tool that can be easily used to assess memory, mood, thinking and activity level over time to help improve diagnosis and monitor people with Alzheimer’s disease.

The winning team was selected during the Finalist Event held in Washington D.C on June 19, 2012 and was awarded $175,000 to help further develop their solution for commercialization. The Alzheimer’s Challenge 2012 provides an entrepreneurial springboard to harness new thinking and approaches to improve Alzheimer’s care.

The team’s winning idea is the “Ginger.io” Behavioral Analytics Platform. The “Geinger.io” platform is a combination of a mobile phone application and web-based dashboard. The platform passively tracks Alzheimer’s patients’ behavior relevant to their mood, memory, and functional status, and administers standard Alzheimer’s cognitive assessments. The assessments help to provide healthcare providers with a dashboard to measure patient health status, provides easy-to-interpret scores and novel data analytics so providers can follow new treatments and improve patient care.

“We are honored to win the “Alzheimer’s Challenge 2012” and help bring a new tool to the Alzheimer’s community that uses technology in a creative and effective way to help advance patient care,” said Sai Moturo, PhD, Ginger.io team lead. “We are eager to take our concept to the next level of development and we are grateful for the support we’ve received through this Challenge”.

DOD Implementing ITEP

DOD is implementing a Pilot Program known as the Information Technology Exchange Program (ITEP) to promote the interchange of DOD and private sector IT professionals to enhance skills and competencies.

ITEP was authorized by the FY 2010 National Defense Authorization Act. The ITEP Pilot permits DOD to assign information technology civilian employees to private sector organizations and to accept information technology employees from the private sector.

The Pilot is envisioned to promote the interchange of DOD and private sector IT professionals to enhance skills and competencies. Given the changing workforce dynamics in the IT field, DOD is trying to keep pace with the changes in technology.

The personnel assignments will be from three months to one year in length. The first opportunities range from work regarding mobile devices to cloud computing and infrastructure management with DOD.

To date, one private sector candidate has been successfully placed and completed a 6 month ITEP assignment with the DOD Office of the Under Secretary of Defense (Comptroller). Two additional private sector candidates have been identified for ITEP assignments and the details of these assignments are currently being worked on with the respective sponsoring organizations. DOD anticipates that both candidates will be onboard in DOD in the third quarter of FY 2012.

For more information, go to the June 20th issue of the Federal Register or email askitep@osd.mil. 

Wednesday, June 20, 2012

White House Announces "US Ignite"

The White House has announced a new public-private partnership called “US Ignite”. The partnership will work with nearly 100 partners including more than 25 cities, 60 national research universities, as well as federal agencies, industry, and non-profit entities to take advantage of state-of-the-art programmable broadband networks running up to 100 times faster than today’s internet.

Today, more and more of the nation’s broadband infrastructure is capable of moving huge amounts of information quickly and in novel, programmable ways. However, software developers have been unable to create applications that take full advantage of this new capacity. This is in part because potential user communities such as hospitals have lacked the means to coordinate their needs with developers’ capabilities.

The US Ignite Partnership will create a national network of communities and campuses with ultra-fast programmable broadband services operating at speeds of up to 1 gigabit per second. This network will become a test bed for designing and deploying next generation applications to support national priorities such as education, healthcare, energy, and advanced manufacturing.

The new Partnership will challenge students, startups, and industry leaders to create a new generation of applications and services to meet the needs of local communities while creating a broad range of jobs and investment opportunities.

So far, the federal departments and agencies have made commitments to the Partnership:

  • The National Science Foundation is committing $20 million to prototype and then deploy new technologies to advance the development of ultra-high speed programmable broadband networks. NSF has already invested $40 million over four years in the Global Environment for Networking Innovations (GENI) project, which is currently connecting more than a dozen universities with next-generation broadband connections

  • NTIA within the Department of Commerce has announced that six of its project grantees are joining the US Ignite initiative. These grantees have been building and upgrading broadband infrastructure, expanding and improving public computer centers, and bringing more Americans online everyday

  • The Rural Utilities Service within USDA announced that rural communities and anchor institutions connected to ultra-high-speed broadband networks may now qualify for financing under the RUS telecommunications and broadband loan programs

  • With the help of FCC’s rural healthcare program, the Missouri Telehealth Network plans to lend its expertise to a partnership with researchers and network experts at the University of Missouri. These researchers are working on a project to gather data from in-home sensor networks in a senior living facility to provide remotely located nursing staff with early alerts of changes

  • The Office of the National Coordinator has announced that the Southeast Minnesota Beacon Community is going to work with Mayo Clinic as a new partner for the US Ignite initiative and will be expanding this program through a regional telemedicine network

  • The Department of Defense has identified the Defense Research and Engineering Network (DREN) as an ideal national test bed to accelerate the development and deployment of ultra-high-speed bandwidth applications

  • Through the Department of Energy’s National Training & Education Resource, DOE is going to support the NSF/Mozilla US Ignite application competition to help create new workforce online training tools and apps

  • The Delta Regional Authority an independent Federal agency focused on economic development in the Mississippi River Delta region, will pilot a workforce development facility in the region to use next generation networking technologies to develop workforce virtualization

For more information, go to http://www.whitehouse.gov/.

FCC Hosts mHealth Summit

FCC Chairman Genachowski on June 6th hosted a discussion with private, academic, and government leaders in wireless health technology to discuss the promise of mobile communications devices, such as smartphones to improve healthcare and lower costs.

The Chairman was joined by senior executives and leaders from companies at the forefront of the mHealth revolution that included Philips, Qualcomm, Verizon and Medtronic, startups such as MedApps, Telcare, TheCarrot, and WellDoc. He was also joined by non-profits including the West Wireless Health Institute, Alfred Mann Foundation, hospital leaders, and government experts from the FCC, FDA, HHS, VA, CMS, and NIH.

In a new development at the roundtable discussion, the Chairman announced plans to act on an FCC Office of Engineering and Technology proposal to increase innovation in wireless device development by reducing regulatory barriers to testing and evaluating new technologies.

In the coming months, there are plans to move to create more flexibility so that there can be more experimental uses of spectrum for wireless healthcare devices. New, streamlined experimental licensing processes will also be created for universities and non-profits.

The proposal is to create a research license that cuts the red tape to testing new wireless medical devices in coordination with FDA to get new technologies to market. Additionally, the FCC proposes to create an innovation zone license to allow pre-approved spectrum use experimentation in specified locations.

A sample of recent innovations developed by some of the Summit participants:

  • “TheCarrot” is a web and mobile platform for health management and care coordination to allow patients to create a plan, share the plan, and record information on the go
  • MedApps has developed wireless sensors that transmit data on a patient’s health indicators to a central database in the cloud called HealthAir
  • Medtronic has developed an integrated glucose monitor to track blood sugar levels every five minutes and then an infusion pump receives the  data and adjusts insulin levels accordingly
  • Philips has produced clinical decision support tools that interpret raw patient data and then converts the information to actionable information for physicians
  • Qualcomm and their 2net, a cloud based system is designed to universally be interoperable with various medical devices and applications, enabling wireless connectivity while allowing device users and physicians to access patient data
  • Telcare has a smartphone app that automatically receives blood glucose data and creates personalized reports to share with physicians and family members
  • WellDoc has a Patient Coach that provides feedback to patients to help manage their diabetes.

Helping Vets with Coronary Issues

The Veterans Administration is working with the University of Iowa on a pilot program to survey patients as to their behaviors related to the management of heart disease and how the veterans should make healthy lifestyle changes.

Coronary Heart Disease (CHD) is a significant health threat among veterans. Compared to their civilian counterparts, veterans experience greater disability, reinfarction, and mortality following Myocardial Infarction (MI) and other Acute Coronary Syndromes (ACS). High rates of hypertension, diabetes, cardiac risk behaviors, and low socioeconomic status further increase veterans’ CHD-related morbidity and mortality.

The Veterans Administration’s proposed pilot study will look at whether it is feasible to provide nursing intervention to help veterans with CHD who are recovering from MI/ACS. The objective is to change veterans and their ideas on how to self-manage heart disease and how to facilitate health behavior changes.

The study will work with two groups of veterans with an estimated enrollment of 50 that have been admitted to an inpatient medicine unit for MI, ACS, and coronary angiography. One group will receive the usual care but the other group will have their treatment tailored to their risk factors. They will be contacted by phone at two weeks after their hospital discharge. The intervention will be administered by a trained research assistant working with each veteran. Each call will last about 15-to 30 minutes. For more information, email Cassie L. Cunningham at cassie.cunningham@va.gov or go to http://clinicaltrials.gov/ct2/show/NCT01566214.

The VA is conducting another pilot intervention to improve blood pressure and cholesterol control among veterans with CAD. If patients with CAD would control their blood pressure and cholesterol, then heart attacks would be reduced and there would be fewer deaths.

A number of factors hinder veterans’ ability to control their behavior. These factors include patients that have difficulty adhering to medications, physician reluctance to increase medication doses to effective levels, and a lack of clinical programs specifically charged with controlling blood pressure and cholesterol.

The VA’s HSR&D study to be completed by June 2016 will take place at the VA Eastern Colorado Health Care System located in Denver. The researchers are examining the number of VA patients that have CAD with uncontrolled blood pressure and high cholesterol with information available to them via electronic patient data. The VA will assess the patient, physician, and program factors that affect the control, and then design a program to improve the factors that are creating health issues.

PBGH Receives CMS Award

The CMS Innovation Center announced the second and final batch for the Health Care Innovation Awards. The project awards are part of a total of 107 projects representing innovators from 50 states, District of Columbia, and Puerto Rico. The awards support innovative projects nationwide designed to deliver high-quality medicine and lower costs and target many issues.

One of the awards for $19 million went to the Pacific Business Group on Health (PBGH) in California. PBGH will use the funding to start an initiative to improve care for 23,000 Medicare patients in the state living with multiple chronic conditions while dramatically lowering the cost of care. PBGH will operate the new initiative relying heavily on their sister organization California Quality Collaborative (CQC).

The program called “Intensive Outpatient Care Program” will be delivered by PBGH and CQC plus they will work closely with a number of experts and 17 medical group partners in California. The objective is to spread intensive care management for high-risk Medicare beneficiaries across their network of 9,000 primary care practices.

The new program will use well trained care managers embedded in high performing primary care teams to develop close relationships with medically complex patients. The team will deliver highly individualized and accessible primary care based on treatment goals specific to each patient. The goals are to have fewer patients make emergency room visits, avoid hospitalizations, and reduce complications.

The goal is to reduce the cost of care by five percent while improving the care of the beneficiaries and also reduce patient reported experience with care by at least two percent annually.

“This is really about taking some proven models from the private sector and making them work to help improve the health of Medicare patients. This is a powerful private-public sector partnership and we are excited to get started,” said David Lansky, CEO of PBGH.

For more information, go to http://www.pbgh.org/ and http://www.calquality.org/.

mHealth Helps in Kenya

The mHealth Project is a joint effort through Global HEED, SANA at MIT, and Partners for Care in the Marurui slum of Nairobi, Kenya. The area consists of 800 households with mostly female heads of households. Most of the residents are unemployed with homes having no electricity or running water. The slum is also filled mostly with children whose relative have passed away due to AIDS.

The most prevalent diseases displayed in the slum are upper respiratory due to cooking in the small homes with no ventilation, HIV/AIDS, water-borne illnesses, TB, chronic diseases along with very high rates of hypertension and diabetes.

In general, there is an extremely low ratio of physicians-per-person in Kenya. In the specific case of the Marurui slum, most options for healthcare being provided to this population are through government clinics forcing the people living in the slum to take public transportation to the clinic resulting in patients waiting in line for hours.  

Partners for Care have built the only clinic in the nearby vicinity where a physician is only available during limited office hours. Therefore, the mHealth solution is really needed in this community.

The mHealth program enables a patient to call the Android mobile device of a non-medical clinic staff person. This staff member then visits the home at the request of the patient and brings the necessary equipment to enter all of the necessary information into a medical record template created within the nHealth SANA mobile phone application.

In the situation where there is a patient with an infection, the staff person then takes a photo. The file is then uploaded into the server from the field. The clinic doctor looks at their laptop, opens and then reviews the case.

At this point, the doctor can advise the patient to come to the clinic, or refer the patient to seek medical help at the closest referral hospital, inform the patient to get medications at the Partners for Care clinic, or give the patient information that is a non-medical intervention that will alleviate the patient’s complaint.

NIH Launches Online Resource

A web-based interactive anthology will provide psychologists, economists, anthropologists, sociologists and other scientists with the latest research methods and tools. The web-based resource called eSource addresses emerging challenges in public health such as the obesity epidemic and the rise of chronic diseases such as heart disease.  The NIH Office of Behavioral and Social Sciences Research (OBSSR) at NIH has collaborated with the New England Research Institute to create the free online resource available at http://www.esourceresearch.org/.

Because behavioral and social scientists come from widely varying disciplines, there is a need for a central resource for current and high quality behavioral and social science research methods. With contributions from international experts, this anthology provides authoritative answers to methodological questions and sets quality standards for the research community.

The objective is to demonstrate the potential of behavioral and social science research, focusing on applying research findings related to public health activities and to enhance biomedical research. The program will also be useful as a training resource for biological scientists, providing them with a basic foundation for collaborations with behavioral and social scientists.

The web-based interactive collection consists of 20 interactive chapters with new features including a discussion forum and enhanced note-taking capabilities. The 20 chapters cover a range of topics and are accessible to all users including those users with limited familiarity of concepts such as how to conduct a qualitative analysis.

For more information on OBSSR, go to http://obssr.od.nih.gov/.

Sunday, June 17, 2012

Collaborating to Help Children

NIH and the NIH Clinical Center located in Bethesda Maryland and Children’s National Medical Center in Washington D.C. are collaborating on the new “Translational Research in Pediatrics Program” initiated to support state-of-the-art research on very young patients.

The Clinical Center at NIH sees more rare disease patients than anyplace else in the nation, historically caring for those older than 2 years or that weigh more than 20 pounds. Children’s National is the only exclusive provider of acute pediatric services in the Washington metropolitan area.

NIH investigators will identify a research collaborator to work with at Children’s National and then Children’s National will offer NIH access to their Clinical Research Center for outpatient visits. So far, Children’s National has authorized 20 inpatient hospital admissions under the program using private funds.

“We are grateful that Children’s National is opening its doors to help us expand our research profile and establish new partnerships between our institutions that will make a difference in the lives of young children suffering from rare, and often life-threatening diseases,” said NIH Clinical Center Director John I Gallin, M.D.

In addition, NIH’s National Human Genome Research Institute (NHGRI) and Children’s Research Institute located at Children’s National will work together on a study to evaluate young patients with a group of inherited metabolic disorders that affects between 1 in 50,000 and 80,000 babies born in the U.S.

Another unique training program the “Pediatric Hematology and Transfusion Medicine Multidisciplinary Research Training Award” has been funded with the Children’s Research Institute at Children’s National by NIH’s National Heart, Lung, and Blood Institute.

The program leverages faculty and resources from NIH, George Washington University, American Red Cross, FDA, and Howard University School of Medicine. The program addresses the lack of well-trained clinical and translational investigators in pediatric subspecialty fields. This collaboration is an innovative approach or solution to obtaining the number of researchers and pediatric subspecialists in hematology and transfusion medicine.    

Studying Breast Cancer

Some types of breast cancer can be successfully treated with drugs but treatment for a type of breast cancer more commonly found in young African American women is still limited to radiation and general chemotherapy. Called triple negative breast cancer, this type of cancer is the focus of a 20 month $8.6 million research project that aims to find new diagnostic tools and options for drugs to treat this cancer.

The research project taking place at the Department of Energy’s Pacific Northwest National Laboratory (PNNL) and at DOEs Environmental Molecular Sciences Laboratory (EMSL) in Richland Washington will be led by proteomics researcher Richard D. Smith, and funded by DOD.

“Since triple negative cancers are more likely to hit young women and African American women this indicates that a health disparity issue exists.” According to Karin Rodland, a Cancer Biologist at PNNL, “What’s been holding up the research is trying to get enough samples to thoroughly examine how triple negative cancers operate.”

The researchers are looking at the large population of women in the Army since they have received healthcare for years, plus the fact that the Army has a higher percentage of African American woman, than the general U.S. population. By using the Army’s breast cancer repository, researchers will be able to take advantage of one of the most comprehensive collections of breast cancer clinical samples in the U.S to further their research at DOE.

The researchers will access the Walter Reed-Windber breast cancer repository which is part of the Clinical Breast Care Project (CBCP) located at the Walter Reed National Military Medical Center (WRNMMC) in Bethesda Maryland.

Today, CBCP is successfully working to create an integrated communications network for the flow of biomedical informatics into a master database/warehouse to provide information for researchers. CBCP houses the world’s largest biorepository of high-quality, human breast specimens numbering more than 42,000. The tissue-bank repository is used for internal genomic and proteomic research and is targeted for extramural collaborations with facilities such as NCI’s Cancer Genome Atlas Project.

In another development, FDA has drafted a regulatory guidance describing a new way of conducting breast cancer drug trials that promises to substantially reduce the time and cost of getting new treatments to patients.

The approach is based on a trial design being tested in the I-SPY-2 TRIAL, an innovative Phase II breast cancer trial being conducted under the auspices of the Biomarkers Consortium which is a public-private partnership led by the Foundation for NIH.

The l-SPY 2 TRIAL underway at 19 major cancer research centers combines personalized medicine with a novel investigational design to identify women at high risk of early breast cancer recurrence.

Traditionally, patients with early stage breast cancer must wait years to receive new cancer drugs, which are generally tested first in patients with later stage metastatic disease and approved for use in more curable early stage cancer only after additional clinical trials.

The trial led by Laura Esserman, MD, at the University of California at San Francisco and Dr. Donald Berry, PhD at MD Anderson Cancer Center in Houston, uses specific genetic signatures—biomarkers—in the tumors of patients selected who are most likely to benefit from testing using the new approaches. The trial can test new treatments with significantly fewer participants in half the time.

Companies Receive Funds

Connecticut Innovations (CI), the state’s quasi-public authority responsible for technology-based economic development, recently committed $150,000 in Pre-Seed Funds to Notifyi LLC located in New Haven. CI’s Pre-Seed Fund supports the formation of new Connecticut technology companies and provides loans of up to $150,000 to Connecticut-based startup and early-stage technology companies.

The funds are to be used for product development and to initiate the launch of a cloud-based physician collaboration platform. In addition to the CI funding, the company secured matching funds from individual investors.

Notifyi’s platform allows physicians to send clinical messages to other physicians securely, while enabling recipients to choose when and how they are notified. The platform will also include conferencing capabilities, discussion forums and blogs, administrative tools, and customized message receipts.

A few months ago, CI also made another follow-up investment of $500,000 in Innovatient Solutions Inc. in Farmington through the Seed Investment Fund. In 2011, CI made the first investment of $500,000 in Innovatient to help the company develop a patient-centered information system aimed at improving communications between hospital care providers and patients.

The company’s first application, “nVision Information Therapy Solution” (nVision) provides education, communication services, and entertainment to patients using pre-existing hospital infrastructure. Using this system, patients can communicate with their healthcare providers, clinical teams, and families about daily goals, pain levels, and meal preferences. nVision also provides timely feedback to hospital personnel through the delivery of both standardized and user-defined surveys.

Information is provided to patients through their in-room televisions and to the clinical team via personal computers or intelligent handheld devices. nVision can interface with multiple hospital systems such as EMRs and pharmacy software systems concerning diets, transport needs, and medications.

Grants Go to MGH & Mt. Sinai

Massachusetts General Hospital (MGH) in Boston and Mount Sinai School of Medicine were awarded grants from the Institute for Health Technology, a research and educational foundation located in Washington D.C. The grant funds totaling more than $440,000 will be used to support studies on how medical technologies can be used to reduce healthcare-associated infections.

The two research teams receiving the grant awards were among a number of applicants responding to InHealth’s RFP for “The Impact of Advanced Medical Technologies on the control of Healthcare-Associated Infections” which was issued November 2011 and awarded March 2012. The period of performance is from May 1, 2012 to April 30, 2013.

The RFP was focused on studies that would evaluate the role and impact of technologies and how technologies contribute to clinical practices and not on creating or refining clinical practices or protocols. The focus for the RFP on technologies was seeking medical devices and diagnostics.

MGH will receive $229,597 to study the clinical, operational, and economic value of rapid molecular diagnostics for preventing and controlling VRE, an organism resistant to the antibiotic vancomycin which is a common cause of infections acquired in hospitals.

Rapid molecular diagnostics have the potential to improve patient care and resource allocation, and their contribution to patient care and operations has yet to be quantified. The studies will pioneer the application of computer simulation techniques to model patient flow in the hospital and examine how alternative infection control strategies might improve both clinical and economic outcomes.

The second grant funding will award Mount Sinai School of Medicine $213,278 to study healthcare-associated infections following cardiothoracic surgery. The researchers will assess the costs arising from different types of infections and create benchmarks to assess novel interventions.

These infections constitute the most common non-cardiac complication after cardiac surgery and cause substantial morbidity, mortality, prolonged hospitalizations, and higher readmission rates. The study will use data available from the NIH funded cardiothoracic surgical trials network’s data center located at Mount Sinai’s International Center for Health Outcomes and Innovation Research.

The Mount Sinai study is expected to provide a better understanding of the ranges of cost and effectiveness that future innovations will need to offer if they are to supplant or supplement existing technologies or management practices.

For more information, go to http://www.inhealth.org/.

Using Tech to Manage Asthma

With the help of a Madison, Wisconsin-based company called Asthmapolis, a project using cell phones to help asthma patients was initiated in Louisville Kentucky. It was just announced that the Louisville asthma demonstration project has begun enrolling patients in a year-long asthma study. The study is being undertaken to help the city identify possible causes of asthma attacks in the region and help patients better manage their illness. 

Louisville ranks high among U.S. cities in both allergens and poor air quality. A 2009 survey indicated that 15 percent of adults in the area have asthma, which is higher than both the state rate of 14.9 percent and the national percentage of 13.5.

Five hundred participants are being enrolled that:

  • Have a medical diagnosis of asthma and do not have an accompanying diagnosis of COPD or lung cancer
  • Have a current prescription for an emergency inhaler
  • Speak English and are 5 years old or older
  • Have internet and/or email access to receive reports, including a compatible

The enrollment and study will take place at eleven Walgreens locations across Louisville from now until November 2012. Of the total participants receiving the inhaler sensor, 100 enrollees will also have a sensor provided to track their use of controller medication. As of this month, the Asthmapolis medication system and associated software has not yet been cleared for use by FDA.

Asthmapolis was founded in 2010 and was able at that time to receive funding and partner with several organizations such the California HealthCare Foundation (CHCF) which has invested more than $2.5 million since 2010 in healthcare services, technologies, and devices.

For example, On June 12th, the company CareInSync received $500,000 through the CHCF Health Innovation Fund. CareInSync is a care collaboration company that provides mobile technology and proprietary software to help providers coordinate safe and timely transitions between hospitals and community-based providers. The software makes this possible by giving providers a dashboard of the care continuum with checklists, notifications, and reminders designed to help speed discharge, improve patient flow, and reduce hospital readmissions.

The fund is led by the Foundation’s “Innovations for the Underserved” program that is trying to lower healthcare system costs and improve access for the underserved. According to Margaret Laws, Director of the “Innovations for the Underserved” program, the fund seeks to support technologies, products, and services to provide access to care for 100,000 Californians or deliver $25 million in annual cost savings, or both. The Foundation plans to invest $10 million through the CHCF Health Innovation fund over three years.

For more information, go to http://www.innovations.chcf.org/ and for information on Asthmapolis, email David Van sickle, Co-founder and CEO at david@asthmapolis.com.

Medical Device Launches in Europe

Great Lakes NeuroTechnologies will launch their latest version of their medical device technology used to assess Parkinson’s disease this week at the Movement Disorders Society Congress in Dublin Ireland. According to Joseph P. Giuffrida, PhD, President, the launch of the system in Europe highlights the company’s commitment to expand international marketing and sales.

The device technology called the Kinesia HomeView™ system includes patient-worn motion sensors and a tablet computer to quantitatively assess tremor, bradykinesia, and dyskinesia associated with Parkinson’s disease. Physicians use a web interface to setup patient studies and track symptom responses. Market applications include both in-clinic and home-based telemedicine patient care, programming deep brain stimulation, and providing quantitative endpoints to determine efficacy of clinical trials.

The latest system infrastructure includes several key technology updates to improve the telemedicine experience for Parkinson’s patients, physicians, and researchers. To begin with, the patient take-home kit supports broadband data transfer directly from a patient’s home to a secure server. This allows physicians and researchers immediate online access to real-time symptom reports and video diaries.

Next, miniature, patient-worn motion sensors are instrumented with wireless communications. This minimizes setup time and patient burden during home-based assessments. Finally, physicians and researchers can use their own tablets to view web-based reports. Color-coded mapping provides intuitive quantitative tools to document symptom severity and motor fluctuations.

“As broadband and wireless technologies have matured along with the tablet PC market, our development team has be able to successfully integrate them into the Kinesia platform”, said Greg Ferreri, Software Engineering Manager.

For more information, go to http://www.glneurotech.com/ or call 216-361-5410. To view the Kinesia HomeView, go to http://glneurotech.com/Kinesia-HomeView.

Wednesday, June 13, 2012

USDA Awards DLT Projects

Agriculture Secretary Tom Vilsack announced awards for 52 distance learning and telemedicine projects totaling $14 million to take place in 29 states. The projects include 19 distance learning projects, 12 telemedicine projects and one combined project. Nearly half of the total funding will go to counties where the minority population is greater than 30 percent. Another 18 percent will benefit in areas where the Native American population exceeds 30 percent.

A partial list of the DLT projects:

·        $149,094 was awarded to the Appalachian College of Pharmacy located in rural Virginia to enable better management of chronic diseases specifically targeting diabetes and primary health needs in the southwest corner of the state
·        $118,716 will be used by the Professional Home Care Health Care Agency to purchase and install home health equipment and devices
·        $313,626 to be used by U.P Health Care Network to purchase specialized electrocardiogram equipment and software to create an eight-state telemedicine network to manage the information collected and send it to cardiologists and technicians
·        $262,068 will be used to help Saint Francis Medical Center purchase equipment for the first regional telestroke and teletrauma program in the medically-underserved region of Southeastern Missouri
·        $119,833 will be used by Garrison Memorial Hospital to acquire automated medication dispensing units, document cameras, and computers for audio and video contact in a telepharmacy project
·        $414,942 will be used by Samaritan Health Services, Inc. to purchase and install video conferencing technology to expand the delivery of mental healthcare
·        $401,636 will be used by Avera Health to purchase telemedicine equipment for 17 participating hospitals, clinics, and long term care facilities in a 63-end user telemedicine network covering the multi-state frontier and rural territory of the Northern Great Plains

Go to www.rurdev.usda.gov/supportdocuments/rdDLT2012ProjectList.pdf for a complete list of the DLT awards. 

NHGRI Awards Funding

The goal of sequencing a human genome for $1,000 is well within reach but that is just the beginning of the story. With increasingly lower DNA sequencing costs, more and more researchers are generating large amounts of genome sequence data.

With this data, researchers need to use many data analysis tools to detect genetic patterns for underlying common diseases in order to individualize treatments. Many sequence analysis tools have been developed and are publically available, but their use is often limited by the lack of experts who can install and use the tools.

As one component of the new Genome Sequencing Program, the National Human Genome Research Institute (NHGRI) has awarded six researchers approximately $4 million in FY 2012 to create robust, well-documented, and well supported computer software programs to use to analyze genome sequence data that could be used outside of large genome sequencing centers.

NHGRI plans to invest a total of $20 million over the next four years to make existing computational tools more generally accessible and to speed up the ability of investigators to analyze genome sequence data. The teams of project researchers, funded through cooperative agreements are part of a newly established “iSeqTools network”.

The FY 2012 research awards went to:

  • Boston College and the University of Michigan for $1 million to produce robust software tools and workflows for variant identification and functional assessment

  • The University of southern California Los Angeles for $345,000 to produce robust and portable workflow-based tools for mRNA and genome resequencing

  • The Broad Institute, Cambridge Massachusetts for $1 million to develop Genome Analysis Toolkit to provide for high throughput sequence analysis

  • Washington University St. Louis for $805,000 to produce robust toolkits and the GeMS turnkey computational framework for high throughput variant discovery and interpretation

  • Harvard Medical School for $448,000 to produce accurate genome structural variation analysis with Genome STRiP using large-scale sequence data

  • Scripps Tranlational Science Institute, La Jolla, California for $382,000 to develop the Scripps Genome ADVISOR an annotation and distributed variant interpretation service

As the tools are developed within the program, this information will be available to the public and freely available.

NHGRI is also awarding $25 million over the next four years to the “Electronic Medical Records and Genomics” (eMERGE) network to demonstrate that patients’ genomic information located in EMRs can be used to improve their care.

The awardees include Vanderbilt University Medical Center ($772,000), Group Health Cooperative and University of Washington ($823,000), Northwestern University ($762,000), Geisinger Weis Center for Research ($841,000), Essentia Institute for Rural Health ($773,000), Mayo Clinic, Rochester, ($788,000), and the Mount Sinai School of Medicine ($847,000).

The first phase of eMERGE which wrapped up last year, demonstrated that data about disease characteristics in EMRS and patient’s genetic information can be used in large genetic studies. So far, the eMERGE network has been able to identify genetic variants associated with dementia, cataracts, HDL, peripheral arterial disease, white blood cell count, type 2 diabetes, and cardiac conduction defects.

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

Genome-wide association studies are a powerful approach that researchers can use to study hundreds of thousands of genetic variants in people with and without certain health conditions to identify genes that cause or contribute to diseases.

eMERGE researchers will then use the genomic information in clinical care. With patient consent, researchers may use information about genetic variants involved in drug response to adjust patient medications. In addition, eMERGE researchers who discover patients harboring genetic variants associated with diseases such as diabetes or cardiovascular disease will be able to intervene to prevent, diagnose, and/or treat such diseases.

Sensors Can Measure Stress

As CDC reports, 1.7 million Traumatic Brain Injuries (TBI) occur annually in the U.S including soldiers and athletics. In 2010, medical costs associated with TBIs were estimated to be $76.5 billion. Depending on the severity, TBI can result in mental, cognitive, social and behavioral impairments and is a major cause of death and disability.

Management strategies for TBI include monitoring physiological parameters to minimize secondary injury, which improves patient outcome especially when coupled with therapeutic intervention. Unfortunately, current monitors require invasive surgery and can introduce more traumas to patients with pre-existing trauma.

Researchers at Arizona State University have developed a novel percutaneous sensor that continuously measures biochemical or molecular markets related to stress. This sensor is minimally invasive and can monitor multiple biomarkers simultaneously. Moreover, this sensor is highly sensitive, highly specific, and relatively easy to use to monitor stress markers in TBI patients.

This multifunctional sensor with its high performance and quick response time allows for better post-admission or post-hospitalization monitoring of TBI patients and may dramatically reduce the incidence of long-term TBI related side effects.

The sensor is able to do physiologic monitoring of biomarkers related to determining the progress and current state of TBI, dehydration, stress level, and heart dysfunction. Benefits include the ability to respond quickly, produce a low cost sensor, and the ability to wirelessly communicate and interface with drug delivery devices.

 The information on the sensor was posted May 30, 2012. For more information on the project “Minimally Invasive Sensors for Biological Stress” ( AzTE Case #M12-186)--(patent pending), contact Tom Goodman, PhD, Director, for Business Development, Life Sciences, at Arizona Technology Enterprises, LLC (AzTE) at 480-884-1648 or email TomGoodman@AZTE.com.