Researchers at the University of Iowa Children’s Hospital are studying how medication barcode scanning can be effectively used in a neonatal intensive care unit that does not include CPOE. This study is looking at not only the effectiveness of how the system could decrease the combined incidence of preventable and potential adverse drug events, but also how the system could be used to measure the reduction in all medication errors, and then determine if the safety gains achieved can be maintained. The hypothesis is that in this environment, barcode scanning may reduce preventable and potential adverse drug events by at least 45% and still be maintained.
In another research project, Moberg Research Inc in Ambler Pennsylvania with support from the National Institute of Neurological Disorders and Stroke is developing a neonatal EEG monitor that has the capability to use accurate analysis methods to enable earlier detection and management of brain injury in the neonatal population. The monitor could help make care decisions, measure treatment success, would enable more widespread monitoring of the brain status in newborns, and generally promote improved outcomes.
The monitor would have the capability to do complete EEG reviews with verification by clinicians. This would enable more accurate prognoses of neurologically at risk newborns to be done. Unlike adults, neonates cannot undergo traditional mental status testing. Presently, the use of EEG is well established as a means to characterize the health of the cerebral cortex in neonates. However, the availability of expert neonatal EEG interpretation is very limited and at present is available at relatively few specialized pediatric centers in the country.
Sunday, February 24, 2008
Thursday, February 21, 2008
HRSA Comments on HIT
HRSA in the September 2007 Federal Register had asked for comments on what strategies should be used to support HIT among safety net providers. Comments were requested on improving quality, collaborating, general network-related issues, HCCNs sustainability, and building HIT capacity. HRSA received 53 comments from a broad range of stakeholders, including state health departments, non-profit organizations, healthcare providers, and from the health information technology industry.
Some of HRSA’s responses to the many comments appeared in the January 25, 2008 Federal Register such as:
- HRSA is using the HCCN model for HIT adoption because of the HCCN business model in terms of cost efficiencies, the ability to attract competent staff, and the ability to strengthen health center operations in the marketplace
- OHIT will continue to foster collaboration among the telehealth network grantees and HCCN grantees. OHIT has interest in HCCNs with at three organizations, large multi-site health centers, and both urban and rural networks
- HRSA is addressing effectiveness, efficiency, and safety to measure the impact of HIT on quality and views HIT as a tool to use to improve the quality of care. While registries can provide quality improvement, two factors such medication error prevention and live clinical decision support may not improve quality with the use of registries. OHIT and the Center for Quality are working together on efforts for the adoption of HIT and for quality improvement
- HRSA is working internally across bureaus, programs, offices, and externally with other agencies, existing grantees, associations, networks, and other partners to develop new reporting requirements for clinical outcomes and other program data
- Over the coming year, OHIT will collaborate with BPHC to provide TA to health centers through OHIT’s Telehealth Resource Centers and BPHC’s State and National Technical Assistance Cooperative Agreements. The collaborations will address the challenges and opportunities for health centers to use telehealth services in underserved urban as well as rural communities. Also, HRSA has developed an internal HRSA HIT Policy Council to enhance communication and collaboration across all of its offices and bureaus
- Telehealth is a critical component in HRSA’s HIT strategy. OAT initially focused on rural communities but now a greater emphasis is placed on both urban and rural applications for telehealth technologies
- Some of OHIT’s activities include developing a Telehealth Technical Assistance toolbox available over the web to assist health centers in deploying telehealth services to their communities, and awarding 3 three year OAT grants to support telehealth based home services
- The telehealth networks are working to integrate EHRs into their services but this is difficult because of the lack of interoperability among the various health information systems
- HRSA has created a special portal for health centers as part of the AHRQ HIT Resource Center to share information on best practices, literature, and funding opportunities HRSA is including HIE within funding opportunity announcements to promote innovative practices. HRSA realizes that no one source of funding will be sufficient to pay for EHRs and other HIT initiatives. Sustainability after Federal funding will be expected, and grantees will need to move to self-sufficiency within the project period
Sensors to Measure Blast Impacts
While it may still be years away, military medical officials hope to place a sensor on every soldier to be able to measure the impact of a blast while alerting a combat medic to the possibility of a brain injury. According to Michael J. Leggieri Jr, Deputy Coordinator for DOD’s Blast Injury Research Program, fitting helmets with blast sensors that would be used in combat would be the first step to gathering needed data.
The sensor data would be recorded along with other operational data that is typically gathered after an event such as a bomb explosion. The data would be entered into the National Ground Intelligence Center already being used in the field. At the same time, if an injury occurs, the patient data already recorded in a trauma registry is in place.
“The helmet sensors are not medical devices, and the data is not medical data, so it will not be possible for anyone to take the raw sensor data and make any kinds of decisions about medical treatment, or injuries,” Leggieri said.
After the blast data is studied and if found reliable, then the event data will be matched with injury data. The medical community will have access to the data through the Joint Trauma Analysis and Prevention of Injury in Combat Program. Officials want to see if they can make a connection between what is seen on the sensor reading and any resulting injury.
Similar devices could be used in football player’s helmets and if the athletic is hurt, a doctor would be signaled to review the situation. If the devices are used in combat, leaders on the ground could use the data to refer the service member to medical officials who would then use diagnostic tools to determine if an injury occurred.
The Federal government is investing in traumatic brain injury research through DARPA, Office of Naval Research, and the congressionally mandated DOD Traumatic Brain Injury Multidisciplinary Research Consortium Award, which is run by the U.S. Army.
The John Hopkins University, Applied Physics Laboratory has been working on the blast effects on the body for several years. The Biomechanics Section at APL uses a sensor-laden, artificial torso to model how internal organs react to blasts, and the researchers are now developing a head and neck that will help model what goes on inside a skull when it is exposed to a blast.
The company Simbex through SBIR research and development funding was able to develop Head Impact Recording Technology for Field Applications. The system is able to measure head impacts in real-time, and has impact sensors, a processor and transmitter. This technology can transform any helmet or headgear into a head impact monitor.
A data collector receives impact data continuously from the encoders that can be a distance away and is able to monitor dozens of soldiers or helmeted team athletics simultaneously. The software analyzes the data and sends a pager warning if the impact is potentially serious.
The sensor data would be recorded along with other operational data that is typically gathered after an event such as a bomb explosion. The data would be entered into the National Ground Intelligence Center already being used in the field. At the same time, if an injury occurs, the patient data already recorded in a trauma registry is in place.
“The helmet sensors are not medical devices, and the data is not medical data, so it will not be possible for anyone to take the raw sensor data and make any kinds of decisions about medical treatment, or injuries,” Leggieri said.
After the blast data is studied and if found reliable, then the event data will be matched with injury data. The medical community will have access to the data through the Joint Trauma Analysis and Prevention of Injury in Combat Program. Officials want to see if they can make a connection between what is seen on the sensor reading and any resulting injury.
Similar devices could be used in football player’s helmets and if the athletic is hurt, a doctor would be signaled to review the situation. If the devices are used in combat, leaders on the ground could use the data to refer the service member to medical officials who would then use diagnostic tools to determine if an injury occurred.
The Federal government is investing in traumatic brain injury research through DARPA, Office of Naval Research, and the congressionally mandated DOD Traumatic Brain Injury Multidisciplinary Research Consortium Award, which is run by the U.S. Army.
The John Hopkins University, Applied Physics Laboratory has been working on the blast effects on the body for several years. The Biomechanics Section at APL uses a sensor-laden, artificial torso to model how internal organs react to blasts, and the researchers are now developing a head and neck that will help model what goes on inside a skull when it is exposed to a blast.
The company Simbex through SBIR research and development funding was able to develop Head Impact Recording Technology for Field Applications. The system is able to measure head impacts in real-time, and has impact sensors, a processor and transmitter. This technology can transform any helmet or headgear into a head impact monitor.
A data collector receives impact data continuously from the encoders that can be a distance away and is able to monitor dozens of soldiers or helmeted team athletics simultaneously. The software analyzes the data and sends a pager warning if the impact is potentially serious.
Capitol Hill News
Robert T. Howard, Assistant Secretary for Information & Technology, Department of Veterans Affairs, appeared before the House Committee on Veterans Affairs on February 13th to focus on the VA IT program. According to the Secretary, the VA has faced challenges in the move toward a centralized IT Management System, but the IT capability within the VA has been reinvigorated. Now all IT staffing, equipment, and budgetary resources are under the VA Chief Information Officer with oversight across all IT activities in the Department.
The “veteran facing IT” systems and the “internal facing IT” systems comprise the VA system. The “veteran facing IT system” supports programs to provide medical care, deliver compensation benefits, pension benefits, educational opportunities, vocational rehabilitation, and employment services. This program accounts for $1,295 billion of the budget request.
The “internal facing IT” systems are those that require a more effective management of IT resources such in financial resources management, asset management, human capital management, IT infrastructure, and information protection. This budget request totals $418 million.
Some of the VA IT activities include:
The “veteran facing IT” systems and the “internal facing IT” systems comprise the VA system. The “veteran facing IT system” supports programs to provide medical care, deliver compensation benefits, pension benefits, educational opportunities, vocational rehabilitation, and employment services. This program accounts for $1,295 billion of the budget request.
The “internal facing IT” systems are those that require a more effective management of IT resources such in financial resources management, asset management, human capital management, IT infrastructure, and information protection. This budget request totals $418 million.
Some of the VA IT activities include:
- Standardization activities supporting VA/DOD sharing will establish a common architecture to eliminate redundancies in coding, support common terminology sources between applications, and promote software and data use
- The Scheduling Replacement project will improve access, decrease wait times for appointments, and increase provider availability. The first version will be in place at the VA Medical Center in Muskogee, Oklahoma during June 2008, and in FY 2011, the VA anticipates the national rollout to all VA sites
- The Laboratory System Reengineering will provide the VA with a modernized Laboratory Information Management System. In FY 2009, the system will undergo independent verification and validation, plus field tests. The FY 2009 funding is needed to acquire 20% of the equipment needed for the deployment. National deployment will begin in FY 2010 and will be phased in over five years
- The pharmacy suite of applications is undergoing modernization and pharmacy software modules will be replaced with new technology through reengineering, new development, and the purchase of commercial products. Plans are to deploy enhanced order checks in FY 2009, which will improve patient safety standards by reducing adverse drug events by 50%
Activation of new VA facilities will bring new requirements for IT and assets. Some of the needs will be for desktop computers, mobile devices, laptops, etc. By FY 2009, the VA will have 51 new community- based outpatient clinics available. In addition, there are currently 209 readjustment counseling vet centers with more projected to be opened during FY 2008. Both of these facility types will require additional IT equipment.
New legislation “Technologies for Restoring Users Security and Trust (TRUST) in Health Information Act, (H.R. 5442) was recently introduced by Representatives Edward J. Markey (D-MA) and Rahm Emanuel (D-IL). The TRUST Act would promote IT while protecting privacy and security. Specifically, the proposed legislation would enable patients to keep their medical records out of health IT systems unless they give their consent, would require notification if the patient’s health information is exposed, and mandates the use of encryption and other technologies to prevent unauthorized access.
The TRUST Act would also authorize grant funding to be used to purchase qualified health IT systems. The Act would establish a public-private partnership to make recommendations concerning health IT standards, and develop the criteria for the electronic exchange of personal health information to encourage a nationwide interoperable health information technology infrastructure.
Wednesday, February 13, 2008
Recent State Legislation
Several states have recently introduced legislation in New Mexico, Iowa, Oregon, and Oklahoma on topics related to health technology.
Bill Richardson Governor of New Mexico in his state’s Health Solutions Plan wants to see the use of electronic medical records ahead in the state. The plan in general has gained support from businesses, healthcare providers, the Women’s Health Advisory Council, the NM Medical Society, and other groups in the state.
The bill HB 37 was introduced in the NM House Health and Government Affairs Committee in January to help control costs in healthcare and to increase quality by implementing a plan to maintain, use, and protect electronic medical records. On January 22, 2008, HB 37 was unanimously passed by the House Committee.
In February two bills (HSB 636 and SSB 3140) were introduced in the state of Iowa to establish the Iowa Health Care Coverage Exchange. As part of the requirements for the Exchange, all participating healthcare providers would have to use electronic medical records. Information technology would be used to support optimal patient care, performance measures, patient education, and to enhance communications.
The state legislature of Oklahoma, is considering (SB 1719) to create the Task Force on Health Information Technology. The Task Force would study existing state and federal health information technology initiatives, identify health IT needs in the state, and examine strategies for integrating health IT into state public health systems.
The bill (S 1712) submitted to the Oklahoma state legislature would establish an online web site to help consumers find the most affordable prescription drugs. The online site would be called the Oklahoma Prescription Drug Retail Price Registry, otherwise to be known as the Consumer’s Choice Registry. The site would enable consumers to search retail prices at state pharmacies for the 150 most prescribed pharmaceuticals. All of the pharmacies in the state would be required to routinely submit retail prices to the site to be administered by the Oklahoma Department of Health.
Bill Richardson Governor of New Mexico in his state’s Health Solutions Plan wants to see the use of electronic medical records ahead in the state. The plan in general has gained support from businesses, healthcare providers, the Women’s Health Advisory Council, the NM Medical Society, and other groups in the state.
The bill HB 37 was introduced in the NM House Health and Government Affairs Committee in January to help control costs in healthcare and to increase quality by implementing a plan to maintain, use, and protect electronic medical records. On January 22, 2008, HB 37 was unanimously passed by the House Committee.
In February two bills (HSB 636 and SSB 3140) were introduced in the state of Iowa to establish the Iowa Health Care Coverage Exchange. As part of the requirements for the Exchange, all participating healthcare providers would have to use electronic medical records. Information technology would be used to support optimal patient care, performance measures, patient education, and to enhance communications.
The state legislature of Oklahoma, is considering (SB 1719) to create the Task Force on Health Information Technology. The Task Force would study existing state and federal health information technology initiatives, identify health IT needs in the state, and examine strategies for integrating health IT into state public health systems.
The bill (S 1712) submitted to the Oklahoma state legislature would establish an online web site to help consumers find the most affordable prescription drugs. The online site would be called the Oklahoma Prescription Drug Retail Price Registry, otherwise to be known as the Consumer’s Choice Registry. The site would enable consumers to search retail prices at state pharmacies for the 150 most prescribed pharmaceuticals. All of the pharmacies in the state would be required to routinely submit retail prices to the site to be administered by the Oklahoma Department of Health.
UC Berkeley Researching Devices
The Center for Information Technology in the Interests of Society (CITRIS) at the University of California campuses (Berkeley, Davis, Merced, and Santa Cruz) is involved in health IT research. Studies on exchanging medical records and developing and using IT for telemedicine are ongoing.
John Canny at UC Berkeley and his researchers are working on integrating diagnostic medical devices with network technologies in an all-in-one device. A device developed in the current research program monitors EKGs, EMG (back muscle activation), GSR (galvanic skin response—a stress reducer), chest sounds, temperature, and movement.
The researchers want to see the all-in-one device provide longitudinal monitoring for the early warning of more serious conditions. As a Bluetooth device, the goal will be to gather data without network connectivity for daily upload to another Bluetooth device. But at the same time be able to communicate with specific cell phones from Bluetooth for real-time monitoring.
The next step for UC Berkeley is to find partners to explore home and clinical applications for the device by developing data analysis and visualization tools for these applications. The research program is specifically interested in home wellness monitoring, using telemedicine in developing regions, and crisis reporting and analysis.
John Canny at UC Berkeley and his researchers are working on integrating diagnostic medical devices with network technologies in an all-in-one device. A device developed in the current research program monitors EKGs, EMG (back muscle activation), GSR (galvanic skin response—a stress reducer), chest sounds, temperature, and movement.
The researchers want to see the all-in-one device provide longitudinal monitoring for the early warning of more serious conditions. As a Bluetooth device, the goal will be to gather data without network connectivity for daily upload to another Bluetooth device. But at the same time be able to communicate with specific cell phones from Bluetooth for real-time monitoring.
The next step for UC Berkeley is to find partners to explore home and clinical applications for the device by developing data analysis and visualization tools for these applications. The research program is specifically interested in home wellness monitoring, using telemedicine in developing regions, and crisis reporting and analysis.
Grant to Help the Disabled
The Department of Special Education within the Department of Education, seeks grant applications for Disability Rehabilitation Research Projects (DRRP). There is an important need to provide care coordination for individuals with physical disabilities. The DRRP program is working to develop methods and rehabilitation technologies to help individuals with the most severe disabilities.
Grant applicants must meet the DRRP priorities and applications for projects will be considered that would provide healthcare coordination, traumatic brain injury model systems, technology transfer, and supply technology to environments with limited resources.
Applicants are eligible to apply from states, public or private agencies and this includes for profit agencies, and public or private organizations including IHEs, Indian tribes and tribal organizations.
The funding will be $300,000 for one grant and cost sharing or matching is required but will be negotiated at the time of the grant award. A pre-application meeting on possible projects involving healthcare coordination, technology transfer, and supplying technology to environments with limited resources will be held via a conference call. The meeting on developing traumatic brain injury model systems will be held separately. The closing date for the applications is April 01, 2008.
Go to www.grants.gov for more information, or contact Donna Nangle at 202-245-7462, or by email Donna.Nangle@ed.gov.
Grant applicants must meet the DRRP priorities and applications for projects will be considered that would provide healthcare coordination, traumatic brain injury model systems, technology transfer, and supply technology to environments with limited resources.
Applicants are eligible to apply from states, public or private agencies and this includes for profit agencies, and public or private organizations including IHEs, Indian tribes and tribal organizations.
The funding will be $300,000 for one grant and cost sharing or matching is required but will be negotiated at the time of the grant award. A pre-application meeting on possible projects involving healthcare coordination, technology transfer, and supplying technology to environments with limited resources will be held via a conference call. The meeting on developing traumatic brain injury model systems will be held separately. The closing date for the applications is April 01, 2008.
Go to www.grants.gov for more information, or contact Donna Nangle at 202-245-7462, or by email Donna.Nangle@ed.gov.
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