Penn State Medical News

Physicians at Penn State Hershey Stroke Center can now communicate with stroke patients at St. Joseph Medical Center in Reading using LionNet, a system utilizing on-demand patient data and live two-way audio and video. LioNet is the first telemedicine system for stroke patients to be implemented in south-central Pennsylvania.

Plans are for the LionNet team to collaborate with partner hospitals to educate surrounding communities on the symptoms of stroke and the importance of getting to the hospital in a timely manner. The network of LionNet partners is due to grow and put in place at other community hospitals.

In other news, all thirteen of the Penn State Hershey Medical Group’s adult primary care sites have been awarded Patient-Centered Medical Home (PCMH) certifications from the National Committee for Quality Assurance recognizing their transition toward the new care model. 

One important development is that the Penn State College of Medicine will lead the state-level infrastructure for the new national Primary Care Extension Service. AHRQ has chosen only four states to lay the groundwork for the extension service to spread the Medical Home model nationwide. This infrastructure will follow a model similar to the cooperative extension network developed in the early 20^th century to educate farmers about the latest farming methods.

“Pennsylvania Spreading Primary Care Enhanced Delivery Infrastructure” referred to as PA SPREAD will work to disseminate Pennsylvania’s model plus the lessons learned from the other three states that includes New Jersey, New York, and Vermont.

Environmental Scans are being conducted in the four states to identify key messengers to being together the necessary state-level multi-sector representatives to implement large scale primary care transformation. Physicians in Pennsylvania are participating in a statewide survey that is aimed towards identifying what services a primary care physician needs during a practice transformation.

A successful PCMH program to help diabetics was implemented in 25 practices in southeast Pennsylvania as part of the statewide initiative and has expanded to more than 150 practices.

Penn State Hershey received a grant from the Pennsylvania Academy of Family Physicians to evaluate and identify best practices to help residency programs train the next generation of primary care physicians on the PCMH concept. In addition, funding provided under ARRA has helped to incorporate the PCMH concept into the curriculum for medical students and enable the physicians see first-hand how to apply PCMH in a clinical setting.

Tennessee Issues RFI

As part of the ARRA award to the State of Tennessee’s Office of eHealth Initiatives, one of the objectives of the State Health Information Exchange strategy is to create the necessary infrastructure to help in the adoption of Direct technology across the entire spectrum of healthcare professionals. The plan is to provide Direct Health Internet Services and Direct Health Identity Services.

The State of Tennessee is exploring a market-based Direct approach where the State would define the Health Information Service Providers (HISP) certification criteria and where the State would work with a nonprofit third party entity to help providers adopt Direct technology.

The State envisions that HISPs may be responsible for registration authority, certificate authority, help desk, password recovery, provisioning and de-provisioning of users, trouble shooting of help tickets, and for signing participation agreements for services between customer and service providers.

The State in seeking guidance from the vendor community on August 13, 2012 released a Request for Information (RFI) to find the best way to establish a minimum set of requirements for HISP certification.

Vendor responses will be reviewed for planning purposes. The State is particularly interested in analyzing various HISP services, and software, and infrastructure options. The State wants to understand the marketplace in terms of industry capabilities, innovative delivery approaches, and performance strategies and measures.

Go to http://tn.gov/generalserv/purchasing/ocr/documents/RFI31865-0510.pdf to view RFI (31865-00510) due September 7, 2012. For questions, email Eric Harkness at Eric.Harkness@tn.gov.  

NIH/CDC Issue SBIR Solicitation

On August 15^th, NIH and CDC released the 2013 Omnibus NIH/CDC SBIR Solicitation (NOT-OD-12-137) due on November 13, 2012. The SBIR program is a set-aside program for small business concerns to engage in federal R&D with potential for commercialization.

The SBIR legislation requires the Public Health Service, HHS, and certain other Federal agencies to reserve 2.6 percent of their FY 2012 extramural research or R&D budgets for an SBIR program.

SBIR Phase I determines the scientific and technical feasibility and the potential for commercialization of the proposed research but not to exceed $150,000 for direct costs. Phase II is to continue the research or R&D efforts initiated in Phase I but not to exceed $1,000,000 for direct costs. Phase III helps small businesses pursue with non-SBIR funds, ways to commercialize the research funded in Phase and Phase II.

A few of the research topics contained in the solicitation are:

·        (NIH) National Cancer Institute—Real-time integration of sensor and self-report data for clinical and research applications

·        (NIH) National Institute on Drug Abuse—A mobile application to help patients take their medications as prescribed to improve medication adherence

·        (CDC) Center for Global Health—Rapid screening tests to prevent congenital infections and ensure blood safety

·        (CDC) National Center on Birth Defects and Developmental Disabilities—Smartphone application for global birth defects surveillance

·        (CDC) National Center for Chronic Disease Prevention and Health Promotion—A  mobile phone application for advancing teen pregnancy prevention

Go to http://grants.nih.gov/grants/guide/notice-files/NOT-OD-12-137.html to view the solicitation.

ONR to Enhance DOD System

A web-based application developed by the Office of Naval Research (ONR) is going to form the basis for the DOD-wide system to track and manage human subject studies funded by the Federal government. ONR provides the science and technology necessary to maintain the Navy and Marine Corps and works with states, countries, universities, and industry partners

The Navy conducts research studies with human subjects to support warfighter training and operational capability as well as naval medical department’s competency. DOD employs a number of database tools to track their research programs, such as the “electronic Institutional Review Board” (eIRB) management system, which is a preferred application within the military health system to document protocols.

However, a December 2011 report by the Presidential Commission for the Study of Bioethical Issues, found that the government lacks a centralized database to track experiments.  In early July, the Navy Deputy Surgeon General, Rear Adm. Michael Mittelman and the Deputy Assistant Secretary for Defense Force Health Protection and Readiness, Dr. George Peach Taylor Jr. signed a Memorandum of Record.

The Memorandum designates the “Protections in Research, Oversight Management Information System” (PROMIS) as the baseline for the future DOD system.  Plans are to move selected eIRB functions into one consolidated system.

ONR is developing enhancements to PROMIS so it can function as a unified platform to serve the needs across DOD’s user community.  Users will be able to track and manage their studies using the Microsoft SharePoint-based system.

The Navy’s Research Protections Division is responsible for overseeing investigations involving human subjects conducted by Navy and Marine Corps operational forces and non-operational commands. The division also monitors Navy –sponsored experiments by non-governmental institutions, such as universities and contractors.

“PROMIS gives a near real-time in-depth view of protocols,” said Dr. Andy Jones, Deputy Director of the Research Protections Division, “As the basis of the DOD-wide system, PROMIS will enable a wide cross section of users from principle investigators to departmental leaders to monitor and manage projects to ensure that the research complies with regulations.”

According to Dr. Timothy Singer, Director of the Research Protections Division, “PROMIS offers a way for DOD to gain greater insight into protocol submissions, offer better tools to manage active projects, and report on current and historical research.”

PROMIS is currently employed by 16 DOD commands including fifteen Navy commands and one Army command to oversee or conduct research with human subjects. The Research Protections Division is training personnel in its use at additional commands.

ARC Issues RFP

The Appalachian Regional Commission’s recently released RFP “Program Evaluation of the Appalachian Regional Commission’s Health Projects” seeks proposals from researchers and consultants. The program evaluation will examine roughly 230 projects located throughout all 13 Appalachian states funded from FY 2004 to FY 2010 for $30 million.

The program evaluation will include a range of health-related projects in areas including primary care, dental care, workforce, health planning, research, community facilities, health education, telemedicine, and mental health.

ARC is increasingly funding health-related projects in Appalachia but has not commissioned an evaluation of health projects in recent years. The primary goal is to evaluate the performance of ARC health investments from FY 2004 through FY 2010, using contractor-gathered data on project-specific performance measures.

This evaluation will help to enhance and standardize performance measures for ARC health projects and also help ARC more effectively develop, assess, manage health projects and investments, which will help the agency to document and report on the impact of programs.

ARC’s healthcare projects generally fall into three categories:

·        Clinical Services—Activities that support clinical services for underserved populations, populations located in HPSAs or populations experiencing documented health disparities. Usually these are short term programs to support start-up operations, provide gap funding, or address clinical emergencies. Care provided can include primary care and specialty care. Patient services are usually provided in primary care facilities through telemedicine or in specialty clinics

·        Healthcare Access—Activities that improve access to healthcare for underserved populations, especially populations located in HPSAs or experiencing health disparities. Specific activities to be evaluated can include equipment purchases, facilities upgrades or construction, developing telemedicine facilities or providing equipment, and how effectively workforce development efforts have been undertaken

·        Health Promotion and Disease Preventions—Interventions are commonly community-based efforts to change unhealthy behaviors, to promote new policies or services, or to address specific disease conditions of local concern

The RFP’s Scope of Work includes developing and implementing data collection methods to obtain updated, accurate project performance data for ARC health projects. Also, the contractor must have the ability to prepare a database with project information along with key performance data to be uploaded to a web site for viewing by the public.

Go to www.arc.gov/images/grantsandfunding/contracts/HealthProjectsEvaluationRFPAugust 2012.pdf to view the RFP. Proposals are due September 6, 2012. For additional information on ARC’s health projects, go to www.arc.gov/health. For questions, email Kostas Skordas at kskordas@arc.gov.

Protecting Patients Data

Safeguarding patient-generated health information was discussed at the Alliance for Health Reform August 13^th lunch briefing on Capitol Hill. Joy Pritts, JD, Chief Privacy Officer for ONC pointed out that patients need to understand their rights along with privacy and security issues related to their personal health information especially when using today’s mobile technologies.

Deven McGraw, Director of the Health Privacy Project for the Center for Democracy & Technology, reported that one of the major problems in receiving patient-generated data is that HIPAA doesn’t apply to all data collection and exchange. HIPAA applies to the collection, use, and disclosure of data by providers but doesn’t apply when the patient collects, uses, and discloses data.

Pritts mentioned recent studies that have been undertaken related to communicating and protecting patient information. A whitepaper released in April published by RTI for ONC on patient-generated data, discusses technical operations, legal issues, plus cultural, and educational issues. Also, a study conducted by NORC at Geisinger is examining patient access to EMRs and is looking at what types of errors and omissions are found in electronic medical records. This study is due to be released in the first quarter of 2013. 

Steve Downs, Chief Technology and Information Officer and Co-Developer of Project HealthDesign part of the Robert Wood Johnson Foundation’s Pioneer Portfolio, discussed how collecting data from mobile devices requires a new vision for patient-generated health data.

Downs explained that Project HealthDesign helps clinicians understand patients’ everyday lives. This is accomplished by receiving information from their patients on their Observations of Daily Life or (ODL) which is very often sent on mobile devices. This can include information received from patients on their moods, sleep, diet, exercise, medication adherence etc. to help providers give feedback to patients. The question is how safe and secure is the data sent from the patient to the provider?

Patricia Flatley Brennan, R.N., PhD and Project HealthDesign National Program Director at the University of Wisconsin-Madison speaking at the HIT Policy Committee Hearing pointed out as available technologies change and evolve over time, many different combinations of technologies will provide for workable solutions. In any event, it is necessary to provide for a safe and stable storage place for patient-generated data. Once a safe storage solution is in place, many apps could run off of the same data.

For more information on the Capitol Hill event, go to www.allhealth.org.

FCC Issues Progress Report

A FCC report released on August 13^th provides details on the benefits as well as the lessons learned from the Commission’s Rural Health Care Pilot Program. So far, the program supports 50 active projects in 38 states and the territories of Guam, American Samoa, and the Northern Mariana Islands. The five largest statewide networks are located in California, Colorado, Oregon, South Carolina, and West Virginia and on target to connect over 800 healthcare providers. 

Key facts about the Pilot Program:

• As of January 2012, 2,107 healthcare providers were to receive $217 million in universal service support
• Projects range in size from fewer than ten to over 150 healthcare provider sites
• Forty-four of the 50 projects receiving support include urban healthcare providers
• Leaders of pilot projects often come from large medical institutions and universities which frequently are located in urban areas
• Pilot project participants purchase higher bandwidth connections than do participants in the FCC’s existing program

A wide range of pilot projects involving telehealth and telemedicine applications have been deployed over broadband networks. Using these networks, healthcare providers are able to exchange EHRs and send X-rays, MRIs, and CT scans along with other medical images over the networks.

However, since many of the pilot projects are not yet fully implemented, and because not all pilot projects describe their telemedicine and telehealth activities in their quarterly reports, the figures in the report show a small percentage of projects that have implemented utilizing specific telehealth applications to date. When all the pilot projects are fully implemented, there is likely to be an even wider adoption of telehealth and telemedicine applications over the networks.

The most commonly reported telemedicine applications include telepsychiatry, telepsychology, teleradiology, tele-echocardiology and telestroke but the most commonly reported telehealth applications include medical training, using EHRs, and telepharmacy.

Some specific examples of telehealth and telemedicine applications include:

• Palmetto State Providers Network (PSPN) has performed 6,600 telepsychiatry consults over the network and conducts 100 tele-OB/GYN maternal and fetal care visits per week
• Geisinger Health System uses its network for numerous telemedicine applications such as teletrauma, telestroke, tele-echocardiology, tele-electroencephalograms, tele-ICU, telepsychology, teleradiology, telematernal fetal monitoring, and telepathology
• Heartland Unified Broadband Network (HUBNet) installed the HUBNet connection so that Horizon Health Care is able to serve a consortium of rural clinics in South Dakota

 Go to http://transition.fcc.gov/Daily_Releases/Daily_Business/2012/db0813/DA-12-1332A1.pdf to view the report “Wireline Competition Bureau Evaluation of Rural Health Care Pilot Program”—Staff report.