Activities in Telemedicine, Telehealth, and Health Technology

Transcription

1 Federal Agencies: Activities in Telemedicine, Telehealth, and Health Technology By Carolyn Bloch Copyright 2010 Bloch Consulting Group All Rights Reserved

2 Contents INTRODUCTION Executive Office of the President FEDERAL AGENCIES Dept. of Homeland Security Dept. of Health and Human Services.. 13 National Institutes of Health Health Resources Services Administration Agency for Health Research Quality Centers for Medicare and Medicaid Centers for Disease Control and Prevention Substance Abuse and Mental Health Services Administration Food and Drug Administration Indian Health Service Dept. of Defense Army Telemedicine Activities Navy Telemedicine Activities Air Force Telemedicine Activities DARPA Armed Forces Institute of Pathology Uniformed Services University of the Health Services Dept. of Veterans Affairs Dept. of Commerce Dept. of Agriculture Dept. of Energy Dept. of Justice Dept. of Interior Dept.of Education Dept. of Labor Dept. of State Dept. of Transportation INDEPENDENT AGENCIES AND COMMISSIONS NASA National Science Foundation FCC Social Security Administration Federal Trade Commission Office of Personnel Management Consumer Products Safety Commission Appalachian Regional Commission General Services Administration Small Business Administration US Agency for International Development APPENDICES Appendix A: Legislative Branch Appendix B: Telemedicine and Telehealth Web Sites About the Author

3 3 Introduction The American Recovery and Reinvestment Act (ARRA) of 2009, referred to as the stimulus package, provides $19 billion for Health Information Technology Adoption. ARRA established the Health Information Technology for Economic and Clinical Health (HITECH) Act to support the development of health IT. ARRA funding for healthcare and research provides for: The HHS Office of the National Coordinator received $2 billion to coordinate health IT policy and programs. A HIT Policy committee assists HHS in forming a nationwide technology infrastructure and a separate HIT Standards Committee makes recommendations. The HIT provisions to amend Medicare and Medicaid provide incentives to increase EHR adoption. These incentive payments go to physicians and hospitals, and several classes of Medicaid providers ARRA provides temporary increases in Federal Medicaid to be contributed to all states ARRA establishes a Federal Coordinating Council for Comparative Effectiveness Research to work with HHS, VA, and DOD and other Federal agencies to coordinate comparative effectiveness research across the Federal government. ARRA appropriated $300 million for AHRQ, $400 million for NIH, and $400 million for the Office of the Secretary of HHS to coordinate activities that relate to comparative effectiveness. $1.1 billion will be used to do research on clinical outcomes, and effectiveness for medical and health services. The funding will be used to provide for clinical registries, data networks, and other data that needs to be generated electronically. A report with recommendations has been released on how the funding will be spent. Funds to help community health centers construct, renovate, obtain equipment, and health technology. HRSA received $2.5 billion with $500 million to go to community health centers Funding to provide $500 million to help increase the primary healthcare workforce Funding for $500 million will to go to the Indian Health Service. This funding includes $85 million for health information technology. These funds will go for telehealth services and infrastructure requirements Provides for NIH to receive $10 billion for science and technology research projects In the public health area, $650 million was funded for evidence-based clinical and community-based prevention and wellness strategies to deliver outcomes and address chronic disease rates. $300 million went to CDC s immunization program and $50 million to implement healthcare-associated infections reduction strategies. The legislation provides funding for other agencies with responsibilities related to healthcare. $4.7 billion went to NTIA s Broadband Technology Opportunities Program within the Department of Commerce to provide for broadband services where needed. USDA Rural Utility Services will invest $2.5 billion in broadband. $150 million went to the Economic Development Administration. The National Institute of Standards and Technology received $220 million, $3 billion went to the National Science

4 4 Foundation for science, engineering research and education, plus $500 million went to the Social Security Administration. Funding is available through the usual appropriations but in addition, the agencies also received ARRA funding. To receive grants, some research is needed to find funding to match your program activities and the specific areas where grant funding could be viable. Organizations need to look at all the possibilities such as finding sources for matching funds, opportunities to incorporate existing sources for funding with ARRA funds, and look at all possible partners such as community health centers, RHIOs, state HIT offices. The agencies involved in some way in telemedicine, telemonitoring, telehealth, health IT, informatics include the 13 cabinet-level departments and 11 independent and commissions listed in the table of contents to this report. As changes in the administration, personnel, and grant programs are announced, this information appears in the newsletter Federal Telemedicine News. You may either subscribe at ( or go to the blog at ( or subscribe through RSS feed. The information is updated two times a week. This report enables researchers, reporters, writers, scientists, industry, and other healthcare professionals to find information quickly and easily and to track the agencies and their activities in this ever-expanding field. If there are any, questions, or suggestions for new information to appear in future updates, please cb@cbloch.com.

5 5 EXECUTIVE OFFICE OF THE PRESIDENT Office of Science and Technology Policy National Coordination Office for ITR&D The National Coordination Office (NCO) for Information Technology Research and Development plans and budgets activities for the Federal IT R&D program and researches future generations of information technologies. NCO reports to the White House Office of Science and Technology Policy and to the National Science and Technology Council. The NCO works with 12 participating Federal agencies through the Interagency Working Group on IT R&D to prepare and implement the IT R&D budget. The Human Computer Interaction and Information Management Coordinating Group focuses on information interaction, integration, and management research to develop and measure the performance of new technologies. The research supports healthcare, homeland security, emergency planning, and response. Congress enacted a three-year Next Generation Internet Initiative (NGI) and the Administration sponsored an Information Technology for the 21st Century Initiative (IT2). Both the NGI and IT2 initiatives were incorporated into the IT R&D program and are referred to as the Networking and Information Technology R&D (NITRD) program. Federally funded IT R&D provides assistance in times of terrorist attacks and disaster response. This includes using advanced technologies such as robotics, global positioning satellites, optical technologies, environmental monitoring, high-speed networking, computational chemical analysis, mapping, and simulation software. NITRD has focused IT research on cost effective high end computing to provide data storage and computing power for intelligence analysis, large scale data mining and information management technologies, advanced cryptography and authentication technologies, new methods to achieve security with high-speed wireless and wired devices, embedded networked sensor technologies, software for mission critical systems, and improved interfaces for and interoperability of IT devices. In 2009, the President s Council of Advisors on Science and Technology (PCAST) met to develop recommendations to present to the President concerning science and technology including health IT. PCAST is administered by the Office of Science and Technology Policy. Also in 2009, PCAST published a report Leadership Under Challenge: Information Technology R&D in a Competitive World. The report assesses global U.S. competitiveness in networking and information technology. In 2009 PCAST published a report U.S. Preparations for 2009-H1N1 Influenza and PCAST s Working Group detailed how the nation needs to respond to the problem and produced their own report on H1N1 with recommendations. In 2009, NITRD published the report High Confidence Medical Devices: Cyber-Physical Systems for 21st Century Health Care. The report was a result of NITRD s workshops that were held with more than 100 experts coming together to identify crucial challenges facing the design, manufacture, and the use of high confidence medical devices, software and systems. The Guide to the NITRD Program called the blue book is available to the public. The report published each year as a supplement to the President s budget reports, describes the activities of the Federal agencies working together on advanced computing networking, software, and related IT.

6 6 National Science and Technology Council Committee on Science Interagency Working Group on Digital Data In 2009, the Interagency Working Group published the report Harnessing the Power of Digital Data for Science and Society to examine how digital technologies are reshaping science and the tools that scientists need to deal effectively with the enormous amount of data. The Working Group has worked with nearly 30 agencies, offices, and councils to develop strategic requirements.

7 7 FEDERAL AGENGIES Department of Homeland Security The Department of Homeland Security (DHS) works in partnership with federal departments and agencies, state, local and tribal officials, the private sector, and national and international associations. Office of Health Affairs The DHS Chief Medical Officer within the Office of Health Affairs (OHA) reports to the Secretary. The OHA is involved in WMD, biodefense, medical readiness, workforce health protection, and global health security. The OHA Medical Readiness Office identifies and evaluates DHS readiness programs and activities related to medical and public health, coordinates activities with the first health responder community, examines all regional hazards systems for medical and public health preparedness, coordinates with FEMA and HHS to develop risk-based performance objectives for health and medical capabilities, and coordinates medical and health preparedness grants. The OHA Medical Countermeasures Division within HHS provides expertise on countermeasures. The OHA works with HHS, Defense, Agriculture, Commerce, Transportation, Justice, the VA, CDC, EPA, and the U.S. Postal Service. OHA also works with state and local governments, non government organizations, and the private sector. Preparedness Program The Preparedness program works with state, local, and private sector partners to identify threats and target necessary resources. DHS consolidates existing preparedness efforts such as grants, exercises, training, public health infrastructure, cyber security, and telecommunications. Office for Emergency Communication The Office for Emergency Communications (OEC) responds to the department s emergency preparedness and response functions. OEC combined the SAFECOM program, the interoperable communications technical assistance program, and parts of the integrated wireless network. The goal is to help the emergency response community provide security, reliability, scalability, and affordability for not only existing technologies but also for emerging technologies. The OEC has consolidated several interoperability programs and developed the National Emergency Communications Plan. Emergency Management Performance Grants go to support state and local emergency management programs. OEC is playing an important role in the Public Safety Interoperable Communications (PSIC) grant program. OEC provides technical assistance to the states to help them prepare their statewide interoperability plans and provides additional technical assistance. DHS conducts surveys of first responders across all jurisdictions to assess progress in achieving interoperable communications.

8 8 SYSTEMS National Incident Management System The National Response Plan uses the National Incident Management System (NIMS) to establish standardized training, organization, and communications procedures for multi-jurisdictional interaction, and identifies authority and leadership responsibilities. NIMS is the first standardized management plan to create a unified structure for federal, state, and local lines of government for incident response and management. Key elements and features of NIMS include: Establishing an Incident Command System for operations planning, logistics, finance, and administration to better manage all major incidents Using advanced preparedness measures to plan, train, examine qualifications and certifications, buy equipment, and maintain publication management Examining public education, enforcement of building standards and codes, and providing preventive measures to deter or lessen the loss of life or property Prescribing interoperable communications systems for both incident and information management Joint Information System The Joint Information System within NIMS provides the public with incident information, public messages, and brings incident communicators together during an incident to develop, coordinate, and deliver a unified message National Biosurveillance Integration System The DHS studies the vulnerability of critical infrastructures such as food, water systems, agriculture, health systems and emergency services information, and telecommunications. The Bio-Surveillance Program initiative protects against bioterrorism and provides ongoing surveillance programs for health, hospitals, vaccines, food supplies, state and local preparedness, environmental monitoring. One component of the program will expand and deploy the next generation of technologies to the BioWatch Program. The National Biosurveillance Integration System can help with a possible flu pandemic. When an epidemic occurs, data is collected from CDC s BioSense System which reports on syndromic surveillance, and other data is collected from several other sources to report on possible flu outbreaks or a bioterrorist attack. The DHS s Homeland Security Information Network disperses biosurveillance trends and any threats to the proper authorities. National Disaster Medical System NDMS coordinates how federal health officials respond to major emergencies, federally declared disasters, terrorist s attacks, and domestic terrorist incidents involving weapons of mass destruction. Legislation was passed to make the Secretary of HHS responsible for public health and responses to emergencies. The preparedness and response programs are under the HHS Assistant Secretary for Preparedness and Response.

9 9 Metropolitan Medical Response System The Metropolitan Medical Response System grants fund an integrated systematic mass casualty incident preparedness program to help first responders during the first crucial hours of an incident. This program provides funding on a formula basis to 124 MMRS jurisdictions. Directorate for Science and Technology The Directorate is the primary research and development arm to drive development and the use of high technology to support homeland security. The Directorate draws upon technologies that can be developed and delivered within three years. The goals are to develop and deploy state-of-the-art low cost systems to protect against terrorist attacks, develop technology standards, and establish certified laboratories to evaluate technology for Safety Act certification. The Science and Technology Office for Innovation is responsible for examining all the DHS technologies. The technology will be used to create a resistant electronic grid to protect critical infrastructure sites. The Office of Interagency Programs and First Responder Liaison works closely with DOD to develop information sharing opportunities. DHS provides national interagency outreach through meetings, conferences, and symposia. The Coordination of Homeland Security Science and Technology document provides the direction for DHS research and development, and identifies strategic goals through 2015 to help to adapt to a changing world and ever evolving enemy. The Office has published a 5 year plan from for research and development and published a report in May 2009 outlining high priority technology needs. There is information on first responder, chemical/biological defense, and incident management technology needs. TechSolutions The Tech Solutions Program was established by the Science and Technology Directorate to provide information, and help find the resources and technology solutions to identify gaps that are recognized by the emergency response community. Tech Solution looks at technological requirements and provides solutions for first responders. First responders are encouraged to submit ideas that would help the first responder community to increase efficiency and on-the-job-safety. The Homeland Security Advanced Research Project Agency (HSARPA) housed within the Directorate is the external funding arm of the Science and Technology Directorate. HSARPA s purpose is to perform early research and development on the scientific and biological front. Other offices within the Directorate include the Office of Plans, Programs and Requirements, Office of R&D, and the Office of Systems Engineering and Development. The agency awards research grants.

10 10 OTHER PROGRAMS Regional Technology Integration Initiative The Regional Technology Integration (RTI) Initiative works to transition innovative technologies and organizational concepts to regional, state, and local jurisdictions. Four urban areas were selected to be the initial pilot locations in the program. The program has an initial investment of $10 million for studies and assessments. Subsequent funding for the deployment of technology systems will be determined after looking at the results of initial studies and working in collaboration with the selected urban areas. Cincinnati Ohio one of the four locations, enables public health officials, fire departments, and law enforcement to be in contact through a one million dollar command center. Advisory Committees and Collaborative Agreements The Homeland Security Science and Technology Advisory Committee, operates with a technology clearinghouse, the Office for National Laboratories, and an office to handle extramural programs with universities. The National Infrastructure Advisory Committee provides information on the security of information systems for public and private institutions. Federal Emergency Management Agency FEMA is involved in disaster management responds to hazards, mobilizes personnel to help with safety, and coordinates disaster response teams. FEMA has the authority to designate specialized teams for emergency communications and to assist in medical emergencies. FEMA wants to obtain new technologies and equipment to improve disaster readiness. DHS is using satellite imagery, upgrading radios, and employing frequency management. The National Response Coordination Center at FEMA and Mobile Registration Intake Centers are operational. FEMA also coordinates the National Emergency Response Team a part of the National Disaster Response Teams (NDRT) and part of the National Disaster Medical Systems of the U.S. Public Health Service. The NDRT teams include physicians, nurses, and paramedics, coordinated by FEMA. DHS Assistance for Industry Small Business Program DHS has a small business specialist in each contracting office, conducts monthly vendor outreach sessions, participates in small business conferences, has a mentor-protégé program, awards small business contracts, and provides a business website. The program Open for Business assists the business community and provides links to contracts, grants, small business opportunities, and R&D contracts. The Information Technology Acquisition Center establishes department-wide contacts for IT services and commodities under the program names of EAGLE and First Source. EAGLE is a partial small business set-aside for software development, engineering design and development management support services, and operation and maintenance. First Source, a 100 percent small business set aside provides the agency with a variety of commer-

11 11 cial catalogs for IT commodity products. The contracts include IT equipment and software, networking, wireless technology, imaging products, voice recognition technology, and online data reporting services. The goal is to explore network technologies that can forward real-time information about a specific first responder from a flexible array of multiple sensors to a receiver. Commercial Equipment Direct Assistance Program CEDAP operated by the Office of State and Local Government Coordination and Preparedness, provides technology, installation, and technical assistance directly to eligible jurisdictions. DHS is distributing commercial IT and sharing software with first responders and offers sensors and risk management software. FEMA has awarded millions in equipment and equipment training. Eligibility for the grants is limited to law enforcement agencies, fire, and other emergency responder organizations. The awards are offered in personal protective equipment, thermal imaging, night vision, video surveillance tools, chemical and biological detection tools, information technology and risk management tools, and interoperable communications equipment. Technology Transfer Clearing House The Clearing House has information on public health and a community database on technology transfer. A contract was awarded to PSITEC to provide services through the knowledge portal to provide one stop shopping. SBIR Program The HSARPA SBIR program is restricted to for-profit small businesses with 500 or fewer employees. Firms with successful concepts in Phase 1 may be invited to apply for a two-year Phase 2 award not to exceed $750,000 to further develop the concept, usually to the prototype stage. For example, EyeMarker Systems received SBIR funding from DOD to develop an ocular imaging device to detect toxins in the system, if terrorist s attacks should become more deadly with the use of more chemical and biological agents. DARPA helped the company acquire additional funding from the interagency Technical Support Working Group to get the device ready for commercialization. The Science and Technology Directorate within DHS partnered with TSWG to add funding for additional software development and testing. Future TECH The DHS TECH program was established to develop mutually beneficial partnerships with the private sector, national laboratories, university community, and other R&D organizations. The goal is to develop technologies and capabilities to address the long term needs of DHS. Future TECH enables the private sector and others to find out about the critical research and innovation focus areas of interest to the Science and Technology Directorate.

12 12 Technical Support Working Group TSWG is helping the private sector develop technologies and systems needed for homeland security. TSWG looks for new technologies that will detect hazardous biological and chemical agents and to further develop handheld detectors. The S&T Directorate coordinates research and development projects with TSWG to combat terrorism. Several DHS funded tasks addressing S&T requirements were funded through TSWG. Vendor Information Site DHS has created a Vendor Information Site with a database so that businesses can share information about their information technology related products and services. This helps DHS develop partnerships with the private sector to research, develop, and deploy homeland security technologies. The agency retains the information for reference purposes in order to understand IT products and services that may meet emerging requirements through procurements undertaken or that will be undertaken.

13 13 Department of Health and Human Services Office of the Secretary Healthcare Reform HHS released the report Americans Speak on Health Reform: Report on Health Care Community Discussions in The report summarized comments from many Americans who participated in Health Care Community Discussions across the country. The web site enables Americans to share their thoughts about health reform with the Obama Administration. In 2009, the Secretary established the Office of Health Reform to spearhead the passage of health reform and to coordinate closely with the White House Office of Health Reform. Office of Recovery Act Coordination The Office was created to help organize and distribute an estimated $137 billion in Recovery Act Funds to be managed by HHS. A Deputy Assistant Secretary for Recovery Act Coordination was put in place to obtain critical resources and provide potential new job opportunities. Office of the National Coordinator for Health Technology The Office of the National Coordinator for Health Technology (ONC) coordinates the nation s health information technology efforts, and operates under the leadership of four permanent directors Stimulus Package Funds ONC received $2 billion to coordinate health IT policy and programs. The programs will be initiated by the Secretary but the National Coordinator will have the responsibility to move and expand the electronic movement of health information. Vice President Joe Biden in 2009 announced that $1.2 billion in grant funding will be used to help hospitals and healthcare providers implement and use electronic health records. The rollout provides for two HITECH priority grants programs to establish Health Information Technology Regional Extension Centers and grants to help States and Qualified State Designated Entities share information within the emerging nationwide system of networks. The initial funding of $598 million will ensure that comprehensive support is available to providers beginning early in FY 2010 with an additional $5 million available for years 3 and 4 of the program. Federal support will continue for four years and then the program is expected to be self sustaining. The State Health Information Exchange Grant program with funding of $564 million is awarding cooperative agreements to states and qualified state designated entities to advance information sharing

14 14 across the healthcare system. States will need to match grant awards beginning in The ONC has awarded grants to states and Indian Tribes. There are incentive grants to use for HIT for infrastructure and tools for the promotion of telemedicine, and state planning and implementation grants. There is also grant money to set up a national research center and regional extension centers. Grants in consultation with NSF will be provided for demonstration projects to help move and integrate certified EHR technology into clinical education. Loans will be provided through a technology loan program to help providers. Loans may be used by providers to purchase certified EHR technology, improve EHR technology, to train personal to use the new technology and to improve the secure electronic exchange of health information. These loans will be available in ONC released the Federal Health IT Strategic Plan to advance HIT. With the passage of the Recovery Act the plan will be revised by ONC. The plan identifies the federal activities needed to implement the technology infrastructure in both the public and private sectors. The two primary goals are to help Patient Focused Health Care and Population Health. The plan describes 43 strategies needed to achieve each objective. The plan addresses privacy, security, achieving an interoperable health IT architecture, how to accelerate IT adoption, and how to foster collaborative governance. Other ONC Activities ONC is working to integrate HIT in education and include EHR in medical school curricula. The agency is working with NSF on workforce training for HIT professionals The Office of the National Coordinator for HIT provides Use Cases, and is interested in feedback by interested stakeholders by both the private and public sectors. The use cases are both Prototype Use Cases and Detailed Use Cases ONC awarded $450,000 to Booz Allen Hamilton to assess and evaluate the scope of the medical identity theft problem in the U.S. and examine how health IT can be used to detect and prevent medical identity theft NHIN HHS and other agencies are working together to develop and connect to the NHIN. The Federal Health Architecture led by ONC is working with 26 federal agencies with health related activities to advance health information exchange across the federal government and with tribal, state, and private sectors. Contracts were awarded to nine health information exchanges to begin NHIN trial implementations. These trials will demonstrate core services, exchange summary patient records, and support the capabilities of NHIN. Further contracts with CDC will further develop NHIN. Several major contracts were awarded for standards development, for developing requirements for health IT products, developing models and prototypes for NHIN to be used for health information exchange, and to assess variations in state laws and organization. In 2009, NHIN made software called CONNECT available to help public and private health information technology systems communicate to NHIN. NHIN came online and started exchanging live data among those organizations that are ready, willing and able to exchange health information using NHIN specifications and standards. The first agency to use NHIN was SSA to speed up applying for SSA disability benefits. DOD, VA, CDC, IHS, and NCI have also tested and demonstrated CONNECT S ability to share data.

15 15 Federal Health Architecture Office The Office is developing a version of the CONNECT software to help expand the sharing of health information between Medicaid and other state health offices and with federal and commercial health service agencies. Federal Multi-Agency Activity The 2009 stimulus package establishes a Federal Coordinating Council for Comparative Effectiveness Research to assist HHS, VA, DOD, and other agencies to coordinate and conduct comparative effectiveness and related health services research. In addition, a Federal Interdepartmental Health Information Technology Collaborative brings together leaders in the federal departments engaged in health IT programs. Federal agencies included in the collaborative are USDA, Department of Commerce, HHS, FCC, FTC, NASA, and NSF. The Federal Health Architecture Program supports federal health IT by providing a federal framework that is interoperable within the federal government and works with other public and private sector organizations. Standards Development ONC supports the harmonization of standards needed. HITSP is conducting the ONC funded project. There are more than 300 health related organizations working together to identify and harmonize data and technical standards for health IT. ONC set up the Certification Commission for Healthcare Information Technology (CCHIT) to develop the evaluation process for certifying electronic health records. A number of vendors now have earned certification for electronic health record products from CCHIT, and the numbers keeps growing. A web site ( developed in partnership with HITSP, NIST, ONCHIT, provides access to tools and resources. The 2009 stimulus funding gives the National Coordinator the responsibility for standards and certification. New health IT Policy and HIT standards committee are being formed to serve as federal advisory committees Disparities in Populations A collaborative was formed to develop e-health related solutions to alleviate health disparities in underserved rural and urban communities. The National Health IT Collaborative for the Underserved was formed with HHS/Office of Minority Health, the Institute for e-health Policy, Summit Health Institute for Research and Education, Inc. Association of Clinicians for the Underserved, and Apptis to help to those areas in need. ONC serves on the HHS Workgroup on Health IT and Underserved Populations to assess ongoing activities, challenges, and opportunities to help reduce disparities in populations. The workgroup is chaired by the Office of Minority Health and HRSA. Developing HIEs in States ONC in conjunction with the Foundation of Research and Education, part of AHIMA will research

16 16 and report on state level Health Information Exchanges. State HIEs need to work with state governments and others to identify and remove barriers for medically underserved participation in health information exchanges. The State Alliance for e-health was designed to build state government consensus across jurisdictions on many issues related to HIE, and is composed of state governors, legislators, high level officials and technical experts. Privacy and Security Policies The Privacy and Security Solutions contract awarded to RTI International and co-managed by ONC and AHRQ coordinates the work of 33 states and one territory to establish the Health Information Security and Privacy Collaboration (HISPC) along with a broad range of stakeholders to assess current variations in state level privacy and security practices. Advisory Committees National Biodefense Science Board A Public Health Advisory Board advises the Secretary on Chemical, Biological, or Radiological Agents. The National Biodefense Science Board advises on preventing, preparing, and how to respond to the release of agents, trends, challenges, and opportunities in the field. National Committee on Vital and Health Statistics The Committee is a public advisory body to the Secretary on health data and statistics and serves as a forum with private sector groups on a variety of key health data issues. These issues include health statistics, electronic interchange of healthcare information, privacy and security, purchasing or financing of healthcare services, integrating computerized health information systems, health services research, consumer interests, health data standards, e-prescribing standards, and uniform standards for patient medical record information. Advisory Committee on Regulatory Reform The committee provides the Secretary with recommendations regarding potential regulatory changes to reduce burdens and costs associated with departmental regulations. The committee makes recommendations in healthcare delivery, health systems operations, biomedical and health research, and developing pharmaceuticals and other products. National Advisory Committee on Rural Health and Human Services The National Advisory Committee on Rural Health and Human Services is a 21 member panel of experts providing recommendations and reports to the Secretary. The Committee pointed to the need for

17 17 research in substance abuse and the need to use technology to help solve this enormous problem in rural areas. Additional Activities at HHS In 2009, ARRA funds to be administered by CMS went to 12 states to survey more than 125 ambulatory surgical centers before September 30, In October 2009, additional funds went to all of the states to make inspections of ASCs. CDC made $40 million available for state public health departments to create or expand state-based HAI prevention and surveillance efforts. Researchers are studying how to integrate genomics into clinical information systems so that physicians will know their patients genetic makeup HHS has outlined a Personalized Health Care Initiative to combine the basic scientific breakthroughs of the human genome with the computer to exchange and manage data. The agency has released a second report that looks at findings in genetics and other molecular level medicine HHS has developed a new downloadable online, diagnostic, and treatment toolkit designed for healthcare providers, primarily physicians who may have to provide medical care during a radiation incident HHS has established a Patient Safety Task Force to coordinate efforts among several department agencies to improve patient safety data collection. The Federal agencies include AHRQ, the Centers for Disease Control and Prevention, FDA, and Centers for Medicare and Medicaid. The task force is building a Medicare patient safety monitoring system that the agency will use to gather information from medical and administrative records HHS has established Patient Safety Organizations to allow for the voluntary reporting of patient safety events without fear. A final rule effective January 2009 provides for final requirements and procedures for PSOs and new entities HHS Office of Inspector General and CMS announced final regulations to support physician adoption of electronic prescribing and electronic health records technology. The final rules create new exceptions and safe harbors to two federal fraud and abuse laws that involve electronic health information technology and services. The exceptions and safe harbors allow for donations to physicians of interoperable electronic health records software, IT, and training services, plus hospitals may provide physicians with technology to be used solely for electronic prescribing Assistant Secretary for Health Office of Public Health and Science The Assistant Secretary for Health advises the Secretary on public health and oversees the U.S. Public Health Service. The Office of Public Health and Science within the Office of the Assistant Secretary for Health is working to improve infectious disease surveillance, improve connectivity between hospitals

18 18 and health departments, help hospitals with casualties, and help to expand public health laboratories. The Laboratory Response Network, a system of over 80 public health laboratories identifies pathogens that could cause bioterrorism. The Assistant Secretary for Health showcases best practices in public health from all over the country with information on Houston Texas, Boston Medical Center, Utah Department of Health, Massachusetts Department of Public Health, Michigan Department of Community Health, and the Rhode Island Department of Health. OPHS has a plan to reduce and possible eliminate healthcare associated infections. The document Action Plan to Prevent Health Care Associated Infections lists areas where HAIs can be prevented and also outlines cross agency efforts to initiate HAI prevention efforts. Office of Disease Prevention and Health Programs (ODPHP) The Office of Disease Prevention and Health Programs (ODPHP) under the direction of the Office of Public Health and Science, conducts the Developing a National Action Agenda for the National Health Information Infrastructure (NHII) conference. The NHII addresses information and communication technologies to advance personal health, population health, prevention, and healthcare. ODPHP is involved in a number of other initiatives: Steps to a Healthier US (STEPS) is an initiative to help Americans live longer, better, and healthier, and identifies and promotes healthy behaviors and prevention. Priority areas for the initiative are diabetes, obesity, asthma, heart disease, stroke, and cancer. The National Health Information Center (NHIC) is an internet accessible clearinghouse with a toll free number that provides a central health information referral service for consumers and professionals using a database of national associations, government agencies, and other organizations. ODPHP publishes the directory of Federal Health Information Centers and Clearinghouses compiled annually by NHIC The Healthy People 2010 Program promotes health and has established health improvement objectives with ten year targets. Healthfinder ( links consumers and professionals to information from the federal government and many partners. The department wide project includes resources on over 1000 topics Assistant Secretary for Preparedness and Response The Assistant Secretary for Public Health and Emergency Preparedness (ASPHEP) advises the Secretary on bioterrorism and other public health emergencies. ASPHEP coordinates activities between HHS and other federal departments, agencies, and offices responsible for emergency preparedness. Funding is provided to increase hospital preparedness in the states, territories, and metropolitan areas. HHS established the Biological Advanced Research and Development Authority (BARDA) to fund the advanced development of medical countermeasures. BARDA coordinates interagency efforts to define and prioritize requirements for public health medical emergency countermeasures related to research,

19 19 product development, and procurement. BARDA manages Project BioShield as well as manages the advanced development and procurement of medical countermeasures for pandemic influenza and other emerging infectious diseases that fall outside the auspices of Project BioShield. The Assistant Secretary through the Hospital Preparedness Program is funding ways to improve the readiness of hospitals and other healthcare organizations. The goal is to develop interoperable communication systems, track available hospital beds electronically, register volunteer health professionals, develop procedures for hospital evacuations, and provide for fatality management. The Emergency Care Coordination Center (ECCC) is located in the Assistant Secretary s office. The ECCC supports the coordination of in-hospital emergency medical care activities and promotes programs and resources to improve the delivery of emergency medical care and emergency behavioral health care. The program is looking for the best approaches to support regionalized, comprehensive, and accountable emergency care and trauma systems. The ECCC is planning on developing demonstration programs in this field. Other HHS Bioterrorism and Collaborative Efforts PAHPA calls for the Secretary to establish a near real-time electronic nationwide public health situational awareness capability through an interoperable network of systems HHS has a national epidemiologic surveillance system based on state, regional, and community-level capabilities. The network enables information flow among all entities to help in health emergencies and disasters if bioterrorism occurs. A Command Center monitors public health and coordinates HHS activities with international, federal, state, and local public health authorities during emergencies CDC, FDA, DHS, and USDA are working together on the Bio-Surveillance Initiative. The goal is to develop new tools and procedures to identify potential disease outbreaks more rapidly HHS has awarded funds to states, territories, and major metropolitan areas to help hospitals and other healthcare facilities respond to bioterrorism attacks, infectious diseases, and natural disasters that may cause mass casualties. The funds are used to provide or improve interoperable communications systems to track available hospital beds, and plan for both fatality management and hospital evacuations HHS initiated the Healthcare Facilities Partnership Program to award grants to enable healthcare partnerships to prepare for public health emergencies. The program focuses on hospital surge capacity and emergency care system capability. Assistant Secretary for Administration Office of Grants Management and Policy

20 20 Federal E-Health Initiative HHS is the managing partner for the Federal E-Grants Initiative, one of 24 initiatives of the overall E-Government program to improve access to government services via the internet. Eleven departments and agencies have been designated as supporting partners to develop a one-stop electronic grant portal where potential grant recipients receive full service electronic grant administration. The first step in searching for grant opportunities is to register and receive automatic notifications of new grant opportunities as they are posted on the site. The next step is to download an application package and register with the Central Contractor Registry online, and the third step is to register the organization s E-Business Point of Contact, confirm the CCR Marketing Partner ID password, and the last step is to register the Authorized Organization Representative. Grantsnet Grantsnet is an internet application tool developed to provide information on HHS grants and other Federal grant programs. HHS does not have one publication that describes all of HHS grants and programs, The agency uses the Catalog for Federal Domestic Assistance to profile all Federal grant programs, and publishes information on ( and on the agency web sites. TAGGS The Tracking Accountability in Government Grants System (TAGGS) is a tool developed by the HHS Office of Grants with a database on grants that have been awarded by the 12 HHS Operating Divisions. Information is available by keyword and by doing an advanced search. Assistant Secretary for Financial Resources As of 2009, the Office provides advice and guidance on budget issues, financial management, information technology, grants, and ARRA coordination. Before 2009, the office was known as the Assistant Secretary for Resources and Technology. This office now has responsibility for the Office of Small and Disadvantaged Business Utilization. Assistant Secretary for Planning and Evaluation ASPE has funded a number of studies related to health IT and provides an analysis of costs and benefits, an analysis of consumer control of personal electronic health information, an economic assessment of small physician practices adoption of EMRs, and studies examining the exchange of health information for persons receiving long term care. ASPE analyzes and models factors associated with successful EHR adoption and evaluation.

21 21 Technology for Long Term Care The HHS office studies technologies that are available to provide higher quality care for the elderly and the disabled. The information is available for professionals in nursing homes, assisted living facilities, adult day care facilities, and continuing care retirement communities. Office of Global Health Affairs The site has information on global health issues as well as worldwide health statistics for reports and publications and provides links to global health partners. The Office has funded a cooperative agreement with the Arizona Department of Health Services, and the Arizona Outreach Office of the U.S. Mexico Border Health Commission to strengthen the bi-national public health projects and programs along the Arizona-Sonora border. The program is working with the Arizona Department of Health Services, Office of Border Health, the Secretaria de Salud de Sonora, and the USMBHC Arizona and Sonora Delegation Offices. The office works on data analysis, public information, communication and Health Gente/Health Border 2020 activities. Office of Inspector General The Office of Inspector General (OIG) provides oversight for patient safety grants, local health departments bioterrorism preparedness, state laboratory response networks, health alert networks, reportable disease surveillance, national electronic disease surveillance systems, hospital bioterrorism preparedness programs, urban Indian health programs, research grants, and medical records privacy. Goals are to study smart card technology, examine how State Medicaid agencies will use health IT, study the Clinical Trials Data Bank to see if complete information is received, examine the Adverse Event Reporting for Medical Devices System, and assess the Quality Improvement Organization program. Council on Private Sector Initiatives to Improve Security, Safety, and Quality of Health Care The Council reviews requests from companies that have innovative ideas and products to sell to the government and looks for products to enhance security, safety, and quality of the nation s healthcare system including bioterrorism preparedness. NATIONAL INSTITUTES OF HEALTH NIH Challenge Grants in Health and Science Research As part of the Recovery Act, NIH is funding at least $200 million in FY for this new grant initiative. The program supports research on Challenge Topics to address specific scientific and