CMS and ONC To Announce Next Steps for Electronic Health Records Programs

FOR IMMEDIATE RELEASE                                         

 

Wednesday, December 30, 2009 

 

Contact:  CMS Office of Media Affairs                                                          

(202) 690-6145                                                                                                              

ONC Media Affairs                                                                                                              

(202) 690-7385

MEDIA ADVISORY 

CMS and ONC To Announce Next Steps for Electronic Health Records Programs

 

On Wednesday, Dec. 30, 2009, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) will announce two regulations that lay a foundation for improving quality, efficiency, and safety through meaningful use of electronic health record (EHR) technology.

 

The regulations will help implement the EHR incentive programs enacted under the Health Information Technology for Clinical and Economic Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act of 2009.  Public comments on both regulations are being encouraged.

 

WHO:   David Blumenthal, M.D., M.P.P., national coordinator for health information technolog

            Jonathan Blum, director, Center for Medicare Management

            Cindy Mann, director, Center for Medicaid and State Operations

 

WHAT:                      Reporter briefing

 

WHEN:                      Wednesday, Dec. 30, 2009

4:30 p.m. – 5:15 p.m. Eastern Time

 

WHERE:                   Toll-Free Dial:           (877) 251 – 0301

                                    Conference ID:          49089834

                                    Pass Code:                 HITECH

 

 

Christmas Tree cluster

NGC 2264 and the Christmas Tree cluster


This colour image of the region known as NGC 2264 — an area of sky that includes the sparkling blue baubles of the Christmas Tree star cluster — was created from data taken through four different filters (B, V, R and H-alpha) with the Wide Field Imager at ESO's La Silla Observatory, 2400 m high in the Atacama Desert of Chile in the foothills of the Andes. The image shows a region of space about 30 light-years across.

Credit:

ESO

 

Johns Hopkins scientists discover a controller of brain circuitry

By combining a research technique that dates back 136 years with modern molecular genetics, a Johns Hopkins neuroscientist has been able to see how a mammal's brain shrewdly revisits and reuses the same molecular cues to control the complex design of its circuits.

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A pyramidal neuron in the mouse cerebral cortex is labeled using the Golgi technique.

Image by Tracy Tran, David Ginty and Alex Kolodkin of Johns Hopkins Medicine

Details of the observation in lab mice, published Dec. 24 in Nature, reveal that semaphorin, a protein found in the developing nervous system that guides filament-like processes, called axons, from nerve cells to their appropriate targets during embryonic life, apparently assumes an entirely different role later on, once axons reach their targets. In postnatal development and adulthood, semaphorins appear to be regulating the creation of synapses — those connections that chemically link nerve cells.

"With this discovery we're able to understand how semaphorins regulate the number of synapses and their distribution in the part of the brain involved in conscious thought," says David Ginty, Ph.D., a professor in the neuroscience department at the Johns Hopkins University School of Medicine and a Howard Hughes Medical Institute investigator. "It's a major step forward, we believe, in our understanding of the assembly of neural circuits that underlie behavior."

Because the brain's activity is determined by how and where these connections form, Ginty says that semaphorin's newly defined role could have an impact on how scientists think about the early origins of autism, schizophrenia, e pilepsy and other neurological disorders.

The discovery came as a surprise finding in studies by the Johns Hopkins team to figure out how nerve cells develop axons, which project information from the cells, as well as dendrites, which essentially bring information in. Because earlier work from the Johns Hopkins labs of Ginty and Alex Kolodkin, Ph.D., showed that semaphorins affect axon trajectory and growth, they suspected that perhaps these guidance molecules might have some involvement with dendrites.

Kolodkin, a professor in the neuroscience department at Johns Hopkins and a Howard Hughes Medical Institute investigator, discovered and cloned the first semaphorin gene in the grasshopper when he was a postdoctoral fellow. Over the past 15 years, numerous animal models, including strains of genetically engineered mice, have been created to study this family of molecules.

Using two lines of mice — one missing semaphorin and another missing neuropilin, its receptor — postdoctoral fellow Tracy Tran used a classic staining method called the Golgi technique to look at the anatomy of nerve cells from mouse brains. (The Golgi technique involves soaking nerve tissue in silver chromate to make cells' inner structures visible under the light microscope; it allowed neuroanatomists in 1891 to determine that the nervous system is interconnected by discrete cells called neurons.)

Tran saw unusually pronounced "spines" sprouting willy-nilly in peculiar places and in greater numbers on the dendrites in the neurons of semaphorin-lacking and neuropilin-lacking mice compared to the normal wild-type animals. It's at the tips of these specialized spines that a lot of synapses occur and neuron-to-neuron communication happens, so Tran suspected there might be more synapses and more electrical activity in the neurons of the mutant mice.

The researchers tested this hypothesis by examining even thinner brain slices under an electron microscope.

The spines of both semaphorin-lacking and neuropilin-lacking mice were dramatically enlarged, compared to those of the smaller, spherical-looking spines in the wild-type mice. In wild types, Tran generally noted a single site of connection per spine. In the mutants, the site of connection between two neurons was often split.

Next, the team recorded the electrical output of mutant and wild-type neurons and found that the mutants, with more spines and larger spines, also had about a 2.5-times increase in the frequency of electrical activity, suggesting that this abnormal synaptic transmission is due to an increase in the number of synapses.

What causes synapses to form or not form in appropriate or inappropriate places is an extremely important and poorly understood process in the development of the nervous system, Kolodkin says, explaining that the neurons his team studies can have up to 10,000 synaptic connections with other neurons. If connections between neurons are not being formed how and where they're supposed to, then miscommunication occurs and circuits malfunction; as a result, any number of diseases or disorders might develop.

"Seizures can be interpreted as an uncontrolled rapid-firing of certain neural circuits," Kolodkin asserts. "Clearly there's a deficit in these animals that has a human corollary with respect to epilepsy. It's also thought that schizophrenia and autism spectrum disorders have developmental origins of one sort or another. There likely are aspects to the formation of synapses — if they're not in the correct location and in the correct number — that lead to certain types of defects. The spine deficits in these mice that are lacking semaphorin or its receptor appear very similar to those that are found in Fragile X, for instance."

 

###

 

This work was supported by the National Institutes of Health, National Science Foundation, and the Howard Hughes Medical Institute.

Johns Hopkins authors of this paper are Tracy S. Tran, Alex L. Kolodkin, David D. Ginty, Richard L. Huganir, Roger L. Clem, and Dontais Johnson. Other authors are Maria E. Rubio of the University of Connecticut; and Lauren Case and Marc Tessier-Lavigne, of Stanford University.

 

Congressman Blunt Introduces Health IT Legislation

Congressman Roy Blunt (R-MO) has introduced H.R. 3987, a bill intended to lower health care costs and improve quality of care for patients through enhanced health information technology. Blunt's plan would allow providers such as hospitals and group practices to supply physicians with products or services used for health information technology.

Blunt says this will help physicians improve medical record keeping; increase access to health care by reducing paperwork and speeding accurate communication, offer quick access to lab and test results, and ensure patient diagnosis and treatments are delivered more quickly and more accurately. The plan will offer a safe harbor to anti-kickback civil penalties and criminal penalties, and an exception to the limitation on certain physician referrals under the Stark laws for the provision of HIT and training services to health care professionals. The HIT will include hardware, software, licenses, intellectual property, equipment, or other information technology designed or provided primarily for the electronic creation, maintenance or exchange of health information.

"You can drive up to any gas station in the country, and they can immediately figure more out about your car than a doctor knows about a patient," Blunt said in a press release on his web site. "A straightforward way to lower health care costs is by increasing the use of health information technology. Health IT will help doctors and health care providers share information about a patient's history and prevent duplicative testing and other expensive, unnecessary medical mistakes."

 

Concept Demonstration: Global Climate Data

In late 2009 the UK Government launched an Open Data initiative, headed by Sir Tim Berners-Lee, along with a call for innovationschallenging the developer community to make this data more accessible. In response, Geo.me Solutions is showcasing a number of concept demonstrations using map-based visualisations.

The data set represented in the demos below was released by the UK Met Office in December 2009. It consists of a network of individual land stations designated by the World Meteorological Organization for use in climate monitoring. The data show monthly average temperature values for over 1,500 land stations.

Click here or on the image below to view an interactive map where you can browse climate stations and view historical and current temperature data.

click here to launch demo

 

via geo.me

 

DocMatcher.com: Web Platform to Enhance Patient-Doctor Relationships and Improve Health Outcomes

Brooklyn-based start-up DocMatcher.com has launched an intuitive, personalized health care web platform that helps people find a doctor to match their specific health needs.

After the patient and doctor are personally matched using a specifically designed algorithm, patients can book an appointment on-line, store and share their medical information, read expert articles and communicate over DocMatcher.com’s secure web interface. DocMatcher.com’s office management features also directly benefit health professionals by allowing them to build, grow and efficiently manage their practices.
"Having autonomy over the physician selection process has been shown to enhance patient trust and improve health outcomes"
About 1.3 million adults in New York City are without a regular health care provider, of which 80% have sufficient health coverage, according to a survey by the New York City Department of Health and Mental Hygiene. Access to a regular care provider and insurance helps patients secure preventive care. Those with regular providers receive more advice on nutrition, exercise, and weight control than those without, the survey notes.

These findings underline the significant role played by a good patient-doctor relationship in improving health outcomes and reducing health care costs. This also raises the question of why so many patients are without a regular provider, according to Dr Tara Khan, founder and chief executive officer of DocMatcher.com.

“It has been shown that continuity of care by your doctor heightens your satisfaction, decreases hospitalizations and emergency department visits and leads to the receipt of preventive services, thereby improving health outcomes” said Dr Khan.

Against this background, the Internet is fast becoming the primary source of medical information, especially in researching and choosing a physician. Nearly 150 million people in the US have searched the Internet for health information, a recent Harris Poll revealed.

“People joke that DocMatcher.com sounds like a dating site. Though you can’t find true love using DocMatcher – it follows a similar principle. DocMatcher’s intuitive search engine finds specific information about your potential health professional matches using criteria important to you. We then make it easier for you to meet and communicate to find out if that doctor is right for you. This leads to long, healthy relationships and better care,” said Dr Khan.

For example, adults with both a regular provider and insurance are almost 3 times more likely to have had a colonoscopy compared with adults with neither (58% vs. 21%), according to the survey. Adults aged 65 and older, a population particularly susceptible to complications from influenza, are about 4 times more likely to have obtained a flu shot in the past year if they have medical coverage and a regular provider.

“We’ve made great strides in medicine. Many of our current health epidemics are preventable and/or treatable. Health screening and preventive care is the most powerful way to fight disease. Having a doctor is the best way to make sure you and your family are receiving the prevention and treatment you need,” said Dr Khan.

Moreover, adults without a regular provider are about 4 times more likely to use the emergency department as their usual source of care than those with regular providers; this is true for both insured (13% vs. 3%) and uninsured (32% vs. 8%) adults.

“Why wait in a busy Emergency Department for hours when you could just securely instant message your doctor and ask for advice or book an appointment on-line, even if you are uninsured?” said Dr Khan.

Data suggests that regardless of insurance or use of a regular provider, patients do not always comply with provider advice. About 15% of adults said they did not follow some of their provider’s advice in the past year. This is as common among those with a regular provider as those without.

“This is a consequence of a lack of trust in your doctor. Having autonomy over the physician selection process has been shown to enhance patient trust and improve health outcomes. If you don’t trust your doctor, it’s more difficult to follow their advice. A site like DocMatcher.com lets you pick a doctor based on your own particular needs so he or she is matched to you rather than just picked from the phone book or an insurance company website,” said Dr Khan.

By personalizing the search for a doctor and providing tools for enhanced communication and self-efficacy, DocMatcher.com is helping patients and health professionals build and maintain trusting, long-term healthy relationships.

The Internet now plays a central role in building and maintaining personal and professional relationships. DocMatcher.com’s web platform is using health information technology to create a health care culture shift that can revolutionize the traditional patient-doctor experience.

For additional information contact:

Sean Barry
Marketing manager
DocMatcher.com
Brooklyn
New York
Tel: 718 858 3627
Website: http://www.docmatcher.com

About DocMatcher.com

Developed by an Emergency Department doctor and patient advocate, Brooklyn-based DocMatcher.com is using health information technology to empower doctors and patients to work together to build a healthier America and revolutionize the traditional patient-doctor experience.
DocMatcher.com’s intuitive, personalized health care web-platform uses a specially formulated algorithm to help people conveniently find a doctor right for their specific needs and provides the tools needed to stay in control of their health.

HIT Policy Committee schedules new NHIN Workgroup meeting

Date: Jan 7 2010 - 9:00am - 12:30pm

HIT Policy Committee's NHIN Workgroup

Office of the National Coordinator for Health Information Technology
Department of Health and Human Services
January 7, 2010
9 a.m. -- 12:30 p.m.
(location to be determined)
http://edocket.access.gpo.gov/2009/pdf/E9-30673.pdf

Contact Person:
Judy Sparrow
Office of the National Coordinator, HHS
330 C Street, SW
Washington, DC 20201
202-205-4528, Fax: 202-690-6079
judy.sparrow@hhs.gov

The NHIN Workgroup is charged with creating a policy and technical framework that allows the internet to be used for the secure and standards-based exchange of health information, in a way that is open to all and fosters innovation.

The workgroup will be discussing the nationwide health information network (NHIN), with a primary emphasis on authentication mechanisms used by the NHIN and the private sector. The workgroup will be hearing testimony from stakeholder groups. ONC intends to make background material available to the public no later than two (2) business days prior to the meeting. If ONC is unable to post the background material on its Web site prior to the meeting, it will be made publicly available at the location of the advisory committee meeting, and the background material will be posed on ONC's Web site after the meeting, at http://healthit.hhs.gov. The meeting will be available via webcast; visit http://healthit.hhs.gov for instructions on how to listen via telephone or Web.

 

Unwanted Memories Might Be Erasable Without Harming Other Brain Functions

The brain acts as a computer to both store information and process that information. In a computer, separate devices perform these roles; while a hard disk stores information, the central processing unit (CPU) does the processing. But the brain is thought to perform both these functions in the same cells – neurons – leading researchers to ask if distinct molecules within the brain cells serve these different functions.

Researchers have found a molecule that stores complex, high-quality memories, in a discovery that may one day lead to the ability to erase debilitating painful memories and addictions from the brain. (Credit: iStockphoto/Sebastian Kaulitzki))

In a discovery that may one day lead to the ability to erase debilitating painful memories and addictions from the brain, researchers at SUNY Downstate Medical Center have found that a molecule known to preserve memories – PKMzeta – specifically stores complex, high-quality memories that provide detailed information about an animal’s location, fears, and actions, but does not control the ability to process or express this information. This finding suggests that PKMzeta erasure that is designed to target specific debilitating memories could be effective against the offending memory while sparing the computational function of brain.

The findings are detailed in the December edition of PLoS Biology in a paper titled, “PKMzeta Maintains Spatial, Instrumental, and Classically Conditioned Long-Term Memories.” The paper is authored by Andre A. Fenton, PhD, associate professor of physiology and pharmacology, Todd C. Sacktor, MD, professor of physiology and pharmacology and of neurology, and Peter Serrano, PhD, research assistant professor of physiology and pharmacology, at SUNY Downstate, as well as by colleagues at other institutions in Michigan, New York, Wisconsin, and the Czech Republic.   

Dr. Fenton said, “The work published in PLoS reveals that PKMzeta is a general storage mechanism for different types of memory content but, fortunately, that PKMzeta stores only high-quality memories, the kind that provide detailed information rather than general abilities.”

“If further work confirms this view we can expect to one day see therapies based on PKMzeta memory erasure,” Dr. Fenton suggests. “Negative memory erasing not only could help people forget painful experiences, but might be useful in treating depression, general anxiety, phobias, post-traumatic stress, and addictions,” he adds.

Dr. Sacktor said the research “shows that PKMzeta is fundamental for storing many different forms of memory, which previously has been viewed as potentially mediated by distinct mechanisms.”

The PloS Biology paper may be accessed via this link:

http://biology.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pbio.0060318

 

**********

SUNY Downstate Medical Center, founded in 1860, was the first medical school in the United States to bring teaching out of the lecture hall and to the patient’s bedside. A center of innovation and excellence in research and clinical service delivery, SUNY Downstate Medical Center comprises a College of Medicine, Colleges of Nursing and Health Related Professions, a School of Graduate Studies, a Graduate Public Health Program, University Hospital of Brooklyn, and an Advanced Biotechnology Park and Biotechnology Incubator.
SUNY Downstate ranks eighth nationally in the number of alumni who are on the faculty of American medical schools.  More physicians practicing in New York City have graduated from SUNY Downstate than from any other medical school.

 

 

Scientists Discover How the Brain Encodes Memories at a Cellular Level

Scientists at UC Santa Barbara have made a major discovery in how the brain encodes memories. The finding, published in the December 24 issue of the journal Neuron, could eventually lead to the development of new drugs to aid memory.

The team of scientists is the first to uncover a central process in encoding memories that occurs at the level of the synapse, where neurons connect with each other.

"When we learn new things, when we store memories, there are a number of things that have to happen," said senior author Kenneth S. Kosik, co-director and Harriman Chair in Neuroscience Research, at UCSB's Neuroscience Research Institute. Kosik is a leading researcher in the area of Alzheimer's disease.

"One of the most important processes is that the synapses –– which cement those memories into place –– have to be strengthened," said Kosik. "In strengthening a synapse you build a connection, and certain synapses are encoding a memory. Those synapses have to be strengthened so that memory is in place and stays there. Strengthening synapses is a very important part of learning. What we have found appears to be one part of how that happens."

Part of strengthening a synapse involves making new proteins. Those proteins build the synapse and make it stronger. Just like with exercise, when new proteins must build up muscle mass, synapses must also make more protein when recording memories. In this research, the regulation and control of that process was uncovered.

The production of new proteins can only occur when the RNA that will make the required proteins is turned on. Until then, the RNA is "locked up" by a silencing molecule, which is a micro RNA. The RNA and micro RNA are part of a package that includes several other proteins.

"When something comes into your brain –– a thought, some sort of stimulus, you see something interesting, you hear some music –– synapses get activated," said Kosik. "What happens next is really interesting, but to follow the pathway our experiments moved to cultured neurons. When synapses got activated, one of the proteins wrapped around that silencing complex gets degraded."

When the signal comes in, the wrapping protein degrades or gets fragmented. Then the RNA is suddenly free to synthesize a new protein.

"One reason why this is interesting is that scientists have been perplexed for some time as to why, when synapses are strengthened, you need to have proteins degrade and also make new proteins," said Kosik. "You have the degradation of proteins going on side by side with the synthesis of new proteins. So we have now resolved this paradox. We show that protein degradation and synthesis go hand in hand. The degradation permits the synthesis to occur. That's the elegant scientific finding that comes out of this."

The scientists were able to see some of the specific proteins that are involved in synthesis. Two of these –– CaM Kinase and Lypla –– are identified in the paper.

One of the approaches used by the scientists in the experiment was to take live neuron cells from rats and look at them under a high-resolution microscope. The team was able to see the synapses and the places where proteins are being made.

The first author on the paper is Sourav Banerjee, a postdoctoral fellow with the Neuroscience Research Institute and the Department of Cellular, Molecular, and Developmental Biology. The other author is Pierre Neveu, who is affiliated with the Neuroscience Research Institute and the Kavli Institute of Theoretical Physics.