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'Meaningful Use,' Federal Health IT Rules Will Be Hot Topics at Annual HIMSS Conference

iHealthBeat Audio Report:

The "meaningful use" of electronic health records is expected to be the hot topic of the annual Healthcare Information and Management Systems Society Conference in Atlanta.

The federal government recently released proposed rules describing how health care providers can demonstrate meaningful use of certified EHRs to qualify for incentive payments included in the 2009 federal economic stimulus package.

In an iHealthBeat Special Report by Deirdre Kennedy, health IT experts discussed how the conference will help attendees learn more about the federal government's health IT efforts and strategies for meeting the new regulations.

The Special Report includes comments from:

  • Patricia Brennan, a professor of engineering at the University of Wisconsin-Madison and director of Project Health Design;
  • David Kibbe, an expert in health informatics and a senior adviser to the American Academy of Family Physicians; and
  • Carla Smith, executive vice president of HIMSS.

The conference also includes several keynote speakers, such as National Coordinator for Health IT David Blumenthal and CNN Senior Medical Correspondent Sanjay Gupta, as well as town hall meetings and sessions on personal health records, health IT standards and health information exchanges (Kennedy,iHealthBeat, 2/26)

via ihealthbeat.org

 

Brain implant reveals the neural patterns of attention


A paralyzed patient implanted with a brain-computer interface device has allowed scientists to determine the relationship between brain waves and attention.

Characteristic activity patterns known as beta and delta oscillations have been observed in various regions of the brain since the early 20th century, and have been theoretically associated with attention. The unique opportunity to record directly from a human subject's motor cortex allowed University of Chicago researchers to investigate this relationship more thoroughly than ever before.

"This gave us a really unique opportunity to record, at the micro scale, signals from the human motor cortex," said Nicholas Hatsopoulos, PhD, professor in the Department of Organismal Biology and Anatomy and Chair of the Committee on Computational Neuroscience.

The experiments, published this week in the journal Neuron, reveal the intricate dynamics of the attentive brain. Beta oscillations can be read as a reflection of how much attention a subject is paying to the task at hand, while slower delta oscillations act as an internal metronome, allowing the brain to anticipate moments when attention is most needed.

"Our study shows that when a person can count at a rhythm provided by an external stimulus, your brain can act as a metronome to take advantage of this timing and become more efficient," said Maryam Saleh, graduate student in the Committee on Computational Neuroscience and lead author of the study.

The experimental subject was implanted with a BrainGate neuroprosthetic implant in 2006, a device that allows quadriplegic individuals to control a computer cursor using brain activity. As part of a clinical trial, a small chip containing nearly 100 microelectrodes was implanted in the subject's primary motor cortex, where electrical signals could be translated by computer into cursor motion directed by the patient's thoughts.

In the experiments described in Neuron, Saleh and colleagues from the laboratory of Nicholas Hatsopoulos recorded electrical activity, called local field potentials, collected by the implanted chip as the subject performed a simple computer task. The subject was shown a series of five instructions of where to move a cursor, but told to only follow the second or fourth instruction and disregard the rest.

The recordings found a characteristic pattern of activity as the subject paid close attention to the task. High-frequency beta oscillations increased in strength as the subject waited for the relevant instruction, with peaks of activity occurring just before each instructional cue. After receiving the relevant instruction and before the subject moved the cursor, the beta oscillation intensity fell dramatically to lower levels through the remaining, irrelevant instructions.

"Previously, no one has been able to dissociate if beta oscillations are related to attention or to just holding, waiting to initiate movement," Saleh said. "Our results show that these oscillations are tied to the anticipation of oncoming information that is used to make a movement."

The slower delta oscillation also showed a regular pattern as the subject performed the task, adjusting its frequency to mirror the timing of each instructional cue. The authors suggest that this "internal metronome" function may help fine-tune beta oscillations, so that maximum attention is paid at the appropriate time.

"There are lots of stimuli in the world that have rhythm," said Jacob Reimer, post-doctoral researcher at Baylor College of Medicine and another author of the study." If you're waiting for a signal that is informative, you could pay attention constantly for a long period of time. But if that thing you're waiting for has some rhythmicity to it, maybe a more efficient method is to only pay attention 'on the beat.'"

For example, when someone is playing tennis or basketball, the brain may utilize the rhythm of a volley or a dribble to better attune its attention and motor response. To make this fine-tuning possible, electrical oscillations at different frequencies in cortex may play off each other like the instruments of a jazz band.

"The slow rhythm is kind of like the rhythm section, and you anticipate notes at particular moments in time based on that slower rhythm." Hatsopoulos explained.

This new understanding of the relationship between brain activity and attention may have relevance in the field of neuropsychology, where EEG recordings are able to pick up beta and delta oscillations with reduced spatial resolution. A diagnostic and therapeutic tool could be developed that uses such recordings to assess a person's attention from moment to moment, Hatsopoulos speculated, with the signal fed back to the person to improve their attention.

The rhythmic patterns of oscillations may also be useful in developing better brain-machine interface technology for quadriplegic individuals to operate prosthetics, Saleh said.

"The brain-computer interface is meant to help a person move a cursor with his thoughts about movement," Saleh said. "But when a person is 'plugged into' a brain-computer interface, he doesn't always want to use it; occasionally, he might just want to tune out and do nothing. Using features from these oscillations, the computer can determine when a patient is ready to move."

The ability to understand the role these oscillations play in the motor cortex of humans was "unbelievably valuable," said Charles Schroeder, a professor of psychiatry at Columbia University College of Physicians and Surgeons who has previously studied low-frequency oscillations in cortex.

"All these things converge on this idea that low-frequency oscillations reflect the brain's plans; they are really critical," Schroeder said. "Understanding the oscillatory dynamics of cortex helps you think about how you can develop therapies that help the cortex learn or re-learn after damage."

The paper, "Fast and Slow Oscillations in Human Primary Motor Cortex Predict Oncoming Behaviorally Relevant Cues," will appear in the February 25, 2010 issue of Neuron. Other authors on the paper include Richard Penn of Rush University Medical Center and Catherine L. Ojakangas of the University of Chicago.

via uchospitals.edu

 

Scorpion venom could be an alternative to morphine

Pinch Away the Pain

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Scorpion venom is notoriously poisonous, but it might be used as an alternative to dangerous and addictive painkillers like morphine, a Tel Aviv University researcher claims.

Prof. Michael Gurevitz of Tel Aviv University's Department of Plant Sciences is investigating new ways for developing a novel painkiller based on natural compounds found in the venom of scorpions. These compounds have gone through millions of years of evolution and some show high efficacy and specificity for certain components of the body with no side effects, he says.

Peptide toxins found in scorpion venom interact with sodium channels in nervous and muscular systems, and some of these sodium channels communicate pain, says Prof. Gurevitz. "The mammalian body has nine different sodium channels of which only a certain subtype delivers pain to our brain. We are trying to understand how toxins in the venom interact with sodium channels at the molecular level and particularly how some of the toxins differentiate among channel subtypes.

"If we figure this out, we may be able to slightly modify such toxins, making them more potent and specific for certain pain mediating sodium channels," Prof. Gurevitz continues. With this information, engineering of chemical derivatives that mimic the scorpion toxins would provide novel pain killers of high specificity that have no side effects.

An ancient Chinese secret?

In his research, Prof. Gurevitz is concentrating on the Israeli yellow scorpion, one of the most potent scorpions in the world. Its venom contains more than 300 peptides of which only a minor fraction has been explored. The reason for working with this venom, he says, is the large arsenal of active components such as the toxins that have diversified during hundreds of millions of years under selective pressure. During that process, some toxins have evolved with the capability to directly affect mammalian sodium channel subtypes whereas others recognize and affect sodium channels of invertebrates such as insects. This deviation in specificity is for us a lesson of how toxins may be manipulated at will by genetic engineering, he says.

While the use of scorpion venom to treat some body disorders seems counter-intuitive, the Chinese have recognized its effectiveness hundreds of years ago. "The Chinese, major practitioners of what we call 'alternative medicine,' use scorpion venom, believing it to have powerful analgesic properties," Prof. Gurevitz says. Some studies have also shown that scorpion venom can be used to treat epilepsy. "We study how these toxins pursue their effects in the Western sense to see how it could be applied as a potent painkiller."

Using an approach called "rational design" or "biomimicry," Prof. Gurevitz is trying to develop painkillers that mimic the venom%u2019s bioactive components. The idea is to use nature as the model, and to modify elements of the venom so that a future painkiller designed according to these toxins could be as effective as possible, while eliminating or reducing side effects.

No more morphine addicts

Finding a new and effective pain medication could solve one of the biggest problems in the medical world today. Pain is an important physiological response to danger, physical injury and poor health, yet doctors need to reduce extreme pain in patients which aspirin could never palliate. To date, opiate-derived painkillers have been quite effective, but the medical community is eager to find other solutions due to the risks associated with their use.

"This new class of drugs could be useful against serious burns and cuts, as well as in the military and in the aftermath of earthquakes and natural disasters. Instead of running the risk of addiction, this venom-derived drug, mimicking the small peptide toxin, would do what it needs to do and then pass from the body with no traces or side-effects," Prof. Gurevitz says.

AFTAU welcomes your support of cutting-edge medical research at Tel Aviv University. To make a donation, click here.

 

via aftau.org

 

Going Beyond Paper and Pencil: Investments in Health IT

Secretary Kathleen Sebelius 

Keeping track of huge piles of paperwork is not an easy task for anyone. Imagine doing that for our entire health care system. In effect, that is what is going on with our current paper and pencil system of medical record keeping -- until now.
 
At the Department of Health and Human Services, part of our mission is to ensure quality health care for all Americans. And today I am excited to announce that we are delivering on this in the form of over $750 million in new grants that are part of a federal initiative to build capacity to enable widespread meaningful use of health IT, helping doctors adopt electronic medical records.
 
As part of the Recovery Act, the legislation President Obama signed into law last year to help strengthen the economy, these grants benefit both patients and doctors by cutting costs, eliminating paperwork, and helping doctors deliver high-quality, coordinated care. They also help eliminate errors that come with having a paper and pencil system and save patients from having to fill out the same form dozens of times.
 
You can find examples of this from across the country.  At one health system, they used electronic health records to identify older women who hadn%u2019t received an osteoporosis screening and mail them personal letters encouraging them to get screened.  Screenings went up 300%. 
 
At another health system, only a third of their diabetes patients were receiving the recommended foot and eye exams.  They started tracking these patients using electronic health records, and within five months, the share of patients getting the recommended exams doubled to around two out of three.
 
Yet despite all these benefits, only 20 percent of doctors and 10 percent of hospitals have even basic electronic health records today.  That%u2019s because even though many doctors around the country can see the potential benefits, there are also obstacles.
 
That%u2019s where these grants come in. We want to spread the benefits of health information technology to our entire health care system. Led by our National Coordinator for Health IT, Dr. David Blumenthal, our grants team has identified major areas where we can begin to implement new technology to make delivering health care more efficient and more effective. Read Dr. Blumenthal%u2019s blog about it here.
 
Electronic health records will provide major technological innovation to our current health care system by allowing doctors to work together to make sure patients get the right care at the right time and want to be clear that in all our Health IT investments, patient privacy is our top priority.

Kathleen Sebelius is Secretary of Health and Human Services 

via whitehouse.gov

 

Get Your Google Buzz Profile Verified

Raju is the owner and editor-in-chief of TechPP. A proud geek and an Internet freak, who is also a social networking enthusiast. You can follow him on Twitter @rajupp 

The Buzz about Google Buzz is still on and doesn’t seem to die down anytime soon. My personal opinion is neutral when it comes to Google Buzz, so I have managed to use it as much as I can over the last 2 days.

While browsing, I found that some people have “Verified name” badge next to their names on their Google Profiles. This is much similar to the “Verified account” badge on Twitter. Moreover, having a Google verified profile enables your profile name to appear in Google web results! Now, that’s a real cool bonus, isn’t it? Luckily, verifying a Google Profile is not too tough really. The only thing is, currently, this works only in US right now.

Below is an example screenshot from the profile of Google’s executive – David Glazer.

google-buzz-profile-verified

 

The process involves registering self on Knol, one of Google’s side projects. It’s easy, free, and important to be able to give people the peace of mind that it’s really you, especially if you run an online business. This process is nothing new and exists for over an year now. Only because of Google Buzz, people have started to notice it in more numbers.

How to Verify your Google Buzz profile?

Step 1: Go to Knol. Click on “Sign in” on right top end of the page. Sign in with your Google username and password.

Step 2: Click on Preferences and then select Name Verification tab

knol-name-verification

 

Step 3: Choose an option to verify. You can either verify with your credit card or SSN (Social security number). Both of them work equally well. Previously, they used to provide an option to verify via Phone, which has now been replaced by SSN.

Once you submit your info, the system processes it rather quickly. Now, simply go to your Google Profile page and voila! You’re verified.

 
via techpp.com

Scientists develop universal DNA reader to advance faster, cheaper sequencing efforts

Arizona State University scientists have come up with a new twist in their efforts to develop a faster and cheaper way to read the DNA genetic code. They have developed the first, versatile DNA reader that can discriminate between DNA's four core chemical components⎯the key to unlocking the vital code behind human heredity and health.

Led by ASU Regents' Professor Stuart Lindsay, director of the Biodesign Institute's Center for Single Molecule Biophysics, the ASU team is one of a handful that has received stimulus funds for a National Human Genome Research Initiative, part of the National Institutes of Health, to make DNA genome sequencing as widespread as a routine medical checkup.

The broad goal of this "$1000 genome" initiative is to develop a next-generation DNA sequencing technology to usher in the age of personalized medicine, where knowledge of an individual's complete, 3 billion-long code of DNA information, or genome, will allow for a more tailored approach to disease diagnosis and treatment. With current technologies taking almost a year to complete at a cost of several hundreds of thousands of dollars, less than 20 individuals on the planet have had their whole genomes sequenced to date.

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As a single chemical base of DNA (blue atoms) passes through a tiny, 2.5nm gap between two gold electrodes (top and bottom), it momentarily sticks to the electrodes (purple bonds) and a small increase in the current is detected. Each of the chemical bases of the DNA genetic code, abbreviated A, C, T or G, gives a unique electrical signature as they pass between the electrodes.

To make their research dream a reality, Lindsay's team has envisioned building a tiny, nanoscale DNA reader that could work like a supermarket checkout scanner, distinguishing between the four chemical letters of the DNA genetic code, abbreviated by A, G, C, and T, as they rapidly pass by the reader. To do so, they needed to develop the nanotechnology equivalent of threading the eye of a needle. In this case, the DNA would be the thread that could be recognized as it moved past the reader 'eye.' During the past few years, Lindsay's team has made steady progress, and first demonstrated the ability to read individual DNA sequences in 2008—but this approach was limited because they had to use four separate readers to recognize each of the DNA bases. More recently, they demonstrated the ability to thread DNA sequences through the narrow hole of a fundamental building block of nanotechnology, the carbon nanotube.

Lindsay's team relies on the eyes of nanotechnology, scanning tunneling- (STM) and atomic force- (ATM) microscopes, to make their measurements. The microscopes have a delicate electrode tip that is held very close to the DNA sample. In their latest innovation, Lindsay's team made two electrodes, one on the end of microscope probe, and another on the surface, that had their tiny ends chemically modified to attract and catch the DNA between a gap like a pair of chemical tweezers. The gap between these functionalized electrodes had to be adjusted to find the chemical bonding sweet spot, so that when a single chemical base of DNA passed through a tiny, 2.5 nanometer gap between two gold electrodes, it momentarily sticks to the electrodes and a small increase in the current is detected. Any smaller, and the molecules would be able to bind in many configurations, confusing the readout, any bigger and smaller bases would not be detected.

"What we did was to narrow the number of types of bound configurations to just one per DNA base," said Lindsay. "The beauty of the approach is that all the four bases just fit the 2.5 nanometer gap, so it is one size fits all, but only just so!"

At this scale, which is just a few atomic diameters wide, quantum phenomena are at play where the electrons can actually leak from one electrode to the other, tunneling through the DNA bases in the process. Each of the chemical bases of the DNA genetic code, abbreviated A, C, T or G, gives a unique electrical signature as they pass between the gap in the electrodes. By trial and error, and a bit of serendipity, they discovered that just a single chemical modification to both electrodes could distinguish between all 4 DNA bases.

"We've now made a generic DNA sequence reader and are the first group to report the detection of all 4 DNA bases in one tunnel gap," said Lindsay. "Also, the control experiments show that there is a certain (poor) level of discrimination with even bare electrodes (the control experiments) and this is in itself, a first too."

"We were quite surprised about binding to bare electrodes because, like many physicists, we had always assumed that the bases would just tumble through. But actually, any surface chemist will tell you that the bases have weak chemical interactions with metal surfaces."

Next, Lindsay's group is hard at work trying to adapt the reader to work in water-based solutions, a critically practical step for DNA sequencing applications. Also, the team would like to combine the reader capabilities with the carbon nanotube technology to work on reading short stretches of DNA.

If the process can be perfected, DNA sequencing could be performed much faster than current technology, and at a fraction of the cost. Only then will the promise of personalized medicine reach a mass audience.

###

The authors on the Nano Letters paper are: Shuai Chang, Shuo Huang, Jin He, Feng Liang, Peiming Zhang, Shengqing Li, Xiang Chen, Otto Sankey and Stuart Lindsay

The Nano Letters research article can be accessed online at URL: http://pubs.acs.org/doi/pdfplus/10.1021/nl1001185
(open sponsored access)

via eurekalert.org

 

Are oncologists following the rules?

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Cancer-treatment quality has been particularly hard to track because claims information tells insurers relatively little about the patient. The data often don't make clear, for instance, if a breast-cancer patient is in remission or relapse. The differences in the disease's stage are uniquely important for cancer, since tumors change over time, necessitating different treatments.

So for the past three years, UnitedHealthcare has been collecting clinical information directly from oncologists. The company then compared the choices that a doctor made for a particular patient's treatment with claims data and guidelines developed by the National Comprehensive Cancer Network, a consortium of 21 leading treatment centers. In November, the company mailed the individual reports to 1,321 oncologists.

The company especially probed the use of high-price biotech drugs, which it says it found in some cases are being prescribed inappropriately. One NCCN guideline for colon-cancer patients advises that patients get chemotherapy after surgery, but in 31% of cases, the care did not comply with the rule. Instead, in the bulk of those cases, patients were prescribed Avastin, a Roche Holding AG biologic that is unproven in that patient group, says Dr. Newcomer. And among patients with non-small-cell lung cancer, about 24% received Avastin, even though their disease didn't meet the right criteria to get the drug, UnitedHealthcare found.

via sg.wsj.net

 

Seeing the Brain Hear Reveals Surprises About How Sound Is Processed

New research shows our brains are a lot more chaotic than previously thought, and that this might be a good thing. Neurobiologists at the University of Maryland have discovered information about how the brain processes sound that challenges previous understandings of the auditory cortex, which had suggested an organization based on precise neuronal maps. In the first study of the auditory cortex conducted using advanced imaging techniques, Patrick Kanold, an assistant professor of biology, Shihab Shamma, a professor of electrical and computer engineering and the Institute for Systems Research, and Sharba Bandyopadhyay, an assistant research scientist in the Institute for Systems Reserch, describe a much more complex picture of neuronal activity. Their findings are published in the January 31 online edition of Nature Neuroscience.

All our knowledge of how the brain really works has been based on taking a small sampling of all available neurons and making inferences about how the other neurons respond, Kanold explains. "This is like showing someone who wants to know how America looks, 'Here is one person from New York City and one person from California.' You don't get a very good picture of what the country looks like from that sampling," says Kanold, originally from Germany.

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Images above: The left shows thousands of dye-loaded cells in the mouse auditory cortex over a large area. The right shows the preferred frequency of many cells, and shows that neighboring cells can have dramatically different frequency preference.

In contrast, Kanold and colleagues were able to look at the activity of all the neurons in a large region of the auditory cortex simultaneously. To get the highest resolution picture to date of how auditory cortex neurons are organized, the researchers used a technique to fill neurons in living mice with a dye that glows brightly when calcium levels rise, a key signal that neurons are firing. They then selectively illuminated specific regions of the cortex with a laser and measured the neuronal activity of hundreds of neurons in response to stimulation by simple tones of different frequencies.

This "in vivo 2-photon calcium imaging" technique was developed by German researchers and advanced by Harvard scientists who used it to study the visual cortex in the mid-2000s. Kanold's study is the first to apply this technique to the auditory cortex and provides an unprecedented amount of detail about how hearing happens.

Andrew King, Professor of Neurophysiology at the University of Oxford, explains that "The functional organization of the auditory cortex has remained unclear and a matter of some controversy, despite the efforts of many labs over a number of years. The approach used by Kanold and colleagues is an important advance in this field."

"We discovered that the organization of the cortex does not look as pretty as it does in the textbooks, which surprised us," explains Kanold. "Things are a lot messier than expected." And we don't see evidence of the maps previously proposed using less precise techniques."

But the disorder they found could indicate that the brain is far more adaptable than previously thought. "These results may rewrite our classical views of how cortical circuits are organized and what functions they serve," suggests Shihab Shamma, whose previous research has involved mapping responses in the auditory cortex using traditional microelectrodes.

By using different dyes, this study measured differences in how the neurons receive sound information (the inputs), and how they process that sound (the outputs). It was previously assumed that neighboring neurons receiving the same inputs would also produce the same outputs, but Kanold's research found something very different. "Neighboring neurons do their own thing by creating different outputs," Kanold explains. "You can imagine that you and your neighbor both receive water to your houses from the same pipe, but you do different things with it - you might cook with it while your neighbor waters the lawn. You can't assume that they are doing the same thing just because they are neighbors."

This is the first time that this level of individuality has been observed in neighboring neurons. Kanold, who is an expert in neuroplasticity, the brain's ability to reorganize neural pathways, believes that there is a tremendous advantage in this apparent disorder. "Each individual neuron is getting inputs from a wide range of frequencies, and by selecting which frequencies they are strongly responding to, they might be very easily able to shift their function," he says. For example, it is well known that we can quickly listen in on a variety of conversations around us, the so-called "cocktail party effect." It may be that neurons having access to a large range of inputs might be able to quickly change which inputs they are responding to.

This suggests that there is very little redundancy in the function of cells in the auditory cortex, which differs notably from the visual cortex, in which neighboring neurons perform the same function as one another. This could be because our acoustic environment, such as the speech we hear, changes much faster than our visual environment, so we have to constantly adapt to new situations.

Kanold continues to study the mechanisms of brain circuitry involved in early development to gain a better understanding of why we can learn so well in early development but lose some of this ability as we age. For example, why can children easily learn new languages, while adults often struggle? Kanold's work has been focusing on identifying circuits in the young brain that mediate this remarkable ability. He is also working to apply his knowledge of developmental brain circuitry to the prevention and treatment of diseases such as cerebral palsy and epilepsy, which can be caused by early brain injuries. With his collaborator Shihab Shamma, who is studying adult mechanisms of plasticity and hearing, he is exploring how brain circuitry and learning changes over time.

Kanold is also an affiliate of the Institute for Systems Research and is associated with the university's Center for the Comparative and Evolutionary Biology of Hearing and the Program in Neuroscience and Cognitive Science.

via newsdesk.umd.edu