University of Louisville announces global licensing agreement with Novartis for collaboration to help transplant patients

The University of Louisville's Suzanne Ildstad 

is shown with research coordinator Thomas Mille

The University of Louisville announced Wednesday a research collaboration agreement between one of its researchers, Suzanne Ildstad, representing Regenerex LLC, with Novartis. The agreement will provide access to stem cell technology that could help transplant patients avoid taking anti-rejection medicine for life and may also serve as a platform for treatment of other diseases.

This global licensing agreement between Regenerex and Novartis will significantly enhance the university’s ability to carry out cutting edge research related to the Facilitating Cell, a novel cell discovered by Ildstad, CEO of Regenerex and director of U of L's Institute for Cellular Therapeutics, says a U of L news release.

"Being a transplant recipient is not easy. In order to prevent rejection, current transplant recipients must take multiple pills a day for the rest of their lives. These immunosuppressive medications come with serious side effects with prolonged use including high blood pressure, diabetes, infection, heart disease and cancer, as well as direct damaging effects to the organ transplant," Ildstad said in the release. "This new approach would potentially offer a better quality of life and fewer health risks for transplant recipients."

Ildstad published results of "Facilitating Cell Therapy," which is undergoing Phase II trials, in March 2012 in Science Translational Medicine. The results say the therapy enables five of eight kidney transplant patients to stop taking about a dozen pills a day to suppress their immune systems; this is the first study in which the donor and recipient did not have to be biologically related or immunologically matched.

Ildstad was originally recruited to U of L under the state's "Bucks for Brains" initiative for endowed professorships, advanced in by then-Gov. Paul Patton in 1998. Along with her research team, she began examining the facilitating cell platform technology for the treatment of kidney transplant recipients.

"Dr. Ildstad was among the first faculty members hired utilizing seed funds from the state to help us attract highly talented researchers through the Bucks for Brains program," U of L President Dr. James Ramsey said. "Regenerex demonstrates the potential for that vision to be realized bringing new jobs to the city, adding to the revenue from the Tax Increment Financing district and providing funding to U of L in support of our academic mission," he said.

The collaboration with Novartis provides for investments in research and applications of new technology as well as milestones and royalty payments from Regenerex to the university.

"The 'holy grail' of transplantation is immune tolerance, that is making the body recognize a transplanted organ as 'self' and not reject it as foreign tissue, but without the need for immunosuppressive drugs with their numerous serious side effects," said Dr. David L. Dunn, executive vice president for health affairs at U of L. "Dr. Ildstad and her team may well have solved this puzzle."

Congressman visits Telehealth Primary Care Clinic in Campton

U.S. Rep. Andy Barr

U.S. Rep. Andy Barr, a freshman Republican from the Sixth District, recently visited the Telehealth Primary Care Clinic in Campton. The clinic, one of two in Kentucky funded by federal telehealth grants, opened in August 2012, and "provides access to primary and specialty care for the community through network established by KentuckyOne Health, the largest health system in the Commonwealth," reports KyForward.

Shelley Neal of KentuckyOne told KyForward, “We established these clinics to make quality health care accessible to the communities in and surrounding Powell and Wolfe counties. If we are to be successful in our mission to create a healthier Kentucky, we must continue to implement new technologies and services to reach our state’s medically underserved communities.”

The clinics minimize "the need to travel to see a specialist therefore reducing the costs of care," KyForward writes. The newest addition is a social worker, who serves both clinics. Through the first six months of this year the social worker "helped 185 patients complete financial assistance paperwork to obtain drug assistance for 1,804 medication orders." During that same span, the clinic saw 1,417 patients from 34 counties. The clinics, which have specialists in cardiology and pulmonology, plan to add specialists in urology, obstetrics and gynecology, endocrinology, neurology and psychiatry. (Read more)

Norton Healthcare implements a mobile application that allows doctors to monitor patients, especially expectant mothers

 

Norton Healthcare is the first health-care provider in Kentucky to implement a patient monitoring system that allows obstetricians to monitor expectant mothers while they're in labor via the physician's smart phone or tablet. The real-time application uses wave-form technology and works with iPhones, Androids, BlackBerrys and a variety of Windows Mobile devices. Its use has been cleared by the U.S. Food and Drug Administration.

The implications are vast for doctors in busy urban settings as well as for those in rural areas where doctor shortages may limit a physician's personal attention to individual patients. According to Norton Healthcare press materials and their obstetrician spokesperson, Dr. Reed Netter, the application allows the doctor to view "the same patient information that he or she would see at the patient’s bedside, looking at the monitor for heartbeat, contraction patterns, or signs of distress." This could save valuable time when a fetus is in trouble or if nurses see something that worries them.

The applications of the technology are evident for use in ambulances, in intensive care units, operating and emergency rooms, said Steve Heilman, Norton's system vice president and chief medical information officer for Norton Healthcare. (Read more)

Here are the seven factors driving health care cost increases

Escalating health care costs are everybody's problem and no one entity's fault. Julie Appleby at Kaiser Health News reports that the United States spends about18 percent of its gross domestic product -- or about $2.6 trillion a year -- on health care costs. So what's making that figure rise? A Bipartisan Policy Center study took on the task of finding out and came up with it believes are seven major factors:

1. Paying our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient. Even insurers like Medicare pay on a fee-for-service system. New efforts in the federal health law look to change that.
2. Growing older, sicker and fatter as a nation.Medicare is set to grow by an average of 1.6 million people annually. With two-thirds of adults are either overweight or obese, lots of additional medical spending looms.
3. Wanting the latest drugs, technologies, services and procedures. Prices for newer treatments are often higher than for the products they replace.
4. Employers and employees get tax breaks on health insurance, and it costs employees little to seek care. Appleby writes, "The majority of people with insurance get it through their jobs. The amount employers pay toward coverage is tax deductible for the firm and tax exempt to the worker, thus encouraging more expensive health plans with richer benefits, the report says. How that coverage is designed also plays a role: Low deductibles or small office co-payments can encourage overuse of care, the report says. Increasingly, however, employers are moving toward high-deductible coverage as a way to slow premium growth and require workers to pay more toward the cost of care."
5. Not having enough information to make decisions on which medical care is best for us.
6. Hospitals increasingly gain market share through consolidation and demand higher prices.
7. Legal issues complicate efforts to slow spending. Doctors sometimes prescribe tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing is another concern. The report notes that laws sometimes limit the ability of medical professionals to do work for which they are trained but that more highly paid doctors must do. (Read more)

To read the entire Bipartisan Policy Center report here.

Tenn. study suggests rural residents have as much access to care as anyone, if they're insured and don't mind the drive

A health-care study in Tennessee, which started with the premise that people in rural areas have less access to care than urban dwellers, ended with a rather surprising conclusion: They don't. Not if they have health insurance. "When it comes to commercially insured patients, there’s little disparity in access to health care between residents of rural communities and urban areas in Tennessee," said Dr. Steven L. Counter, president of the BlueCross BlueShield of Tennessee Health Institute.

How can this be? The study found that almost half of rural residents pass up the hospitals closest to their homes to go to larger urban hospitals, even if the same services are available locally, writes Getahn Ward of The Tenneseean. "The conclusion we came to is that we’re living in a very mobile society, and the distance is not necessarily a determinant factor in whether people get care or not," said Coulter.

Because the survey did not include consumers, it's only a guess about why they chose to take the time and trouble to go to the big town, but experts says it's a combination of services not being available or a perception that they aren't, even if they are. This raises, again, age-old questions about the viability of rural hospitals, some of which often don’t have the money for capital-intensive technology and services. However, Coulter told the Tennessean that "a recent increase in alliances between rural hospitals and larger hospitals and urban health systems raises hopes that non-urban hospitals may be able to expand their menus of services."

Such partnerships between non-profits and for-profit chains are becoming more common, reports Ward, and some say those efforts will change the perception of those in far-flung regions that great medicine is being practiced close-by. This could be especially important, said Wes Littrell, chief strategy officer and president of Nashville-based Saint Thomas Health, in the new world of health reform. “We expect that when you get more into population management that you need to take care of the patient closer to home in the lower-cost setting,” he said. (Read more)

Facebook app personalizes message to women about getting cervical cancer screening and HPV vaccine

To raise awareness about cervical cancer and ways to avoid getting it, the Cervical Cancer-Free Kentucky Initiative has created a Facebook application that "incorporates pictures of users' Facebook pals into an educational video on cervical cancer," reports Darla Carter of The Courier-Journal.

"We want to get the message [to] where we know people are getting their information, and Facebook, Twitter and websites are 'the things'," said Dr. Baretta R. Casey, director of the University of Kentucky initiative.

The application can be found at www.causethemovement.org. "Their friends' and family's faces will actually come up into the video," Casey said, to make the subject resonate more with the viewer.

The goal is to educate women about cervical cancer, which can be prevented through screening and the HPV vaccine. The disease is more likely to occur in women over the age of 30, according to the Centers for Disease Control and Prevention. There are 12,170 new cases of cervical cancer each year and 4,220 deaths, according to the National Cancer Institute. The American Cancer Society states there will be 180 new cases in Kentucky this year.

The most common cause of the cancer is the human papilloma virus, which is transmitted sexually. Two HPV vaccines, Gardasil and Cervarix, have been approved by the U.S. Food and Drug Administration.

"Right now, this is the only vaccine on the market that can prevent a cancer," Casey said. "I have a daughter and I have a granddaughter, and they have both received the HPV immunization because I don't ever want them to come and look at me and say, 'Mom, why didn't you give me this shot? I wouldn't be going through treatment for cervical cancer now.'"

Women can be screened for the disease with a Pap test, which detects abnormal cells that could lead to cancer. (Read more)

UK opening new operating rooms, including high-tech hybrid

The region's first hybrid operating room, one that adds imaging and robotics to traditional surgery, is opening this week at the University of Kentucky Albert B. Chandler Hospital. The only other hybrid OR in Kentucky is at the Trover Clinic in Madisonville, according to Kristi Lopez of UK Public Relations.

News media are being invited to see demonstrations and tour the facility, as well as eight new operating rooms opening in the next phase of the hospital's construction, on Wednesday afternoon. Those on the 1:30 p.m. tour will include Dr. Michael Karpf, UK's executive vice president for health affairs; Ann Smith, the hospital's chief administrative officer; Dr. Joseph "Jay" Zwischenberger, UK HealthCare surgeon-in-chief; Dr. Bernard Boulanger, surgical services director; Dr. David Minion, a vascular and endovascular surgeon; and Dr. Justin Fraser, a neurosurgeon.

"Advantages to a hybrid operating room include greater accuracy of surgical procedures, reduced recovery time, and reduced risk of postoperative complications," a UK press advisory said. "Vascular and endovascular surgeries will begin being performed in the new OR in the next few weeks."

Journalists wanting to take the tour and watch the demonstrations should park in the UK HealthCare parking garage at South Limestone and Transcript Avenue and meet university public-relations representatives promptly at 1:30. For more information or assistance, call or text Lopez at 859-806-0445.

Electronic health records are helping nurses provide better care, big study finds

Electronic health records are helping nurses get better health outcomes and are improving nursing care, the first big study on the subject has found.

The study conducted by the University of Pennsylvania School of Nursing involved 16,000 nurses at 316 hospitals in California, Florida, Pennsylvania and New Jersey. It found that "implementation of an EHR may result in improved and more efficient nursing care, better care coordination, and patient safety," wrote lead author Ann Kutney-Lee, a health-outcomes researcher at Penn Nursing.

The study, which was published in the Journal of Nursing Administration, also found, "having a basic EHR was associated with better outcomes independently of nurse staffing, indicating that they both play an important role in quality of care."

Nurses in hospitals that had comprehensive EHR systems were "significantly less likely to report unfavorable patient safety issues, frequent medication errors, and low quality of care," research-reporting service Newswise reports.

The most current estimates show just 12 percent of U.S. hospitals have an EHR system in place, but that will change with the Health Information Technology for Economic and Clinical Health Act. Starting in 2011, hospitals and physicians received incentive payments from Medicare and Medicaid to switch over to EHRs. The study did not measure outcomes in rural vs. urban settings "although we do know from other studies that hospitals that used electronic health records during this time period were less likely to be in rural areas," Kutney-Lee said. (Read more)

Device lets diabetics get blood-sugar levels using Web, iPhone

Starting next week, diabetics will be able to test their blood-sugar levels using a device that instantly sends their readings to an online database that can be accessed by the patient, doctor or caregiver. “This system charts the results to highlight trends and spot problems, and can be accessed via a Web browser or an iPhone app,” writes Walt Mossberg in a column in The Wall Street Journal.

With 366,000 adults in Kentucky already diagnosed with diabetes, the technology could signal a big change in diabetic care and could be a boon for diabetics living in rural areas.

Mossberg, a Type 2 diabetic, used the new device, made by Maryland-based Telcare, and assessed it uses. Looking like a “thick, old cellphone,” it works like a traditional meter, requiring the user to prick their finger to get a drop of blood and touch a test strip to it. That information is then sent to an online database. “Because it automatically logs results and allows real-time sharing, I believe diabetics who use this new system will be less likely to skip readings, or to fudge the numbers, especially if they allow doctors and other caregivers to see the results instantly. And that could mean an improvement in their health,” he writes.

Cyber predators have easier access to children because of phones, video games

Child predators have it easier than ever to entice their young victims, due to the ever-growing accessibility of the Internet. "It's a lot easier now than everybody has the Internet in their pocket," Lexington Police Detective David Flannery told Karla Ward of the Lexington Herald-Leader. "Every day that we think of a way to combat it, people are thinking of a way to get around us," Flannery said. "It changes every day, and you have to keep up with it."

Using the World Wide Web to lure children for sex acts has skyrocketed since 1998, when the National Center for Missing and Exploited Children received 707 reports of people trying to entice children via the Internet. In 2008, there were 8,787 reports.

"Computers and cell phones remain the primary means of communication, but game systems including Xbox 360, Nintendo DS and Wii also can be connected to the Internet, giving predators another way to gain access to children," Ward reports.

Though parents are becoming more aware, more education is needed, said Erin May Roth, an assistant U.S. attorney and the Project Safe Childhood coordinator for the Eastern District of Kentucky. "What they don't really think about is the fact that their kids are going to sleep with their phone," she said.

Flannery is the only police officer in Lexington assigned full-time to investigate Internet crimes against children. While he does not go into detail about his methods to track down predators, the concept involves pretending. "Anything that a kid can do, we can do," Flannery said.

Sometimes officers from several agencies and departments work together. The Kentucky State Police administers an Internet Crimes Against Children Task Force, the state attorney general's office has a similar unit, and, because cases can involve a number of jurisdictions, sometimes the Federal Bureau of Investigations, the U.S. Postal Service, the Secret Service and U.S. Immigrations and Customs Enforcement are involved.

Mother Frieda Curry, right, discovered her 14-year-old daughter was entangled with a 38-year-old man who initially pretended to be 16. She contacted the Richmond Police Department and found more than 40 text messages and 10,000 pages of messages and videos on the computer. "I was frantic," she said. "I was in the worst state I've ever been in." (Photo by H-L's David Perry)

But Curry, whose daughter is now in college, dealt with the problem and the predator was sentenced in U.S. District Court to 10 years in prison. Thinking about the crimes can be difficult, but "only by shining a light on the problem will we ever hope to find a solution for it," said Assistant Commonwealth's Attorney Lou Anna Red Corn. (Read more)

Appalachian Regional Commission conference in Prestonsburg Sept. 7-9 to focus on improving access to health care

Featuring the insight of 42 federal, state and local health experts, officials and community leaders, the Appalachian Regional Commission's Healthy Families: Healthy Future conference will be held Sept. 7-9 in Prestonsburg.

The keynote address will look at different ways access to quality health care can be expanded. It will be given by Marcia Brand, deputy administrator of the Health Resources and Service Administration. HRSA is the primary federal agency for improving access to health-care services for people who don't have insurance, are geographically isolated, or are medically vulnerable.

Other conference topics include childhood obesity and diabetes; substance abuse in adolescents; improving access to dental care for children; health information technology; and Appalachian perspectives on infant mortality reduction.

The conference will be at Jenny Wiley State Resort Park in Prestonsburg. To register, click here. Online registration ends Wednesday, Aug. 31.

Pediatrics academy tells parents to monitor kids' online activities

A report from the American Academy of Pediatrics stresses children's physicians can play a vital role in educating parents about setting limits for kids when it comes to technology like texting and Facebook.

"Pediatricians are in a unique position to help families understand these sites and to encourage healthy use," the report says. The academy recommends that parents communicate often with their kids about time spent on computers, both to make sure it is not harmful to them and it doesn't conflict with family time. "I think even in the tween years, this has to be happening because ... more and more, pop culture is percolating down to tweens," Dr. Kathleen Clarke-Pearson, a North Carolina pediatrician and co-author of the report, told The Courier-Journal's Darla Carter.

Parents should look for signs of sleep deprivation and "Facebook depression," which can happen when children spend a lot of time on social media sites. Parents should also have a plan regarding when electronics should be allowed to be used at home, during dinner or at bedtime, for example. Parents should also talk to their children about how to be a "responsible digital citizen," Clarke-Pearson said, which involves talking about subjects like sexting, cyberbullying or posting inappropriate matter or comments.

Kids and teens can be influenced by social media and other websites to try risky behavior, such inhaling chemicals or trying the choking game, experts say. "The mantra basically is it's not going to happen to me, so they will do these things because everybody else is," Dr. Hatim Omar, a pediatrics professor at the University of Kentucky, told Carter.

Earlier this year, the academy reported about one in five teens log onto their favorite social media site more than 10 times a day, and more than half log on more than once a day. "It also notes that 75 percent of teens own cell phones and 25 percent use them for social media while 54 percent use them for texting and 24 perfect use them for instant messaging," Carter notes. (Read more)

Louisville doctors help woman with extremely rare condition

Louisville doctors have helped a woman with an extremely rare type of dwarfism deal with the deterioration caused by her disorder. Monica Zaring, who is one of just two women in the world who has osteodysplastic microcephalic dysplasia, has had her shoulder joint replaced using custom-made implants and instruments, The Courier-Journal's Laura Ungar reports.

The 3-foot-6 Bellarmine University student (C-J photo by Matt Stone) started having problems when she woke up one morning last year and couldn't move her right arm. Over time, she was able to move it again, but not without severe pain. Doctors found arthritis had caused the cartilage to deteriorate, causing the joint's bony surfaces to rub on each other. "We needed to do something," said Dr. Ryan Krupp of Norton Orthpaedic Specialists, who was the lead surgeon.

So began months of preparation, part of which involved designing a custom-made shoulder stem, head and socket. Custom instruments were also needed to install the implants. "Krupp even flew to a company lab in New Jersey to try the instruments on a cadaver to make sure they would work," Ungar reports.

The Dec. 7 operation took 90 minutes and Zaring spent four days in the hospital, resulting in a $85,000 hospital bill; she is covered through her mother's insurance. Norton Healthcare officials would not say how much the procedure cost, but the custom implant was 47 percent more expensive than a standard one. However, the operation was considered necessary. Zaring, who plans to graduate in December with a degree in communications, does not dwell on future health problems that will likely be caused by her condition. "I have challenges," she said. "But if if I let them get me down, I'd always be sad." (Read more)

Switch to electronic medical records not without concerns

Though touted as a way to improve patient care and supported by federal funding, Kentucky physicians have concerns about switching to electronic medical records. Doctors are worried about cost, lost productivity, the possibility that the technology becomes obsolete and that systems can't share information, The Courier-Journal's Laura Ungar reports.

"The main reason is financial. It's just so expensive," Dr. Emily Johnson of Kaplan Barron Pediatric Group, told Ungar. "Also, we'd have to take time out of the day and do training. It would be expensive to learn this new thing." Johnson's group plans to stick with its paper-based patient charts (Photo: Rebecca Dorwart, medical receptionist and recordkeeper, by C-J's Matt Stone)

But the Obama administration and health professionals say EHRs will "help reduce costs and make health care safer by avoiding such problems as duplicate medical tests and allergic reactions to medications," Ungar notes. The new health law will pay $20 billion in incentives to eligible doctors and hospitals who make the switch. Thoe who don't will get smaller Medicare and Medicaid reimbursements.

Last year, a Kentucky Medical Association survey of rural doctors (left) showed 45 percent didn't have an EHR system, and about half said they had no plans to have one. "The most frequently cited barriers to e-record adoption were lack of initial capital for software and training, concerns about loss of productivity and lack of technical support within the practice," Ungar reports. (Read more)

Electronic health records are the new frontier in health care

By Tara Kaprowy
Kentucky Health News

Just two years ago, the acronym EHR didn't mean much to many people. But since Congress passed the health-care reform law last year, physicians and hospitals have become intimately acquainted with it — and patients may follow suit.

EHRs are electronic health records. They are quickly being adopted by hospitals and physicians as the federal government begins to pay out $19 billion in incentives: extra Medicare and Medicaid payments. Kentucky health care facilities and providers have been especially eager to sign up, perhaps because so few of the state's doctors had adopted EHRs. Kentucky doctors' offices were the least digitized in the nation last year, according to a national survey.

An EHR is a digitized copy of a person's health record, essentially replacing the file folder that has typically held handwritten information about a patient. It generally contains information about a patient's laboratory and radiology results, diagnoses, prescriptions and other treatment.

EHRs' advantage is their easier accessiblity. Rather than being locked in a doctor's office, the information, in theory, can be accessed by other health-care providers, regardless of which one the patient is seeing. "It's about the information always moving with you," said Nancy Szemraj, spokeswoman for the Office of the National Coordinator for Health Information Technology.

"That's like the pot of gold," said Jeff Brady, executive director of the Governor's Office of Electronic Health Information. "If you've been to six different hospitals and three different doctor's offices, literally all of that data can be viewed."

EHRs are expected to reduce unnecessary tests and treatment because they will list tests that have been performed, and to reduce the potential for medical errors, because they containing such cautionary information as the patient's allergies.

Protecting your information

One risk of electronic health records is the potential for the information being leaked, lost, altered or merely read by an unauthorized person. Leaks can be purposeful or by accident. In January, the private information of thousands of people who visited the Green River District Health Department in Owensboro was found online, where it had been mistakenly available for several months.

Brady acknowledged the danger of unauthorized access, but said safeguards have been taken to avoid it. Participating providers in the Kentucky Health Information Exchange, the state clearinghouse for EHRs, have to sign several agreements in which they attest the information they obtain will be used responsibly.

"The golden rule is this data will only be viewed by a provider who is providing care to a patient," Brady said. To make sure that is happening, he said, the software has an audit function, in which administrators are able to see who looks at a patient's data, when they did, from what computer and what piece of data they examined.

The national network will not be a database, and thus not in danger of being hacked, said Szemraj, of the national office. "It's simply a means to securely push and pull information as needed," she said, citing an example of a person traveling around the country and falling ill in New York City. "At that time, they would be able to tap into your medical record in your home base and say, 'I want to pull your medical information.' It's not literally sitting out there in a repository where anybody could hack into it."

To set up EHR systems, hospitals and doctors choose from a list of federally approved software. The programs don't "necessarily have to communicate with each other," Brady said, "but they do have to conform to certain standards that would allow them to communicate with a health information exchange."

The state's exchange has been operating in the pilot stage since April 2010. It will act as a "middleman" between hospitals and health care providers, Brady said. "We will be the hub and all information will flow from a provider, to us, back to another provider."

Under ideal circumstances, Brady said he hopes to see half of the state's hospitals and doctors' offices connected to the exchange by the end of the year, with the other half signed on by the end of 2012. That may be ambitious, since a recent survey showed Kentucky had the lowest percentage of doctors' offices that have adopted EHRs, just 38 percent, compared to 51 percent nationwide.

While Kentucky builds its exchange, other states are doing the same. Eventually, the goal is to create a National Health Information Network that will allow information to flow from state to state. That will be especially beneficial to Kentucky, Brady said, "because we have so many hospitals and medical facilities on our border. We're talking to Tennessee and Ohio about exchanging data with them. There's going to be a lot of development in the next 12 months."

But when will the state information exchange or national network be useable? Brady said no date has been set for the state exchange, and Szemraj said of the national network, "We are truly just beginning."

Cost savings?

The Obama administration and other supporters of the health-reform law say EHRs will save money. A 2005 study by the RAND Corp. indicated that implementing EHRs and networks could eventually save more than $81 billion per year by improving health care efficiency and safety, but that study was theoretical in nature and assumed 100 percent compliance, Drs. Jerome Groopman and Pamela Hartzband wrote in an op-ed piece in The Wall Street Journal.

Some data show EHRs do not necessarily improve patient care, the doctors wrote, pointing to a study published in the journal Circulation that reviewed the influence of EHRs on the quality of care received by more than 15,000 patients with heart failure. It concluded that "Current use of electronic health records results in little improvement in the quality of heart-failure care compared with paper-based systems."

Another study looked at the Department of Veterans Affairs' health information technology investments and estimated a potential value of $3.1 billion "in cumulative benefits net of investment costs." But Brandon Glenn of Medcity pointed out "the study's lead researcher stressed the dollar amount reflects only what's possible — not actual savings."

The prevailing opinion in the industry is that EHRs will save money, but no one is really sure how much. On the expectation of savings, the health-reform law calls for extra Medicare and Medicaid payments to providers as incentives to adopt the technology. Providers have until 2014 to adopt EHRs. If they don't, Medicare will start penalizing them by paying them less in Medicare payments.

A rural equalizer?

Since the Centers for Medicare and Medicaid Services started distributing EHR incentive payments in January, Kentucky hospitals and other health-care providers have received more than $18 million of about $38 million handed out nationwide so far. University of Kentucky Healthcare and Central Baptist Hospital, which together received $4.1 million, were the first facilities in the nation to receive the extra payments. In the next four years, Kentucky hospitals are expected to receive more than $100 million in incentives.

For a spreadsheet of incentives paid to Kentucky providers through last week, click here.

To receive the incentives, which can mean up to more than $60,000 for eligible professionals and millions for hospitals, applicants must prove their EHR systems are being used in a meaningful way. To show "meaningful use" in the first of three stages — the only stage that, so far, has been officially defined — eligible professionals must show "continuous quality improvement and ease of information exchange," according to regulations in the Federal Register. Professionals must meet 25 measures, hospitals 24, to prove meaningful use. One measure, for example, is the ability to send electronic data to the state's immunization registry.

The list of incentives already paid shows providers in the most rural to the most urban areas areas of Kentucky are switching over at equally rapid rates. In fact, two of the few hospitals already linked up to the Kentucky Health Information Exchange are Pikeville Medical Center and Murray-Calloway County Hospital, both outside metropolitan areas.

Brady said the Office of the National Coordinator for Health Information Technology "is very interested in rural areas, the critical-access hospitals, the very small but important hospitals . . . that typically get left out on technology. This an effort to bring them along and be the equalizer."

Foundation matches Social Innovation Fund money to create grants for improving health services in seven Kentucky counties

The Foundation for a Healthy Kentucky today announced four equal Social Innovation Fund grants totaling $1 million to improve access to health services, reduce health risks and disparities, and promote health equity in Jefferson, McCreary, Wolfe, Powell, Montgomery, Bath and Menifee counties. The projects are expected to serve nearly 9,000 people in the next year.

Home of the Innocents in Louisville will establish a dental clinic at the newly opened interdisciplinary Hockensmith Pediatric Assessment Center. The program will provide dental services to children in state care, children with special health care needs, and other children and families served by the Home and its partner agencies.

St. Joseph Health System, based in Lexington, will establish primary care clinics in Powell and Wolfe counties, both rural and low-income. These satellite clinics will be staffed by nurse practitioners and will utilize telemedicine to collaborate with physicians and specialists at a central location.

Cumberland Family Medical Center, based in Burkesville, will establish a nurse-managed health center and rural training program for nurse practitioners and physician assistants. Funds will be used to expand the scope of services provided in McCreary County to include x-ray and utilize health IT to connect with other CFMC sites. This will be the county's first x-ray, reducing travel for local residents who previously had to travel ouside the county for x-ray services.

The Montgomery County Health Department in Mount Sterling will establish a health education and navigation program to serve a low-income population in Montgomery, Bath and Menifee counties. Four full-time health navigators will be employed to serve the community by assessing individual needs and linking patients with services.

Each $250,000 grtant includes $125,000 from the Foundation for a Healthy Kentucky. As an endowed public charity, the foundation was able to provide the matching funds that were required to secure the Social Innovation Fund award for Kentucky. Learn more about the grants here.