Joyce Frieden

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, Dr. Jessee said. Physicians can apply for money through either Medicare or Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold—just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, according to Dr. Jessee.

Also still to be determined is what constitutes a certified EHR. “You need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive,” he said.

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” Dr. Jessee said. “Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy adviser at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation,” he said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. “If you liked HIPAA, you'll love the privacy provisions” in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients, the local media must be notified along with HHS so that it can be posted on the department's Web site, he added.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014, to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athenahealth Inc., and MicroMD.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, Dr. Jessee said. Physicians can apply for money through either Medicare or Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold—just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, according to Dr. Jessee.

Also still to be determined is what constitutes a certified EHR. “You need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive,” he said.

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” Dr. Jessee said. “Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy adviser at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation,” he said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. “If you liked HIPAA, you'll love the privacy provisions” in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients, the local media must be notified along with HHS so that it can be posted on the department's Web site, he added.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014, to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athenahealth Inc., and MicroMD.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, Dr. Jessee said. Physicians can apply for money through either Medicare or Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold—just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, according to Dr. Jessee.

Also still to be determined is what constitutes a certified EHR. “You need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive,” he said.

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” Dr. Jessee said. “Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy adviser at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation,” he said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. “If you liked HIPAA, you'll love the privacy provisions” in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients, the local media must be notified along with HHS so that it can be posted on the department's Web site, he added.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014, to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athenahealth Inc., and MicroMD.

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy adviser to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through COBRA; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, Mr. Primus said.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” Mr. Primus said. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000-$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]'” in terms of reimbursement by the government.

Another big chunk of the Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to let physicians know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that it increases government control of health care, especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy adviser to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through COBRA; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, Mr. Primus said.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” Mr. Primus said. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000-$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]'” in terms of reimbursement by the government.

Another big chunk of the Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to let physicians know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that it increases government control of health care, especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy adviser to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through COBRA; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, Mr. Primus said.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” Mr. Primus said. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000-$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]'” in terms of reimbursement by the government.

Another big chunk of the Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to let physicians know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that it increases government control of health care, especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research drew cheers from several diabetes organizations.

Under the previous policy, government funding for embryonic stem cell research was limited to studies using only the few stem cell lines that were in existence in August 2001, when then-President George W. Bush announced the policy. President Obama's executive order, which he signed in March, lifts those restrictions and allows funded research to include embryonic stem cell lines created after that date. However, the order does not lift a current ban on using federal funds to create stem cell lines if the creation involves destruction of human embryos. Federal policy does not affect privately funded stem cell research.

President Obama noted at the signing ceremony that “many thoughtful and decent people are conflicted about, or strongly oppose, [embryonic stem cell] research. I understand their concerns, and we must respect their point of view.”

But he added that “in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values. In this case, I believe the two are not inconsistent.

“After much discussion, debate and reflection, the proper course has become clear,” he said. “The majority of Americans—from across the political spectrum, and of all backgrounds and beliefs—have come to a consensus that we should pursue this research. … That is a conclusion with which I agree. That is why I am signing this executive order and why I hope Congress will act on a bipartisan basis to provide further support for this research.”

The president said that the government “will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction.”

The American Diabetes Association applauded the executive order. “The ethical use of stem cell research holds the promise of accelerating medical advancements in many fields,” Dr. R. Paul Robertson, the association's president for medicine and science, said in a statement. “This brings hope to the nearly 24 million American adults and children with diabetes who face its many complications, including heart disease, amputation, and blindness.”

The Juvenile Diabetes Research Foundation (JDRF) also praised the move. “We're very grateful to President Obama for setting in place a policy to fully explore this promising field of science,” foundation president and CEO Dr. Alan Lewis said in a statement.

JDRF international chairman Mary Tyler Moore agreed. The order “is a strong signal to patients, scientists, and the nation that we have the government's full support to pursue ethical research that may accelerate progress to new treatments and possible cures for diabetes,” she said.

Lawrence Tabak, Ph.D., acting deputy director of the National Institutes of Health, also expressed support for the executive order. “Researchers will now be able to pursue new knowledge about human development, regenerative medicine, and the origins of many of our most devastating diseases,” he said in a teleconference. “NIH will do its part to implement new policy and develop guidelines as expeditiously as possible to make sure the best science is funded and the research is conducted in a responsible manner.”

But Dr. David Stevens, CEO of the Christian Medical Association, in Bristol, Tenn., cited problems with embryonic stem cell research. First, there is a moral issue: “We understand that embryos are human beings. Every one of us was an embryo,” he said. “When you destroy an embryo, you destroy a distinct human being.” Also, the prospects for embryonic stem cell research have been overblown, he continued. “We know that embryonic stem cells are difficult to culture and to control. … Even people in this field say that if treatment is going to come out of this, it's probably 20 years away.”

President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research drew cheers from several diabetes organizations.

Under the previous policy, government funding for embryonic stem cell research was limited to studies using only the few stem cell lines that were in existence in August 2001, when then-President George W. Bush announced the policy. President Obama's executive order, which he signed in March, lifts those restrictions and allows funded research to include embryonic stem cell lines created after that date. However, the order does not lift a current ban on using federal funds to create stem cell lines if the creation involves destruction of human embryos. Federal policy does not affect privately funded stem cell research.

President Obama noted at the signing ceremony that “many thoughtful and decent people are conflicted about, or strongly oppose, [embryonic stem cell] research. I understand their concerns, and we must respect their point of view.”

But he added that “in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values. In this case, I believe the two are not inconsistent.

“After much discussion, debate and reflection, the proper course has become clear,” he said. “The majority of Americans—from across the political spectrum, and of all backgrounds and beliefs—have come to a consensus that we should pursue this research. … That is a conclusion with which I agree. That is why I am signing this executive order and why I hope Congress will act on a bipartisan basis to provide further support for this research.”

The president said that the government “will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction.”

The American Diabetes Association applauded the executive order. “The ethical use of stem cell research holds the promise of accelerating medical advancements in many fields,” Dr. R. Paul Robertson, the association's president for medicine and science, said in a statement. “This brings hope to the nearly 24 million American adults and children with diabetes who face its many complications, including heart disease, amputation, and blindness.”

The Juvenile Diabetes Research Foundation (JDRF) also praised the move. “We're very grateful to President Obama for setting in place a policy to fully explore this promising field of science,” foundation president and CEO Dr. Alan Lewis said in a statement.

JDRF international chairman Mary Tyler Moore agreed. The order “is a strong signal to patients, scientists, and the nation that we have the government's full support to pursue ethical research that may accelerate progress to new treatments and possible cures for diabetes,” she said.

Lawrence Tabak, Ph.D., acting deputy director of the National Institutes of Health, also expressed support for the executive order. “Researchers will now be able to pursue new knowledge about human development, regenerative medicine, and the origins of many of our most devastating diseases,” he said in a teleconference. “NIH will do its part to implement new policy and develop guidelines as expeditiously as possible to make sure the best science is funded and the research is conducted in a responsible manner.”

But Dr. David Stevens, CEO of the Christian Medical Association, in Bristol, Tenn., cited problems with embryonic stem cell research. First, there is a moral issue: “We understand that embryos are human beings. Every one of us was an embryo,” he said. “When you destroy an embryo, you destroy a distinct human being.” Also, the prospects for embryonic stem cell research have been overblown, he continued. “We know that embryonic stem cells are difficult to culture and to control. … Even people in this field say that if treatment is going to come out of this, it's probably 20 years away.”

President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research drew cheers from several diabetes organizations.

Under the previous policy, government funding for embryonic stem cell research was limited to studies using only the few stem cell lines that were in existence in August 2001, when then-President George W. Bush announced the policy. President Obama's executive order, which he signed in March, lifts those restrictions and allows funded research to include embryonic stem cell lines created after that date. However, the order does not lift a current ban on using federal funds to create stem cell lines if the creation involves destruction of human embryos. Federal policy does not affect privately funded stem cell research.

President Obama noted at the signing ceremony that “many thoughtful and decent people are conflicted about, or strongly oppose, [embryonic stem cell] research. I understand their concerns, and we must respect their point of view.”

But he added that “in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values. In this case, I believe the two are not inconsistent.

“After much discussion, debate and reflection, the proper course has become clear,” he said. “The majority of Americans—from across the political spectrum, and of all backgrounds and beliefs—have come to a consensus that we should pursue this research. … That is a conclusion with which I agree. That is why I am signing this executive order and why I hope Congress will act on a bipartisan basis to provide further support for this research.”

The president said that the government “will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction.”

The American Diabetes Association applauded the executive order. “The ethical use of stem cell research holds the promise of accelerating medical advancements in many fields,” Dr. R. Paul Robertson, the association's president for medicine and science, said in a statement. “This brings hope to the nearly 24 million American adults and children with diabetes who face its many complications, including heart disease, amputation, and blindness.”

The Juvenile Diabetes Research Foundation (JDRF) also praised the move. “We're very grateful to President Obama for setting in place a policy to fully explore this promising field of science,” foundation president and CEO Dr. Alan Lewis said in a statement.

JDRF international chairman Mary Tyler Moore agreed. The order “is a strong signal to patients, scientists, and the nation that we have the government's full support to pursue ethical research that may accelerate progress to new treatments and possible cures for diabetes,” she said.

Lawrence Tabak, Ph.D., acting deputy director of the National Institutes of Health, also expressed support for the executive order. “Researchers will now be able to pursue new knowledge about human development, regenerative medicine, and the origins of many of our most devastating diseases,” he said in a teleconference. “NIH will do its part to implement new policy and develop guidelines as expeditiously as possible to make sure the best science is funded and the research is conducted in a responsible manner.”

But Dr. David Stevens, CEO of the Christian Medical Association, in Bristol, Tenn., cited problems with embryonic stem cell research. First, there is a moral issue: “We understand that embryos are human beings. Every one of us was an embryo,” he said. “When you destroy an embryo, you destroy a distinct human being.” Also, the prospects for embryonic stem cell research have been overblown, he continued. “We know that embryonic stem cells are difficult to culture and to control. … Even people in this field say that if treatment is going to come out of this, it's probably 20 years away.”

Diabetes Bill Introduced

Rep. Zack Space (D-Ohio) has reintroduced the Catalyst to Better Diabetes Care Act (H.R. 1402), a bill to increase diabetes treatment, tracking, and outreach. Among other things, the bill would create a patient and provider outreach program aimed at increasing use of the Medicare diabetes screening benefit, track progress in diabetes care through a national report card, promote private-sector diabetes wellness programs through a “best practices” advisory group led by the Commerce Department, and work toward lessening the underreporting of diabetes on death certificates. “Reduced productivity and treatment of diabetes costs the United States more than we spend fighting in Iraq,” Rep. Space said in a statement.

Warning on Sharing Insulin Pens

The Food and Drug Administration has issued an alert warning health care providers and patients about the dangers of sharing insulin pens and cartridges. “Sharing of insulin pens may result in transmission of hepatitis viruses, HIV, or other blood-borne pathogens,” the agency noted. The FDA reported that more than 2,000 patients at William Beaumont Army Medical Center in El Paso, Tex., may have shared insulin pens during 2007–2009. “Although the disposable needles in the insulin pens were reportedly changed for each patient, there is still a risk of blood contamination of the pen reservoir or cartridge,” the alert noted. “Patients who were treated with insulin pens at the hospitals in question are being contacted by the hospitals, and are being offered testing for hepatitis and HIV. Some of the potentially exposed patients have reportedly tested positive for hepatitis C; however, it is not known if the hepatitis infection occurred through insulin pen sharing, or if those who tested positive had previously undiagnosed hepatitis C.” The agency advises providers to report any unexpected adverse or serious events associated with the use of insulin pens or insulin cartridges at

www.fda.gov/medwatch/report/hcp.htm

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and a majority of group practice leaders believe that the change reflects more physicians delaying retirement because of the economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said part-time options encourage physicians to stay while meeting personal needs or to delay retirement. Almost three-quarters of group practices offer preretirement physicians reduced hours, 56% allow for no call responsibility, and 20% allow concentration on certain patient groups.

Upcoding Alleged in MA Plans

Overpayments to Medicare Advantage plans will not be solved until Congress addresses the plans' upcoding practices, according to a new report from the Center on Budget and Policy Priorities. “Upcoding refers to unexplained changes [that] plans make over time in the diagnosis codes they assign that make their enrollees appear less healthy than they actually are,” the report says. “Upcoding helps private plans financially by inflating the payments that Medicare makes to them.” According to 2007 data from the Centers for Medicare and Medicaid Services, the severity of the diagnosis codes being used for beneficiaries is rising faster among beneficiaries who have stayed in Medicare Advantage plans than among those staying in traditional Medicare.

Group Wants Ban on Industry CME

The consumer watchdog group Public Citizen has asked the American Medical Association to support a ban on commercial support of continuing medical education. In a letter to the chairs of the AMA's ethical and CME councils, Public Citizen's Health Research Group said that it wants the ban “because the consequences of any corrupting influence of commercial support on CME are so significant.” The group said that “physician-supported CME” is a viable alternative to commercial funding. The Pharmaceutical Research and Manufacturers of America said in a statement that a ban on commercial support of CME could prevent physicians from accessing critical information about treatments.

Diabetes Bill Introduced

Rep. Zack Space (D-Ohio) has reintroduced the Catalyst to Better Diabetes Care Act (H.R. 1402), a bill to increase diabetes treatment, tracking, and outreach. Among other things, the bill would create a patient and provider outreach program aimed at increasing use of the Medicare diabetes screening benefit, track progress in diabetes care through a national report card, promote private-sector diabetes wellness programs through a “best practices” advisory group led by the Commerce Department, and work toward lessening the underreporting of diabetes on death certificates. “Reduced productivity and treatment of diabetes costs the United States more than we spend fighting in Iraq,” Rep. Space said in a statement.

Warning on Sharing Insulin Pens

The Food and Drug Administration has issued an alert warning health care providers and patients about the dangers of sharing insulin pens and cartridges. “Sharing of insulin pens may result in transmission of hepatitis viruses, HIV, or other blood-borne pathogens,” the agency noted. The FDA reported that more than 2,000 patients at William Beaumont Army Medical Center in El Paso, Tex., may have shared insulin pens during 2007–2009. “Although the disposable needles in the insulin pens were reportedly changed for each patient, there is still a risk of blood contamination of the pen reservoir or cartridge,” the alert noted. “Patients who were treated with insulin pens at the hospitals in question are being contacted by the hospitals, and are being offered testing for hepatitis and HIV. Some of the potentially exposed patients have reportedly tested positive for hepatitis C; however, it is not known if the hepatitis infection occurred through insulin pen sharing, or if those who tested positive had previously undiagnosed hepatitis C.” The agency advises providers to report any unexpected adverse or serious events associated with the use of insulin pens or insulin cartridges at

www.fda.gov/medwatch/report/hcp.htm

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and a majority of group practice leaders believe that the change reflects more physicians delaying retirement because of the economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said part-time options encourage physicians to stay while meeting personal needs or to delay retirement. Almost three-quarters of group practices offer preretirement physicians reduced hours, 56% allow for no call responsibility, and 20% allow concentration on certain patient groups.

Upcoding Alleged in MA Plans

Overpayments to Medicare Advantage plans will not be solved until Congress addresses the plans' upcoding practices, according to a new report from the Center on Budget and Policy Priorities. “Upcoding refers to unexplained changes [that] plans make over time in the diagnosis codes they assign that make their enrollees appear less healthy than they actually are,” the report says. “Upcoding helps private plans financially by inflating the payments that Medicare makes to them.” According to 2007 data from the Centers for Medicare and Medicaid Services, the severity of the diagnosis codes being used for beneficiaries is rising faster among beneficiaries who have stayed in Medicare Advantage plans than among those staying in traditional Medicare.

Group Wants Ban on Industry CME

The consumer watchdog group Public Citizen has asked the American Medical Association to support a ban on commercial support of continuing medical education. In a letter to the chairs of the AMA's ethical and CME councils, Public Citizen's Health Research Group said that it wants the ban “because the consequences of any corrupting influence of commercial support on CME are so significant.” The group said that “physician-supported CME” is a viable alternative to commercial funding. The Pharmaceutical Research and Manufacturers of America said in a statement that a ban on commercial support of CME could prevent physicians from accessing critical information about treatments.

Diabetes Bill Introduced

Rep. Zack Space (D-Ohio) has reintroduced the Catalyst to Better Diabetes Care Act (H.R. 1402), a bill to increase diabetes treatment, tracking, and outreach. Among other things, the bill would create a patient and provider outreach program aimed at increasing use of the Medicare diabetes screening benefit, track progress in diabetes care through a national report card, promote private-sector diabetes wellness programs through a “best practices” advisory group led by the Commerce Department, and work toward lessening the underreporting of diabetes on death certificates. “Reduced productivity and treatment of diabetes costs the United States more than we spend fighting in Iraq,” Rep. Space said in a statement.

Warning on Sharing Insulin Pens

The Food and Drug Administration has issued an alert warning health care providers and patients about the dangers of sharing insulin pens and cartridges. “Sharing of insulin pens may result in transmission of hepatitis viruses, HIV, or other blood-borne pathogens,” the agency noted. The FDA reported that more than 2,000 patients at William Beaumont Army Medical Center in El Paso, Tex., may have shared insulin pens during 2007–2009. “Although the disposable needles in the insulin pens were reportedly changed for each patient, there is still a risk of blood contamination of the pen reservoir or cartridge,” the alert noted. “Patients who were treated with insulin pens at the hospitals in question are being contacted by the hospitals, and are being offered testing for hepatitis and HIV. Some of the potentially exposed patients have reportedly tested positive for hepatitis C; however, it is not known if the hepatitis infection occurred through insulin pen sharing, or if those who tested positive had previously undiagnosed hepatitis C.” The agency advises providers to report any unexpected adverse or serious events associated with the use of insulin pens or insulin cartridges at

www.fda.gov/medwatch/report/hcp.htm

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and a majority of group practice leaders believe that the change reflects more physicians delaying retirement because of the economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said part-time options encourage physicians to stay while meeting personal needs or to delay retirement. Almost three-quarters of group practices offer preretirement physicians reduced hours, 56% allow for no call responsibility, and 20% allow concentration on certain patient groups.

Upcoding Alleged in MA Plans

Overpayments to Medicare Advantage plans will not be solved until Congress addresses the plans' upcoding practices, according to a new report from the Center on Budget and Policy Priorities. “Upcoding refers to unexplained changes [that] plans make over time in the diagnosis codes they assign that make their enrollees appear less healthy than they actually are,” the report says. “Upcoding helps private plans financially by inflating the payments that Medicare makes to them.” According to 2007 data from the Centers for Medicare and Medicaid Services, the severity of the diagnosis codes being used for beneficiaries is rising faster among beneficiaries who have stayed in Medicare Advantage plans than among those staying in traditional Medicare.

Group Wants Ban on Industry CME

The consumer watchdog group Public Citizen has asked the American Medical Association to support a ban on commercial support of continuing medical education. In a letter to the chairs of the AMA's ethical and CME councils, Public Citizen's Health Research Group said that it wants the ban “because the consequences of any corrupting influence of commercial support on CME are so significant.” The group said that “physician-supported CME” is a viable alternative to commercial funding. The Pharmaceutical Research and Manufacturers of America said in a statement that a ban on commercial support of CME could prevent physicians from accessing critical information about treatments.

WASHINGTON — It's tough being diabetic. Life is filled with lots of extra responsibilities: the finger sticks, the hemoglobin A1c testing, the foot and eye exams. So how can things be made easier for diabetes patients and their physicians?

One answer is technology, according to several speakers at a diabetes meeting sponsored by Avalere Health. And for Amand Iyer, president and COO of WellDoc Inc., a Baltimore-based software company, that often means the cell phone.

Cell phone use can help to overcome one of the biggest barriers to the adoption of new technology: cost, said Mr. Iyer, who is a type 2 diabetes patient. With this in mind, his company is marketing a program that diabetes patients can load into their phones and use as a “virtual coach.” The software has blood glucose target ranges, high and low alerts, and [information on] what to do for hypoglycemia, and it can be modified for patients with multiple comorbidities such as diabetes and heart failure, he said.

It also includes a learning library with information on diabetes self-care, and a mobile logbook that users can access on a computer to see how well they're meeting their targets.

The cell phone even acts as a “nerve center” that communicates with the patient and whomever else he or she chooses, such as a physician, caregiver, or diabetes educator.

Physicians can choose to receive the information in whatever way suits them best, Mr. Iyer said. One doctor may say, “I don't have a computer; send it to me in a fax the day before [the patient] comes in,” Mr. Iyer said. “Some doctors with brittle diabetes patients have said, 'Hey, can I actually get the software on my phone? Because I just made this medication change for this brittle patient and I want to see how he is tracking.'”

Mr. Iyer's company also is working with a glucose monitor firm on getting a wireless chip installed right on the meter. “Patients would pull their strips as they do normally, get the feedback on the meter, and get all their alerts and reminders right off the meter.” His company is developing similar modules for other diseases, including hypertension and dyslipidemia.

At Partners in Health, a group practice affiliated with the University of Pittsburgh Medical Center, one technology application that has gotten a good response is electronic “office visits,” according to Dr. Grant Shevchik, the practice's medical director. Patients fill out online questionnaires—“the only physician visit where the patient records the history”—and the messages are sent directly to their physicians for a response. The new service generated 286 “visits” from Aug. 28, 2008, to Jan. 31, 2009, said Dr. Shevchik, a family physician.

“Our oldest patient who has done this is 82,” and many of the others are in the 35- to 44-year-old age group. “These are not the 22-year-olds,” he added.

Not only is the service “affordable, convenient, and efficient,” it also has a CPT code (99444), he noted. The code can be used only once during a 7-day period and the visit must meet several other criteria: It must be patient initiated, it must involve a timely response, and there must be permanent storage of the visit information.

At Johns Hopkins University in Baltimore, employees with chronic illnesses such as diabetes can take advantage of Telewatch, a telephone monitoring program, said Dr. Ines Vigil, associate medical director at Johns Hopkins HealthCare, a health plan that includes 47,000 university employees.

“The employee can call in and type in their blood pressure, last cholesterol-screening results, their symptoms, and their stress levels, and it gets rolled into a system that our nurse case managers and clinical screeners are able to follow over time,” Dr. Vigil explained.

“The system will red-flag something if it's abnormal.” If a patient calls in an abnormally high blood pressure or glucose level, “then our clinical screener will inform the case manager to give the member a call,” she said. The patient is informed about recognizing abnormal values, accessing care, and checking their medications. More than 1,000 people are participating in Telewatch, she said, noting that patients with more serious chronic illnesses talk with nurse case managers more regularly.

Cell phone use can help to overcome one of the biggest barriers to the adoption of new technology: cost. MR. IYER

WASHINGTON — It's tough being diabetic. Life is filled with lots of extra responsibilities: the finger sticks, the hemoglobin A1c testing, the foot and eye exams. So how can things be made easier for diabetes patients and their physicians?

One answer is technology, according to several speakers at a diabetes meeting sponsored by Avalere Health. And for Amand Iyer, president and COO of WellDoc Inc., a Baltimore-based software company, that often means the cell phone.

Cell phone use can help to overcome one of the biggest barriers to the adoption of new technology: cost, said Mr. Iyer, who is a type 2 diabetes patient. With this in mind, his company is marketing a program that diabetes patients can load into their phones and use as a “virtual coach.” The software has blood glucose target ranges, high and low alerts, and [information on] what to do for hypoglycemia, and it can be modified for patients with multiple comorbidities such as diabetes and heart failure, he said.

It also includes a learning library with information on diabetes self-care, and a mobile logbook that users can access on a computer to see how well they're meeting their targets.

The cell phone even acts as a “nerve center” that communicates with the patient and whomever else he or she chooses, such as a physician, caregiver, or diabetes educator.

Physicians can choose to receive the information in whatever way suits them best, Mr. Iyer said. One doctor may say, “I don't have a computer; send it to me in a fax the day before [the patient] comes in,” Mr. Iyer said. “Some doctors with brittle diabetes patients have said, 'Hey, can I actually get the software on my phone? Because I just made this medication change for this brittle patient and I want to see how he is tracking.'”

Mr. Iyer's company also is working with a glucose monitor firm on getting a wireless chip installed right on the meter. “Patients would pull their strips as they do normally, get the feedback on the meter, and get all their alerts and reminders right off the meter.” His company is developing similar modules for other diseases, including hypertension and dyslipidemia.

At Partners in Health, a group practice affiliated with the University of Pittsburgh Medical Center, one technology application that has gotten a good response is electronic “office visits,” according to Dr. Grant Shevchik, the practice's medical director. Patients fill out online questionnaires—“the only physician visit where the patient records the history”—and the messages are sent directly to their physicians for a response. The new service generated 286 “visits” from Aug. 28, 2008, to Jan. 31, 2009, said Dr. Shevchik, a family physician.

“Our oldest patient who has done this is 82,” and many of the others are in the 35- to 44-year-old age group. “These are not the 22-year-olds,” he added.

Not only is the service “affordable, convenient, and efficient,” it also has a CPT code (99444), he noted. The code can be used only once during a 7-day period and the visit must meet several other criteria: It must be patient initiated, it must involve a timely response, and there must be permanent storage of the visit information.

At Johns Hopkins University in Baltimore, employees with chronic illnesses such as diabetes can take advantage of Telewatch, a telephone monitoring program, said Dr. Ines Vigil, associate medical director at Johns Hopkins HealthCare, a health plan that includes 47,000 university employees.

“The employee can call in and type in their blood pressure, last cholesterol-screening results, their symptoms, and their stress levels, and it gets rolled into a system that our nurse case managers and clinical screeners are able to follow over time,” Dr. Vigil explained.

“The system will red-flag something if it's abnormal.” If a patient calls in an abnormally high blood pressure or glucose level, “then our clinical screener will inform the case manager to give the member a call,” she said. The patient is informed about recognizing abnormal values, accessing care, and checking their medications. More than 1,000 people are participating in Telewatch, she said, noting that patients with more serious chronic illnesses talk with nurse case managers more regularly.

Cell phone use can help to overcome one of the biggest barriers to the adoption of new technology: cost. MR. IYER

WASHINGTON — It's tough being diabetic. Life is filled with lots of extra responsibilities: the finger sticks, the hemoglobin A1c testing, the foot and eye exams. So how can things be made easier for diabetes patients and their physicians?

One answer is technology, according to several speakers at a diabetes meeting sponsored by Avalere Health. And for Amand Iyer, president and COO of WellDoc Inc., a Baltimore-based software company, that often means the cell phone.

Cell phone use can help to overcome one of the biggest barriers to the adoption of new technology: cost, said Mr. Iyer, who is a type 2 diabetes patient. With this in mind, his company is marketing a program that diabetes patients can load into their phones and use as a “virtual coach.” The software has blood glucose target ranges, high and low alerts, and [information on] what to do for hypoglycemia, and it can be modified for patients with multiple comorbidities such as diabetes and heart failure, he said.

It also includes a learning library with information on diabetes self-care, and a mobile logbook that users can access on a computer to see how well they're meeting their targets.

The cell phone even acts as a “nerve center” that communicates with the patient and whomever else he or she chooses, such as a physician, caregiver, or diabetes educator.

Physicians can choose to receive the information in whatever way suits them best, Mr. Iyer said. One doctor may say, “I don't have a computer; send it to me in a fax the day before [the patient] comes in,” Mr. Iyer said. “Some doctors with brittle diabetes patients have said, 'Hey, can I actually get the software on my phone? Because I just made this medication change for this brittle patient and I want to see how he is tracking.'”

Mr. Iyer's company also is working with a glucose monitor firm on getting a wireless chip installed right on the meter. “Patients would pull their strips as they do normally, get the feedback on the meter, and get all their alerts and reminders right off the meter.” His company is developing similar modules for other diseases, including hypertension and dyslipidemia.

At Partners in Health, a group practice affiliated with the University of Pittsburgh Medical Center, one technology application that has gotten a good response is electronic “office visits,” according to Dr. Grant Shevchik, the practice's medical director. Patients fill out online questionnaires—“the only physician visit where the patient records the history”—and the messages are sent directly to their physicians for a response. The new service generated 286 “visits” from Aug. 28, 2008, to Jan. 31, 2009, said Dr. Shevchik, a family physician.

“Our oldest patient who has done this is 82,” and many of the others are in the 35- to 44-year-old age group. “These are not the 22-year-olds,” he added.

Not only is the service “affordable, convenient, and efficient,” it also has a CPT code (99444), he noted. The code can be used only once during a 7-day period and the visit must meet several other criteria: It must be patient initiated, it must involve a timely response, and there must be permanent storage of the visit information.

At Johns Hopkins University in Baltimore, employees with chronic illnesses such as diabetes can take advantage of Telewatch, a telephone monitoring program, said Dr. Ines Vigil, associate medical director at Johns Hopkins HealthCare, a health plan that includes 47,000 university employees.

“The employee can call in and type in their blood pressure, last cholesterol-screening results, their symptoms, and their stress levels, and it gets rolled into a system that our nurse case managers and clinical screeners are able to follow over time,” Dr. Vigil explained.

“The system will red-flag something if it's abnormal.” If a patient calls in an abnormally high blood pressure or glucose level, “then our clinical screener will inform the case manager to give the member a call,” she said. The patient is informed about recognizing abnormal values, accessing care, and checking their medications. More than 1,000 people are participating in Telewatch, she said, noting that patients with more serious chronic illnesses talk with nurse case managers more regularly.

Cell phone use can help to overcome one of the biggest barriers to the adoption of new technology: cost. MR. IYER

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy advisor to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, Mr. Primus explained.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other. We're going to try to make sure that doesn't happen.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” said Mr. Primus. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders and things like that.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000–;$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“We were glad to see HIT move forward. Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]'” in terms of reimbursement by the government.

Another big chunk of the Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to “make doctors and [other] providers smarter” by letting them know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that “this is the camel's nose under the tent on government control of your health care,” especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

Mr. Elling offered a cautionary tale about CER. “We've seen how they apply [CER] in other countries,” he said. For instance, the policy at the U.K. National Institute for Health and Clinical Excellence, the organization that determines which treatments the National Health Service will pay for, says that “if you want the expensive drug for macular degeneration, you have to go blind in one eye before they'll give it to you for the other eye. That's CER right there.

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy advisor to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, Mr. Primus explained.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other. We're going to try to make sure that doesn't happen.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” said Mr. Primus. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders and things like that.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000–;$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“We were glad to see HIT move forward. Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]'” in terms of reimbursement by the government.

Another big chunk of the Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to “make doctors and [other] providers smarter” by letting them know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that “this is the camel's nose under the tent on government control of your health care,” especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

Mr. Elling offered a cautionary tale about CER. “We've seen how they apply [CER] in other countries,” he said. For instance, the policy at the U.K. National Institute for Health and Clinical Excellence, the organization that determines which treatments the National Health Service will pay for, says that “if you want the expensive drug for macular degeneration, you have to go blind in one eye before they'll give it to you for the other eye. That's CER right there.

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy advisor to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, Mr. Primus explained.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other. We're going to try to make sure that doesn't happen.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” said Mr. Primus. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders and things like that.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000–;$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“We were glad to see HIT move forward. Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]'” in terms of reimbursement by the government.

Another big chunk of the Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to “make doctors and [other] providers smarter” by letting them know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that “this is the camel's nose under the tent on government control of your health care,” especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

Mr. Elling offered a cautionary tale about CER. “We've seen how they apply [CER] in other countries,” he said. For instance, the policy at the U.K. National Institute for Health and Clinical Excellence, the organization that determines which treatments the National Health Service will pay for, says that “if you want the expensive drug for macular degeneration, you have to go blind in one eye before they'll give it to you for the other eye. That's CER right there.

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy advisor to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, he explained.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other. We're going to try to make sure that doesn't happen.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” said Mr. Primus. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders and things like that.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000–$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“We were glad to see HIT move forward. Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]' “ in terms of reimbursement by the government.

Another big chunk of Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to “make doctors and [other] providers smarter” by letting them know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that “this is the camel's nose under the tent on government control of your health care,” especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

Mr. Elling offered a cautionary tale about CER. “We've seen how they apply [CER] in other countries,” he said.

For instance, the policy at the U.K. National Institute for Health and Clinical Excellence, the organization that determines which treatments the National Health Service will pay for, says that “if you want the expensive drug for macular degeneration, you have to go blind in one eye before they'll give it to you for the other eye. That's CER right there.”

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy advisor to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, he explained.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other. We're going to try to make sure that doesn't happen.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” said Mr. Primus. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders and things like that.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000–$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“We were glad to see HIT move forward. Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]' “ in terms of reimbursement by the government.

Another big chunk of Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to “make doctors and [other] providers smarter” by letting them know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that “this is the camel's nose under the tent on government control of your health care,” especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

Mr. Elling offered a cautionary tale about CER. “We've seen how they apply [CER] in other countries,” he said.

For instance, the policy at the U.K. National Institute for Health and Clinical Excellence, the organization that determines which treatments the National Health Service will pay for, says that “if you want the expensive drug for macular degeneration, you have to go blind in one eye before they'll give it to you for the other eye. That's CER right there.”

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy advisor to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, he explained.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other. We're going to try to make sure that doesn't happen.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” said Mr. Primus. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders and things like that.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000–$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“We were glad to see HIT move forward. Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]' “ in terms of reimbursement by the government.

Another big chunk of Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to “make doctors and [other] providers smarter” by letting them know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that “this is the camel's nose under the tent on government control of your health care,” especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

Mr. Elling offered a cautionary tale about CER. “We've seen how they apply [CER] in other countries,” he said.

For instance, the policy at the U.K. National Institute for Health and Clinical Excellence, the organization that determines which treatments the National Health Service will pay for, says that “if you want the expensive drug for macular degeneration, you have to go blind in one eye before they'll give it to you for the other eye. That's CER right there.”

President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research will probably not have a large effect on rheumatologic disease research, according to one expert.

Under the previous policy, government funding for embryonic stem cell research was limited to studies using only the few stem cell lines that were in existence in August 2001, when then-President George W. Bush announced the policy. President Obama's executive order, which he signed in March, lifts those restrictions and allows funded research to include embryonic stem cell lines created after that date. However, the order does not lift a current ban on using federal funds to create stem cell lines if the creation involves the destruction of human embryos. Federal policy does not affect privately funded stem cell research.

President Obama noted at the signing ceremony that “many thoughtful and decent people are conflicted about, or strongly oppose, [embryonic stem cell] research. I understand their concerns, and we must respect their point of view.”

But he added that “in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values. In this case, I believe the two are not inconsistent.

“After much discussion, debate and reflection, the proper course has become clear,” he said. “The majority of Americans—from across the political spectrum, and of all backgrounds and beliefs—have come to a consensus that we should pursue this research. … That is a conclusion with which I agree. That is why I am signing this executive order and why I hope Congress will act on a bipartisan basis to provide further support for this research.”

The president said that the government “will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.”

Dr. Alan Tyndall, professor and head of the department of rheumatology at the University of Basel (Switzerland) said it is “not likely” that the executive order will advance stem cell research for rheumatologic diseases. “The order refers to [embryonic] stem cell research, which [is] not being applied to rheumatic disorders,” he said.

Dr. Tyndall noted that much research is instead being done with adult stem cells. “In this way, you do not need to destroy an embryo, which in some religions and cultures is considered to be destroying an individual with a soul.”

Rheumatologic diseases that are potential targets for stem cell research include “inflammatory disorders not responding to conventional treatment, since some adult stem cells—such as mesenchymal stem cells derived from fat, bone marrow, or placenta—exert anti-inflammatory and immunosuppressive effects on tissues without acute toxicity,” said Dr. Tyndall. But despite recent attempts, the use of either embryonic cells or reprogrammed adult cells to replace damaged tissues “is a long way from reality,” he added. “The problem is that the very plastic [embryonic] stem cells also form tumors called teratomas, and this has not yet been solved.”

Lawrence Tabak, Ph.D., acting deputy director of the National Institutes of Health, expressed support for the executive order. “Researchers will now be able to pursue new knowledge about human development, regenerative medicine, and the origins of many of our most devastating diseases,” he said in a teleconference. “This research promises to revolutionize how we predict, treat, and prevent many diseases, and will contribute to the development of lifesaving therapies. NIH will do its part to implement new policy and develop guidelines as expeditiously as possible to make sure the best science is funded and the research is conducted in a responsible manner.”

The American Medical Association also applauded the change. “Stem cell research holds great promise to treat diseases that science has so far been unable to cure, and this change in policy will allow researchers to accelerate their efforts by applying for federal research funds,” Dr. Joseph Heyman, chair of the AMA's board of directors, said in a statement.

“The AMA supports biomedical research on stem cells and has encouraged strong public support of federal funding for this research. [This] action by President Obama will help scientists realize the potential of stem cell research to benefit the many Americans living with diseases such as diabetes, Parkinson's, and Alzheimer's.”

But Dr. David Stevens, CEO of the Christian Medical Association in Bristol, Tenn., cited problems with embryonic stem cell research. In addition to the moral issue, the prospects for embryonic stem cell research have been overblown, he said.

“We know that embryonic stem cells are difficult to culture and to control. … Even people in this field say that if treatment is going to come out of this, it's probably 20 years away.”

Instead of spending money on embryonic stem cell research, “we should put our money where we can get real cures real fast”—with adult stem cells, which already have shown promising preliminary results, Dr. Stevens said. “If we have one path we can go down which is cheaper, less complicated, and gets us to cures quickly, why would we go down another path?”

The order refers to embryonic stem cell research, which is not being applied to rheumatic disorders. DR. TYNDALL

President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research will probably not have a large effect on rheumatologic disease research, according to one expert.

Under the previous policy, government funding for embryonic stem cell research was limited to studies using only the few stem cell lines that were in existence in August 2001, when then-President George W. Bush announced the policy. President Obama's executive order, which he signed in March, lifts those restrictions and allows funded research to include embryonic stem cell lines created after that date. However, the order does not lift a current ban on using federal funds to create stem cell lines if the creation involves the destruction of human embryos. Federal policy does not affect privately funded stem cell research.

President Obama noted at the signing ceremony that “many thoughtful and decent people are conflicted about, or strongly oppose, [embryonic stem cell] research. I understand their concerns, and we must respect their point of view.”

But he added that “in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values. In this case, I believe the two are not inconsistent.

“After much discussion, debate and reflection, the proper course has become clear,” he said. “The majority of Americans—from across the political spectrum, and of all backgrounds and beliefs—have come to a consensus that we should pursue this research. … That is a conclusion with which I agree. That is why I am signing this executive order and why I hope Congress will act on a bipartisan basis to provide further support for this research.”

The president said that the government “will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.”

Dr. Alan Tyndall, professor and head of the department of rheumatology at the University of Basel (Switzerland) said it is “not likely” that the executive order will advance stem cell research for rheumatologic diseases. “The order refers to [embryonic] stem cell research, which [is] not being applied to rheumatic disorders,” he said.

Dr. Tyndall noted that much research is instead being done with adult stem cells. “In this way, you do not need to destroy an embryo, which in some religions and cultures is considered to be destroying an individual with a soul.”

Rheumatologic diseases that are potential targets for stem cell research include “inflammatory disorders not responding to conventional treatment, since some adult stem cells—such as mesenchymal stem cells derived from fat, bone marrow, or placenta—exert anti-inflammatory and immunosuppressive effects on tissues without acute toxicity,” said Dr. Tyndall. But despite recent attempts, the use of either embryonic cells or reprogrammed adult cells to replace damaged tissues “is a long way from reality,” he added. “The problem is that the very plastic [embryonic] stem cells also form tumors called teratomas, and this has not yet been solved.”

Lawrence Tabak, Ph.D., acting deputy director of the National Institutes of Health, expressed support for the executive order. “Researchers will now be able to pursue new knowledge about human development, regenerative medicine, and the origins of many of our most devastating diseases,” he said in a teleconference. “This research promises to revolutionize how we predict, treat, and prevent many diseases, and will contribute to the development of lifesaving therapies. NIH will do its part to implement new policy and develop guidelines as expeditiously as possible to make sure the best science is funded and the research is conducted in a responsible manner.”

The American Medical Association also applauded the change. “Stem cell research holds great promise to treat diseases that science has so far been unable to cure, and this change in policy will allow researchers to accelerate their efforts by applying for federal research funds,” Dr. Joseph Heyman, chair of the AMA's board of directors, said in a statement.

“The AMA supports biomedical research on stem cells and has encouraged strong public support of federal funding for this research. [This] action by President Obama will help scientists realize the potential of stem cell research to benefit the many Americans living with diseases such as diabetes, Parkinson's, and Alzheimer's.”

But Dr. David Stevens, CEO of the Christian Medical Association in Bristol, Tenn., cited problems with embryonic stem cell research. In addition to the moral issue, the prospects for embryonic stem cell research have been overblown, he said.

“We know that embryonic stem cells are difficult to culture and to control. … Even people in this field say that if treatment is going to come out of this, it's probably 20 years away.”

Instead of spending money on embryonic stem cell research, “we should put our money where we can get real cures real fast”—with adult stem cells, which already have shown promising preliminary results, Dr. Stevens said. “If we have one path we can go down which is cheaper, less complicated, and gets us to cures quickly, why would we go down another path?”

The order refers to embryonic stem cell research, which is not being applied to rheumatic disorders. DR. TYNDALL

President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research will probably not have a large effect on rheumatologic disease research, according to one expert.

Under the previous policy, government funding for embryonic stem cell research was limited to studies using only the few stem cell lines that were in existence in August 2001, when then-President George W. Bush announced the policy. President Obama's executive order, which he signed in March, lifts those restrictions and allows funded research to include embryonic stem cell lines created after that date. However, the order does not lift a current ban on using federal funds to create stem cell lines if the creation involves the destruction of human embryos. Federal policy does not affect privately funded stem cell research.

President Obama noted at the signing ceremony that “many thoughtful and decent people are conflicted about, or strongly oppose, [embryonic stem cell] research. I understand their concerns, and we must respect their point of view.”

But he added that “in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values. In this case, I believe the two are not inconsistent.

“After much discussion, debate and reflection, the proper course has become clear,” he said. “The majority of Americans—from across the political spectrum, and of all backgrounds and beliefs—have come to a consensus that we should pursue this research. … That is a conclusion with which I agree. That is why I am signing this executive order and why I hope Congress will act on a bipartisan basis to provide further support for this research.”

The president said that the government “will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.”

Dr. Alan Tyndall, professor and head of the department of rheumatology at the University of Basel (Switzerland) said it is “not likely” that the executive order will advance stem cell research for rheumatologic diseases. “The order refers to [embryonic] stem cell research, which [is] not being applied to rheumatic disorders,” he said.

Dr. Tyndall noted that much research is instead being done with adult stem cells. “In this way, you do not need to destroy an embryo, which in some religions and cultures is considered to be destroying an individual with a soul.”

Rheumatologic diseases that are potential targets for stem cell research include “inflammatory disorders not responding to conventional treatment, since some adult stem cells—such as mesenchymal stem cells derived from fat, bone marrow, or placenta—exert anti-inflammatory and immunosuppressive effects on tissues without acute toxicity,” said Dr. Tyndall. But despite recent attempts, the use of either embryonic cells or reprogrammed adult cells to replace damaged tissues “is a long way from reality,” he added. “The problem is that the very plastic [embryonic] stem cells also form tumors called teratomas, and this has not yet been solved.”

Lawrence Tabak, Ph.D., acting deputy director of the National Institutes of Health, expressed support for the executive order. “Researchers will now be able to pursue new knowledge about human development, regenerative medicine, and the origins of many of our most devastating diseases,” he said in a teleconference. “This research promises to revolutionize how we predict, treat, and prevent many diseases, and will contribute to the development of lifesaving therapies. NIH will do its part to implement new policy and develop guidelines as expeditiously as possible to make sure the best science is funded and the research is conducted in a responsible manner.”

The American Medical Association also applauded the change. “Stem cell research holds great promise to treat diseases that science has so far been unable to cure, and this change in policy will allow researchers to accelerate their efforts by applying for federal research funds,” Dr. Joseph Heyman, chair of the AMA's board of directors, said in a statement.

“The AMA supports biomedical research on stem cells and has encouraged strong public support of federal funding for this research. [This] action by President Obama will help scientists realize the potential of stem cell research to benefit the many Americans living with diseases such as diabetes, Parkinson's, and Alzheimer's.”

But Dr. David Stevens, CEO of the Christian Medical Association in Bristol, Tenn., cited problems with embryonic stem cell research. In addition to the moral issue, the prospects for embryonic stem cell research have been overblown, he said.

“We know that embryonic stem cells are difficult to culture and to control. … Even people in this field say that if treatment is going to come out of this, it's probably 20 years away.”

Instead of spending money on embryonic stem cell research, “we should put our money where we can get real cures real fast”—with adult stem cells, which already have shown promising preliminary results, Dr. Stevens said. “If we have one path we can go down which is cheaper, less complicated, and gets us to cures quickly, why would we go down another path?”

The order refers to embryonic stem cell research, which is not being applied to rheumatic disorders. DR. TYNDALL

President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research drew cheers from some medical groups and jeers from others.

Under the previous policy, government funding for embryonic stem cell research was limited to studies using only the few stem cell lines that were in existence in August 2001, when then-President George W. Bush announced the policy. President Obama's executive order, which he signed in March, lifts those restrictions and allows funded research to include embryonic stem cell lines created after that date. However, the order does not lift a current ban on using federal funds to create stem cell lines if the creation involves destruction of human embryos. Federal policy does not affect privately funded stem cell research.

President Obama noted at the signing ceremony that “many thoughtful and decent people are conflicted about, or strongly oppose, [embryonic stem cell] research. I understand their concerns, and we must respect their point of view.”

But he added that “in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values. In this case, I believe the two are not inconsistent.

“After much discussion, debate, and reflection, the proper course has become clear,” he said. “The majority of Americans—from across the political spectrum, and of all backgrounds and beliefs—have come to a consensus that we should pursue this research. … That is a conclusion with which I agree. That is why I am signing this executive order and why I hope Congress will act on a bipartisan basis to provide further support for this research.”

The president said that the government “will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.”

Lawrence Tabak, Ph.D., acting deputy director of the National Institutes of Health, expressed support for the decision. “Researchers will now be able to pursue new knowledge about human development, regenerative medicine, and the origins of many of our most devastating diseases,” he said in a teleconference. “This research promises to revolutionize how we predict, treat, and prevent many diseases, and will contribute to the development of lifesaving therapies. NIH will do its part to implement new policy and develop guidelines as expeditiously as possible to make sure the best science is funded and the research is conducted in a responsible manner.”

The American Medical Association also applauded the change. “Stem cell research holds great promise to treat diseases that science has so far been unable to cure, and this change in policy will allow researchers to accelerate their efforts by applying for federal research funds,” Dr. Joseph Heyman, chair of the AMA's board of directors, said in a statement. “The AMA supports biomedical research on stem cells and has encouraged strong public support of federal funding for this research. [This] action by President Obama will help scientists realize the potential of stem cell research to benefit the many Americans living with diseases such as diabetes, Parkinson's and Alzheimer's.”

But Dr. David Stevens, CEO of the Christian Medical Association, in Bristol, Tenn., cited problems with embryonic stem cell research. First, there is a moral issue: “We understand that embryos are human beings. Every one of us was an embryo,” he said. “When you destroy an embryo, you destroy a distinct human being.” Also, the prospects for embryonic stem cell research have been overblown, he continued. “We know that embryonic stem cells are difficult to culture and to control. … Even people in this field say that if treatment is going to come out of this, it's probably 20 years away.

President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research drew cheers from some medical groups and jeers from others.

Under the previous policy, government funding for embryonic stem cell research was limited to studies using only the few stem cell lines that were in existence in August 2001, when then-President George W. Bush announced the policy. President Obama's executive order, which he signed in March, lifts those restrictions and allows funded research to include embryonic stem cell lines created after that date. However, the order does not lift a current ban on using federal funds to create stem cell lines if the creation involves destruction of human embryos. Federal policy does not affect privately funded stem cell research.

President Obama noted at the signing ceremony that “many thoughtful and decent people are conflicted about, or strongly oppose, [embryonic stem cell] research. I understand their concerns, and we must respect their point of view.”

But he added that “in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values. In this case, I believe the two are not inconsistent.

“After much discussion, debate, and reflection, the proper course has become clear,” he said. “The majority of Americans—from across the political spectrum, and of all backgrounds and beliefs—have come to a consensus that we should pursue this research. … That is a conclusion with which I agree. That is why I am signing this executive order and why I hope Congress will act on a bipartisan basis to provide further support for this research.”

The president said that the government “will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.”

Lawrence Tabak, Ph.D., acting deputy director of the National Institutes of Health, expressed support for the decision. “Researchers will now be able to pursue new knowledge about human development, regenerative medicine, and the origins of many of our most devastating diseases,” he said in a teleconference. “This research promises to revolutionize how we predict, treat, and prevent many diseases, and will contribute to the development of lifesaving therapies. NIH will do its part to implement new policy and develop guidelines as expeditiously as possible to make sure the best science is funded and the research is conducted in a responsible manner.”

The American Medical Association also applauded the change. “Stem cell research holds great promise to treat diseases that science has so far been unable to cure, and this change in policy will allow researchers to accelerate their efforts by applying for federal research funds,” Dr. Joseph Heyman, chair of the AMA's board of directors, said in a statement. “The AMA supports biomedical research on stem cells and has encouraged strong public support of federal funding for this research. [This] action by President Obama will help scientists realize the potential of stem cell research to benefit the many Americans living with diseases such as diabetes, Parkinson's and Alzheimer's.”

But Dr. David Stevens, CEO of the Christian Medical Association, in Bristol, Tenn., cited problems with embryonic stem cell research. First, there is a moral issue: “We understand that embryos are human beings. Every one of us was an embryo,” he said. “When you destroy an embryo, you destroy a distinct human being.” Also, the prospects for embryonic stem cell research have been overblown, he continued. “We know that embryonic stem cells are difficult to culture and to control. … Even people in this field say that if treatment is going to come out of this, it's probably 20 years away.

President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research drew cheers from some medical groups and jeers from others.

Under the previous policy, government funding for embryonic stem cell research was limited to studies using only the few stem cell lines that were in existence in August 2001, when then-President George W. Bush announced the policy. President Obama's executive order, which he signed in March, lifts those restrictions and allows funded research to include embryonic stem cell lines created after that date. However, the order does not lift a current ban on using federal funds to create stem cell lines if the creation involves destruction of human embryos. Federal policy does not affect privately funded stem cell research.

President Obama noted at the signing ceremony that “many thoughtful and decent people are conflicted about, or strongly oppose, [embryonic stem cell] research. I understand their concerns, and we must respect their point of view.”

But he added that “in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values. In this case, I believe the two are not inconsistent.

“After much discussion, debate, and reflection, the proper course has become clear,” he said. “The majority of Americans—from across the political spectrum, and of all backgrounds and beliefs—have come to a consensus that we should pursue this research. … That is a conclusion with which I agree. That is why I am signing this executive order and why I hope Congress will act on a bipartisan basis to provide further support for this research.”

The president said that the government “will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.”

Lawrence Tabak, Ph.D., acting deputy director of the National Institutes of Health, expressed support for the decision. “Researchers will now be able to pursue new knowledge about human development, regenerative medicine, and the origins of many of our most devastating diseases,” he said in a teleconference. “This research promises to revolutionize how we predict, treat, and prevent many diseases, and will contribute to the development of lifesaving therapies. NIH will do its part to implement new policy and develop guidelines as expeditiously as possible to make sure the best science is funded and the research is conducted in a responsible manner.”

The American Medical Association also applauded the change. “Stem cell research holds great promise to treat diseases that science has so far been unable to cure, and this change in policy will allow researchers to accelerate their efforts by applying for federal research funds,” Dr. Joseph Heyman, chair of the AMA's board of directors, said in a statement. “The AMA supports biomedical research on stem cells and has encouraged strong public support of federal funding for this research. [This] action by President Obama will help scientists realize the potential of stem cell research to benefit the many Americans living with diseases such as diabetes, Parkinson's and Alzheimer's.”

But Dr. David Stevens, CEO of the Christian Medical Association, in Bristol, Tenn., cited problems with embryonic stem cell research. First, there is a moral issue: “We understand that embryos are human beings. Every one of us was an embryo,” he said. “When you destroy an embryo, you destroy a distinct human being.” Also, the prospects for embryonic stem cell research have been overblown, he continued. “We know that embryonic stem cells are difficult to culture and to control. … Even people in this field say that if treatment is going to come out of this, it's probably 20 years away.

WASHINGTON — It's not easy being diabetic.

Life is filled with lots of additional responsibilities: the finger sticks, the glucose monitoring, the hemoglobin A_1c testing, the foot and eye exams. So how can things be made easier for diabetes patients and their physicians?

One answer is technology, according to several speakers at a diabetes meeting sponsored by Avalere Health. And for Amand Iyer, president and COO of WellDoc Inc., a Baltimore-based software company, that often means the cell phone.

Cell phone use can help to overcome one of the biggest barriers in the adoption of new technology: cost, said Mr. Iyer, who is a type 2 diabetes patient. “Wireless operators are measured on two things: average revenue per user, and the amount of marketing dollars they invest to [regain] a lost subscriber, which is $343 per lost subscriber per year,” he said. “If you can extend the wireless operator's contract for 1 year by providing a 'sticky' health application, they're willing to share that $343 with you.”

That's exactly what WellDoc is doing: marketing one program as a “virtual coach” that diabetes patients can load onto their phones. “You register online or on the phone and provide your demographic information, phone number, and the drug regimen you're on, and when you're finished, you get a text message that says, 'Click here to download the software,' “ Mr. Iyer explained, noting that it will work on most commercially available cell phones. The software has blood glucose target ranges, high and low alerts, and [information on] what to do for hypoglycemia, and it can be modified for patients with multiple comorbidities such as diabetes and heart failure, he said.

The software also includes a learning library with information on diabetes self-care, and a mobile logbook that users can access on a computer so they can see how well they're meeting their targets. And the cell phone acts as a “nerve center” that communicates with the patient and whomever else he or she chooses, such as a physician, caregiver, or diabetes educator.

Patients can enter useful data for alerting themselves and physicians to preset trends—for example, if the patient is hypoglycemic twice in a 10-day period. Physicians can choose to receive the information in whatever way suits them best, Mr. Iyer said.

“[One doctor may say] 'I don't have a computer; send it to me in a fax the day before [the patient] comes in.' Some doctors with brittle diabetes patients have said, 'Hey, can I actually get the software on my phone? Because I just made this medication change for this brittle patient and I want to see how he is tracking.' “

Mr. Iyer's company also is working with a glucose monitor firm on getting a wireless chip installed right on the meter. “Patients would pull their strips as they do normally, get the feedback on the meter, and get all their alerts and reminders right off the meter.” His company is developing similar modules for other diseases, including heart failure, hypertension, and dyslipidemia.

At Partners in Health, a group practice affiliated with the University of Pittsburgh Medical Center, one technology application that has gotten a good response is electronic “office visits,” according to Dr. Grant Shevchik, the practice's medical director. Patients fill out online questionnaires—“the only physician visit where the patient records the history”—and the messages are sent directly to their physicians for a response. The new service generated 286 “visits” from Aug. 28, 2008, to Jan. 31, 2009, said Dr. Shevchik, a family physician.

“Our oldest patient who has done this is 82,” and many of the others are in the 35- to 44-year-old age group. “These are not the 22-year-olds,” he added.

Not only is the service “affordable, convenient, and efficient,” it also has a CPT code (99444), he noted. The code can be used only once during a 7-day period and the visit must meet several other criteria: It must be patient initiated, it must involve a timely response, and there must be permanent storage of the visit information.

At Johns Hopkins University in Baltimore, employees with chronic illnesses such as diabetes can take advantage of Telewatch, a telephone monitoring program, said Dr. Ines Vigil, associate medical director at Johns Hopkins HealthCare, a health plan that includes 47,000 university employees.

“The employee can call in and type in their blood pressure, last cholesterol-screening results, their symptoms, and their stress levels, and it gets rolled into a system that our nurse case managers and clinical screeners are able to follow over time,” Dr. Vigil explained. “The system will red-flag something if it's abnormal.” If a patient calls in an abnormally high blood pressure or glucose level, “then our clinical screener will inform the case manager to give the member a call,” she said. The patient is then informed about recognizing abnormal values, accessing care, and checking their medications. More than 1,000 people are participating in Telewatch, she said, noting that patients with more serious chronic illnesses talk with nurse case managers more regularly.

WASHINGTON — It's not easy being diabetic.

Life is filled with lots of additional responsibilities: the finger sticks, the glucose monitoring, the hemoglobin A_1c testing, the foot and eye exams. So how can things be made easier for diabetes patients and their physicians?

One answer is technology, according to several speakers at a diabetes meeting sponsored by Avalere Health. And for Amand Iyer, president and COO of WellDoc Inc., a Baltimore-based software company, that often means the cell phone.

Cell phone use can help to overcome one of the biggest barriers in the adoption of new technology: cost, said Mr. Iyer, who is a type 2 diabetes patient. “Wireless operators are measured on two things: average revenue per user, and the amount of marketing dollars they invest to [regain] a lost subscriber, which is $343 per lost subscriber per year,” he said. “If you can extend the wireless operator's contract for 1 year by providing a 'sticky' health application, they're willing to share that $343 with you.”

That's exactly what WellDoc is doing: marketing one program as a “virtual coach” that diabetes patients can load onto their phones. “You register online or on the phone and provide your demographic information, phone number, and the drug regimen you're on, and when you're finished, you get a text message that says, 'Click here to download the software,' “ Mr. Iyer explained, noting that it will work on most commercially available cell phones. The software has blood glucose target ranges, high and low alerts, and [information on] what to do for hypoglycemia, and it can be modified for patients with multiple comorbidities such as diabetes and heart failure, he said.

The software also includes a learning library with information on diabetes self-care, and a mobile logbook that users can access on a computer so they can see how well they're meeting their targets. And the cell phone acts as a “nerve center” that communicates with the patient and whomever else he or she chooses, such as a physician, caregiver, or diabetes educator.

Patients can enter useful data for alerting themselves and physicians to preset trends—for example, if the patient is hypoglycemic twice in a 10-day period. Physicians can choose to receive the information in whatever way suits them best, Mr. Iyer said.

“[One doctor may say] 'I don't have a computer; send it to me in a fax the day before [the patient] comes in.' Some doctors with brittle diabetes patients have said, 'Hey, can I actually get the software on my phone? Because I just made this medication change for this brittle patient and I want to see how he is tracking.' “

Mr. Iyer's company also is working with a glucose monitor firm on getting a wireless chip installed right on the meter. “Patients would pull their strips as they do normally, get the feedback on the meter, and get all their alerts and reminders right off the meter.” His company is developing similar modules for other diseases, including heart failure, hypertension, and dyslipidemia.

At Partners in Health, a group practice affiliated with the University of Pittsburgh Medical Center, one technology application that has gotten a good response is electronic “office visits,” according to Dr. Grant Shevchik, the practice's medical director. Patients fill out online questionnaires—“the only physician visit where the patient records the history”—and the messages are sent directly to their physicians for a response. The new service generated 286 “visits” from Aug. 28, 2008, to Jan. 31, 2009, said Dr. Shevchik, a family physician.

“Our oldest patient who has done this is 82,” and many of the others are in the 35- to 44-year-old age group. “These are not the 22-year-olds,” he added.

Not only is the service “affordable, convenient, and efficient,” it also has a CPT code (99444), he noted. The code can be used only once during a 7-day period and the visit must meet several other criteria: It must be patient initiated, it must involve a timely response, and there must be permanent storage of the visit information.

At Johns Hopkins University in Baltimore, employees with chronic illnesses such as diabetes can take advantage of Telewatch, a telephone monitoring program, said Dr. Ines Vigil, associate medical director at Johns Hopkins HealthCare, a health plan that includes 47,000 university employees.

“The employee can call in and type in their blood pressure, last cholesterol-screening results, their symptoms, and their stress levels, and it gets rolled into a system that our nurse case managers and clinical screeners are able to follow over time,” Dr. Vigil explained. “The system will red-flag something if it's abnormal.” If a patient calls in an abnormally high blood pressure or glucose level, “then our clinical screener will inform the case manager to give the member a call,” she said. The patient is then informed about recognizing abnormal values, accessing care, and checking their medications. More than 1,000 people are participating in Telewatch, she said, noting that patients with more serious chronic illnesses talk with nurse case managers more regularly.

WASHINGTON — It's not easy being diabetic.

Life is filled with lots of additional responsibilities: the finger sticks, the glucose monitoring, the hemoglobin A_1c testing, the foot and eye exams. So how can things be made easier for diabetes patients and their physicians?

One answer is technology, according to several speakers at a diabetes meeting sponsored by Avalere Health. And for Amand Iyer, president and COO of WellDoc Inc., a Baltimore-based software company, that often means the cell phone.

Cell phone use can help to overcome one of the biggest barriers in the adoption of new technology: cost, said Mr. Iyer, who is a type 2 diabetes patient. “Wireless operators are measured on two things: average revenue per user, and the amount of marketing dollars they invest to [regain] a lost subscriber, which is $343 per lost subscriber per year,” he said. “If you can extend the wireless operator's contract for 1 year by providing a 'sticky' health application, they're willing to share that $343 with you.”

That's exactly what WellDoc is doing: marketing one program as a “virtual coach” that diabetes patients can load onto their phones. “You register online or on the phone and provide your demographic information, phone number, and the drug regimen you're on, and when you're finished, you get a text message that says, 'Click here to download the software,' “ Mr. Iyer explained, noting that it will work on most commercially available cell phones. The software has blood glucose target ranges, high and low alerts, and [information on] what to do for hypoglycemia, and it can be modified for patients with multiple comorbidities such as diabetes and heart failure, he said.

The software also includes a learning library with information on diabetes self-care, and a mobile logbook that users can access on a computer so they can see how well they're meeting their targets. And the cell phone acts as a “nerve center” that communicates with the patient and whomever else he or she chooses, such as a physician, caregiver, or diabetes educator.

Patients can enter useful data for alerting themselves and physicians to preset trends—for example, if the patient is hypoglycemic twice in a 10-day period. Physicians can choose to receive the information in whatever way suits them best, Mr. Iyer said.

“[One doctor may say] 'I don't have a computer; send it to me in a fax the day before [the patient] comes in.' Some doctors with brittle diabetes patients have said, 'Hey, can I actually get the software on my phone? Because I just made this medication change for this brittle patient and I want to see how he is tracking.' “

Mr. Iyer's company also is working with a glucose monitor firm on getting a wireless chip installed right on the meter. “Patients would pull their strips as they do normally, get the feedback on the meter, and get all their alerts and reminders right off the meter.” His company is developing similar modules for other diseases, including heart failure, hypertension, and dyslipidemia.

At Partners in Health, a group practice affiliated with the University of Pittsburgh Medical Center, one technology application that has gotten a good response is electronic “office visits,” according to Dr. Grant Shevchik, the practice's medical director. Patients fill out online questionnaires—“the only physician visit where the patient records the history”—and the messages are sent directly to their physicians for a response. The new service generated 286 “visits” from Aug. 28, 2008, to Jan. 31, 2009, said Dr. Shevchik, a family physician.

“Our oldest patient who has done this is 82,” and many of the others are in the 35- to 44-year-old age group. “These are not the 22-year-olds,” he added.

Not only is the service “affordable, convenient, and efficient,” it also has a CPT code (99444), he noted. The code can be used only once during a 7-day period and the visit must meet several other criteria: It must be patient initiated, it must involve a timely response, and there must be permanent storage of the visit information.

At Johns Hopkins University in Baltimore, employees with chronic illnesses such as diabetes can take advantage of Telewatch, a telephone monitoring program, said Dr. Ines Vigil, associate medical director at Johns Hopkins HealthCare, a health plan that includes 47,000 university employees.

“The employee can call in and type in their blood pressure, last cholesterol-screening results, their symptoms, and their stress levels, and it gets rolled into a system that our nurse case managers and clinical screeners are able to follow over time,” Dr. Vigil explained. “The system will red-flag something if it's abnormal.” If a patient calls in an abnormally high blood pressure or glucose level, “then our clinical screener will inform the case manager to give the member a call,” she said. The patient is then informed about recognizing abnormal values, accessing care, and checking their medications. More than 1,000 people are participating in Telewatch, she said, noting that patients with more serious chronic illnesses talk with nurse case managers more regularly.