A Nanotube Patch to Help Heal the Heart
Brown University researchers have created a tiny patch made out of carbon nanotubes that they hope will someday help regenerate heart cells. Credit: Thomas Webster at Brown University
Researchers create carbon nanotubes that mimic natural tissue and can regenerate heart cells in a dish
MIT Technology Review, May 23, 2011, by Karen Weintraub — A conductive patch of carbon nanotubes can regenerate heart tissue growing in a dish, according to preliminary research from Brown University. The patch, made of tiny chains of carbon atoms that fold in on themselves, forming a tube, conducts electricity and mimics the rough surface of natural tissue. The more nanotubes the Brown researchers added to the patch, the more cells around it were able to regenerate.
During a heart attack, areas of the heart are deprived of oxygen, killing muscle and nerve cells used to keep the heart beating strongly and rhythmically. The tissue cannot regenerate on its own, which disrupts the heart’s rhythm, weakens it, and sometimes leads to a repeat heart attack. Tissue engineers around the globe are searching for ways to regenerate or repair this damaged tissue using different types of scaffolds and stem cells.
Thomas Webster, an associate professor of engineering and orthopedics at Brown and senior author of the study, says his work is distinctive because he examined not just the muscle cells that beat, but also the nerve cells that help them contract and the endothelial cells that line the blood vessels leading to and from the heart. The fact that the patch helped regenerate all three types of cells, which function interdependently in the heart, suggests the newly grown tissue is similar to normal heart tissue. The research was published today in Acta Biomaterialia.
Jeff Karp, codirector of the Regenerative Therapeutics Research Center at Brigham and Women’s Hospital, says he’s impressed by Webster’s idea. But Karp cautions that the work is still preliminary. “It will be some time before we know how promising this approach truly is,” he says, because it has not yet been tested in animals.
Webster’s nanotube patch is just one of many approaches underway to help repair the heart. Many involve injecting stem cells collected from the patient into the damaged heart or implanting patches of muscle derived from these stem cells. He says the nanotubes could be used on their own, or as scaffolds for stem cells.
Webster’s team is now fine-tuning the nanomaterial to create a linear pattern to more closely mimic the pattern in natural tissue. Others have shown that creating this kind of structure can provide a natural scaffold that supports tissue strength and growth. The team is also working to make the patch as precisely as conductive as heart tissue, to see if that improves its function. The next step will be to figure out how to deliver the patch, which could be rolled up and transported to the heart via a catheter.
Of course, researchers need to do extensive safety testing before the technology can be used in patients. Unlike other materials used in tissue engineering, the carbon nanotube patch would not naturally degrade in the body. “The idea would be that the heart tissue would grow around these carbon nanotubes and they would continue to provide electrical stimulus to the heart,” Webster says.
To avoid regulatory delays, Webster says, he may try his carbon nanotube patch first on pets. Right now, heart attacks are usually fatal for the family dog, Webster says, because most animals don’t get diagnostic medical care or treatment, and have smaller hearts that have a harder time than human hearts compensating for damage. Treating pets “could be a way to get this technology out earlier,” he says.
Published May 2011 – Original Research
IMPROVING PATIENT CARE
A Survey of Health Information Exchange Organizations in the United States: Implications for Meaningful Use
+ Author Affiliations1. From Harvard Business School, Harvard School of Public Health, Brigham and Women’s Hospital, Harvard Medical School, and Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
Background: To receive financial incentives for meaningful use of electronic health records, physicians and hospitals will need to engage in health information exchange (HIE). For most providers, joining regional organizations that support HIE is the most viable approach currently available.
Objective: To assess the state of HIE in the United States through regional health information organizations (RHIOs).
Setting: All RHIOs in the United States.
Participants: 179 U.S.-based RHIOs that facilitated HIE as of December 2009.
Measurements: Number of operational RHIOs, the subset of operational RHIOs that supported stage 1 meaningful use, and the subset that supported robust HIE; number of ambulatory practices and hospitals participating in RHIOs; and number of financially viable RHIOs.
Results: Of 197 potential RHIOs, 179 (91%) reported their status and 165 (84%) returned completed surveys. Of these, 75 RHIOs were operational, covering approximately 14% of U.S. hospitals and 3% of ambulatory practices. Thirteen RHIOs supported stage 1 meaningful use (covering 3% of hospitals and 0.9% of practices), and none met an expert-derived definition of a comprehensive RHIO. Overall, 50 of 75 RHIOs (67%) did not meet the criteria for financial viability.
Limitations: Survey data were self-reported. The sample may not have included all HIE efforts, particularly those of individual providers who set up their own data-exchange agreements.
Conclusion: These findings call into question whether RHIOs in their current form can be self-sustaining and effective in helping U.S. physicians and hospitals engage in robust HIE to improve the quality and efficiency of care.
Primary Funding Source: Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.
IMPROVING PATIENT CARE
Despite Government Incentives, Few Hospitals Able to Adopt Electronic Health Records
AnnalsOfInternalMedicine, May 2011 – Congress has allocated $30 billion to stimulate adoption and meaningful use of electronic health records. Meaningful use is defined by three central components: 1) electronic prescribing with decision support; 2) automated quality measurement; and 3) health information exchange (HIE). To be considered meaningful, providers must purchase technology and comply with metrics related to implementation. Regional health information organizations (RHIOs) are entities that facilitate clinical data exchange in a local area. With grant support from the federal government, RHIOs give local providers an efficient way to exchange data with other participating providers and stakeholders (laboratories, physician practices, public health departments, etc.) so they may comply with expert-derived criteria for meaningful use of electronic records. In 2009, investigators surveyed 179-U.S.-based RHIOs to assess the state of HIE. Of the 179 RHIOs surveyed, only 13 could support meaningful use of health information technology and none met expert-derived criteria for the comprehensive HIE needed to substantially improve care quality and efficiency. The author of an opinion piece in the same issue says that “meaningful use” policies are unrealistic from a provider’s perspective. The author recommends that policy makers take a new approach that focuses on improving usability and functionality before emphasizing widespread adoption. The author of an accompanying editorial says that no matter what the obstacles, it is time to leave paper records behind and move closer to full adoption of electronic records. He writes: “Our patients increasingly demand that we operate with at least the same level of service as their banks, car rental companies, and online retailers.” According to the author, these demands are perfectly reasonable in 2011.
It’s Time to Meaningfully Use Electronic Health Records: Our Patients Are Demanding It
- 1. Richard J. Baron, MD
+ Author Affiliations1. From Greenhouse Internists, Philadelphia, PA 19119.
In this issue, Hussain (1) offers a critique of “meaningful use” incentives as being top-down and provides a list of what he believes to be erroneous assumptions that undergird the program, including limited evidence of return on investment, effect on quality, or the superiority of a comprehensive approach over an isolated functionality approach. Others (2, 3) have compiled similar lists of “fallacies” and offered cautionary notes. The core of Hussain’s proposed alternative is that a successful approach should “build on the needs of providers first.”
As one who has experienced both the pitfalls and the promise of adopting an electronic health record (EHR) in the small office setting, I must respectfully disagree with Hussain’s position. In a dysfunctional payment system, return on investment means producing more low-value services, such as visits and lengthy progress notes (4), at a time when the public and purchasing community are clamoring for higher-value services, such as e-mail communication with physicians, assurance that health care disparities are addressed and eradicated, and continuous movement to improve population health status. As a practitioner, I would genuinely like to know whether African American women get mammography at the same rate as white women in my practice. Evidence suggests that they probably do not (5), and I would like to address such a disparity if it exists. With 2 minutes’ effort, I can consult our EHR and state with confidence that the rates are the same. I could no more do that without health information technology (HIT) than I …
This 100-word excerpt has been provided in the absence of an abstract.
Are Regional Health Information Organizations in Peril?
FierceHealthIT.com, May 23, 2011, by Ken Terry — A new Harvard study published in the Annals of Internal Medicine questions whether regional health information organizations (RHIOs) will ever be able to function on their own. What’s interesting about the survey is that its data is substantially the same as that in the latest survey of the eHealth Initiative, an organization that promotes RHIOs (better known today as regional health information exchanges). Yet the eHealth Initiative sees promise where the Harvard researchers see failure.
The Harvard researchers found that only 75 of the 197 known regional HIE initiatives were up and running, with only 25 not dependent on government grants. Similarly, the eHealth Initiative notes that last year, there were 73 operational initiatives, up from 57 in 2009, and 18 of the operational HIEs were financially independent.
The slow progress is viewed by the Harvard researchers as evidence that the regional HIEs were having trouble becoming self-sustaining.
May 23, 2011
A recent publication in the Annals of Internal Medicine has gotten quite a bit of attention in Health IT related media:
- Few RHIOs Meet Basic Criteria for Meaningful Use, Researchers Find
- Only 13 RHIOs Meet Meaningful Use Criteria
- Few docs, hospitals exchanging patient information
A quick summary of the reporting tells me that few if any actually read the report, since most only reported data available in the abstract. I won’t bother repeating the abstract, simply read it for yourself.
Age of the data? The Survey data was gathered between December 2009 and March of 2010. Where are we now? May of 2011. This study is based on data more than a year old.
On RHIO criteria for Meaningful Use, which is alluded in many of the article titles: There isn’t any, at least in the Meaningful Use Standards and Certification Rule or in the Incentives Rule. That’s right. There is NO criteria specified for what an HIE / RHIO must do under any of these rules. Nor are there any incentives being given to RHIOs/HIEs by CMS. Yes, there were public funds made available by ONC, about 1/2 a billion dollars. The study clearly acknowledges this, even if the reporting on it does not.
The next is the spin on financial viability. Of 75 organizations, 1/3 (25 / 75 = 1/3) are financially viable, and another 20 expect to be so in the future. Of startups with a product for sale in a specific sector, 1/3 are financially viable? That sounds like positive news to me, not negative — where do I invest?
Of new startups in a sector, over 40% (75 / 179) have a product in the market in the Health IT sector? That also sounds positive to me.
In that group of new startups, around 17% (13 / 75) meet the current market need (Meaningful Use)? Also positive, even if none meet the Comprehensive criteria that their expert panel put together. New markets rarely produce the “perfect” product in early years.
Some other factoids: The number of RHIOs continues to increase over time when compared to similar studies by the authors in mid 2008 and early 2007. The rate of increase seems to be slowing somewhat, but the number of RHIOs now defunct has been shrinking over that same time period. It is now less than half of its 2007 numbers. There are a couple of confounding factors that could influence the observed rate of growth, including the effect of ONC State HIE grants and Meaningful Use regulation on the industry, but the study doesn’t address that these.
What were the biggest challenges for RHIOs according to the study? In the core set, reporting quality measures, supported by slightly less than a quarter of the operational RHIOs. In the menu set, reporting to public health (immunizations, syndromic surveillance, and electronic laboratory reporting) as an aggregate was the weakest. A quarter of operational RHIOs were able to support that. A critical observation that I would make here is that public health needs to get more engaged with RHIO initiatives.
The strengths? Exchange of summary patient data (core) and laboratory reporting (menu-set) was supported by more than half of the operational RHIOs.
The authors’ conclusion? These findings call into question whether RHIOs in their current form can be self-sustaining and effective in helping U.S. physicians and hospitals engage in robust HIE to improve the quality and efficiency of care.
Yes, it does “call the question”, but the study doesn’t answer it, and it wasn’t designed to do so. Compare these findings to that of any other nascent industry that started in the last century. I think you’ll find that we are in better shape than some, and worse than others. The authors would be advised to compare this new industry with others. This is my biggest issue with the study. I didn’t find it badly done as other studies on Health IT were, just under-analyzed and very poorly reported.
If we want to understand how well RHIOs are doing, we should compare them to other new businesses that have been “invented” or even “re-invented” in the past few decades. One example would be alternative fuels or electric/hybrid cars — both recipients of government incentives. We could compare this initiative to the failure of similar initiatives in the past (see this article on CHINs from 1994), or to others being done internationally (e.g., Canada Health Infoway, or the NHS program). I’m sure others can find similar examples. Doing so would provide some analysis about how we are fairing compared to other industries and initiatives. It also might set some realistic expectations about how soon we can expect results and what those results might look like.
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