Maryland Registry Links AEDs to Emergency Responders

In 2008, when NBC journalist and Meet the Press moderator Tim Russert died as a result of cardiac arrest inside an NBC office, questions emerged about the location and use of an automated external defibrillator (AED). The office building had an AED inside; however, it is unknown how soon after the collapse it was retrieved.

When defibrillation is provided within 5 to 7 minutes of cardiac arrest, the survival rate is 30 to 45 percent, according to the American Heart Association. A victim’s chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation.

Instances like Russert’s have prompted private organizations and state agencies to provide support to individuals and businesses that choose to purchase and maintain AEDs.

“The Achilles’ heel of these devices is that people buy the devices and they may not follow up on maintenance,” said Elliot Fisch, president and CEO of Atrus, which specializes in information technology and public access defibrillation. “They set it, and they forget it. An AED doesn’t do anyone any good if no one knows where it is in the time needed.”

The state of Maryland is working with Atrus to launch an AED registry on Sept. 1. The registry will generate email reminders for users to check the device to ensure it is functioning properly. Registered users will also receive prompts to replace electrode pads and batteries that are nearing their expiration date. Additionally, the state will use Atrus’ software AED Link, which will provide registered AED information to 911 dispatchers so they can guide a caller to the nearest device in the event of an emergency.

“We want to work with these good citizens so they can use AEDs successfully,” said Dr. Robert R. Bass, Executive Director of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). “We want to partner with you. We want to know where you are. And we want to pass this info on to the local folks so they know where the AED is.”

There are 4,165 active AED program sites in the state. Prior to the new system, each of these sites would receive a maintenance reminder by mail every few years. The database was limited, however, and communication was not automated.

Today, when individuals obtain an AED, they notify MIEMSS and fill out a registration form. In Maryland, someone at each program site is designated responsible for AED maintenance, and receives the email reminders. MIEMSS will also make registration information available to local jurisdictions. In a couple of years, the registrant will receive a reminder to re-register.

The registry is free to users. Should a business or an individual choose to purchase an AED, it is a state mandate to register the device; however, the operator does not have to make the AED available to another facility in the event of an emergency. If the owner makes the device available to others, Maryland’s 911 dispatchers will receive location data in real-time, thus enabling dispatchers to communicate AED location information to callers reporting potential cardiac arrest incidents.

Another benefit to Maryland is that registration information is automatically uploaded to the National AED Registry, created and managed by Atrus.

“Even if we don’t look at the issue of improved health outcomes, simply from the standpoint of agency workload, this is a great labor saver,” Bass said. “This will streamline a process and get more reminders out. It improves the accuracy and efficiency of the registration process. And we’re going to look for cases in which this registry is facilitating access to these AEDs. So, we’ll be able to measure the health outcomes of this investment.”

Controlled areas, such as Las Vegas casinos, report a survival rate of 70 percent from sudden cardiac arrest by making AEDs available and retrieving them in a timely manner. Chicago O’Hare Airport reports a survival rate of more than 60 percent. The national average for survival is about 5 percent. Maryland is taking a proactive step towards increasing its survival rates by adopting a system that encourages people to register and maintain devices.

“We don’t fine them if they do not re-register,” Bass said. “It’s not a driver’s license. But it’s something that we encourage them to do. It’s really to create a system where these AEDs are able to be used if they need to be.”

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California’s Gregory Franklin to Retire from State Service

Gregory Franklin

Gregory Franklin, California’s assistant secretary of health information technology, will retire from state service in September. Jessica Mulholland

Gregory Franklin, the assistant secretary of health information technology in the California Technology Agency, will be retiring from state service in September.

Franklin has served in the California Technology Agency since June 2011, providing oversight in California’s health IT infrastructure.

Prior to the CTA, Franklin worked as the deputy director of health care operations for the California Department of Health Care Services from October 2009 to June 2011, in which he directed Medi-Cal program administration. He also worked as assistant executive officer in CalPERS from February 2007 to October 2009 as the executive of health care services purchases.

His first high-profile state government position was as the deputy director of health information and strategic planning in the California Department of Public Health from June 2002 to February 2007.

Franklin has long served as the senior health administrator for the United States Air Force Reserves, from January 1996 to the present day, where he ensures medical services for 3000 military personnel.

In 2012, Franklin told Government Technology that when California entered discussions on health-care reform in 2007, an electronic health records system also was being developed in the military, giving him valuable experience — even if the approach is different because of the setting.

“From purchasing health care to IT to project management, all of the political and administrative pieces are pretty much the same in the reserves, but [they’re] at a Department of Defense and federal level,” Franklin said. “A lot of the training and necessary skill sets that you need to be successful in both environments are the same.”

The majority of this story was originally published by Photo of Gregory Franklin by Jessica Mulholland.

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Making Obamacare Work: California’s Encouraging Start

June 14, 2013 By Robert K. Ross, president and CEO, California Endowment

Put aside, for just a few minutes, whatever political rhetoric has infiltrated your airspace about the federal Affordable Care Act (ACA). Whatever you think of the health-reform law, it’s coming, and with the clock ticking toward an Oct. 13, 2013, pre-enrollment deadline, some of the most important work for implementing “Obamacare” is going on now in the states.

As a member of the California Health Benefit Exchange Board, I’ve had a front-row seat for our state’s efforts, and we’re off to an encouraging start with our state exchange, branded as Covered California.

These state-level health benefit exchanges are the central, essential structural element of the ACA — an effort to create a competitive, transparent health insurance marketplace for individual consumers in which price and quality for comparable products drive the purchase of those products. As of this writing, more than half of the states have opted to pass up on creating their own health exchanges, deferring their operation to the federal government. In my view, every state that relegates this decision to Washington reduces our chances of finding innovative solutions to controlling costs while improving health.

That’s certainly what we’ve been trying to do in California. Our five-member health-exchange board adopted the ACA’s mission of expanding health-insurance coverage, improving health-care quality, improving choice and value, and controlling rising costs. We’ve known from the start that the keys to our success would be contracting with affordable health plans, embarking on an effective outreach and marketing strategy, and executing a smooth, user-friendly enrollment process.

We issued a request for proposals statewide, inviting health plans to compete in one or more of 18 geographic regions across our sizable state. Thirty-three health plans responded. In an evaluation process driven by price, value, quality and provider-network adequacy, we selected 13 health plans to be on the selection panel for Covered California consumers. Moreover, four of the health plans were newcomers to the individual health-insurance market, one that suffers in choice and affordability compared to plans based on large- and small-group rates.

The most encouraging news: the rates we were able to negotiate. The prices that came in were far lower than the most dire, doomsday predictions, and even lower than actuarial and Government Accountability Office projections. In the most populous California regions, our 2014 individual market rates will be equal to or cheaper than 2013 small-group rates.

So we now have health-plan partners and provider networks that are ready, willing and able to provide a reasonably affordable product, and in a new, online, transparent marketplace for consumers. But with that Oct. 13 deadline approaching and the Jan. 1, 2014, open-enrollment and coverage start date not far behind, we still have much wood to chop. Over the next few years, we need to find and enroll as many as 5 million uninsured Californians who stand to benefit from Obamacare.

Our outreach and enrollment will be both “high tech” and “high-touch.” Some Californians will choose the technology-friendly online shopping and enrollment route. Others will need more human, hands-on assistance to enroll. We are building infrastructure and readying ourselves for either approach.

This story was originally published by Image courtesy of Shutterstock.

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Enhancing the Tablet Experience in Federal Government

Tablets have become a key component of operational reform at the federal level, enabling increased productivity for field workers, reduced facilities costs and greater flexibility in service delivery, among other benefits. However, there is even more untapped potential when it comes to adopting tablets in the federal space. Tablets are highly functional and versatile devices by themselves, but outfitting a tablet with an appropriate peripheral device, like a keyboard, can improve its performance significantly. This Center for Digital Government issue brief describes how peripheral keyboards can bring added functionality to tablet operations at minimal extra cost, helping federal government users operate more efficiently and productively than ever before.

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Oregon Treadmill Desks Gaining Traction

In April, Oregon state legislators were pursuing a bill that could someday bring treadmill desks to state offices. If passed, the bill would initiate a two-year pilot program to test the “walking workstations,” determine their cost and effectiveness, and define the parameters of a potential larger-scale deployment within state agencies.

The bill, introduced by Rep. Jim Thompson, is expected to pass, according Legislative Director Jim Williams — and the idea is already attracting attention out of state.

Oregon was one of the first states to opt for a quasi-governmental state-based health insurance exchange following President Obama’s Affordable Healthcare Act. This bill by Rep. Thompson, Williams said, should be a no-brainer given the state’s dedication to public health, and the sedentary nature of the typical office environment.

The bill is currently in committee waiting on funding, Williams said, adding that he feels the votes will come in. “That’s not really an issue,” he said, adding that it’s time to stop talking about improving delivery of medicine and delivering health. “Let’s go ahead and do something about it… If we have a goal of losing weight and obesity is one the leading causes of medical problems, why shouldn’t we do everything that we can to go ahead and reduce obesity?”

When passed, Williams said, this bill will create a more productive workforce and lower the cost of medical care in the state. “We’re going to lower the cost of medicine,” he said.

Employees would not be forced to walk on a treadmill all day like a hamster, Williams said, but allowing employees the option of having a desk where they can alternate between walking and sitting — or putting a few treadmill desks in common areas — could lead to a healthier, happier workforce.

At the non-profit Association of Washington Cities, CEO Mike McCarty has been using a treadmill desk for the past three months to help fight the degenerative effects of type 2 diabetes.

“It’s a way to stay in motion while you’re working,” he said. “I find that I can do emails for a couple hours walking at two and half miles per hour, and not really break a sweat. It’s quiet, and it allows you to stay in motion while you’re being productive work-wise — maybe even more productive than you probably would be sitting at a desk.”

Using the treadmill desk over the past few months, McCarty said he’s lost five pounds — and not sitting all day helps him manage his blood sugar, which can be a serious issue for diabetics.

“That’s really what my expectation was, that it affords me a better quality of life and the ability to control my blood sugar a little bit better — and hopefully I’ll live longer as well,” he said. “I am an advocate of these things.”

If money and space were no object, he said, he would at the very least start putting the machines in common areas so people who wanted to break up their day could walk while making phone calls or answering emails for a few minutes.

“I’m not sure we’re there culturally yet,” he said, noting that the price of some treadmill desks is comparable to the price of the stand-up desks offered to some employees in their offices.

If the bill in Oregon passes, the Washington state Department of Labor and Industries (DOLI) may try to piggyback on the pilot study, said Doug Spohn, wellness manager for the agency. “We have a pretty comprehensive employee wellness program, so we’re looking at ways to get people to overcome the sitting all day thing.”

The DOLI is like a state government insurance agency, Spohn explained. “The mission of our state agency is to keep Washington state employees safe and at work. Because the nature of our business is insurance claims and trying to prevent insurance claims, we tend to be very conservative as far as risk aversion.”

This climate has made some in his agency hesitant to get people standing up and moving while they work, for fear they could hurt themselves, Spohn said, but he’s confident these machines would be a natural progression to his agency’s Wellness 360° program.

Wellness 360° is the agency’s program intended to provide a holistic approach to employee health, from physical factors in the work environment down to stress-management and the impact of various management techniques.

“I’ve been working about a year on this particular larger-scale effort where we would use these treadmills, and I’ve gotten green lights all across the board so far,” he said. “But when the rubber meets the road, we’ll see what happens.”

Though there are no official plans in place to use treadmill desks in Washington, Spohn said that if Oregon passes their bill, he would love to be part of the effort.

Photo: Dr. James Levine keeps a 1-mph pace on his treadmill while checking his e-mail in Rochester, Minn. AP/Jim Mone

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