Telehealth Monitor

Doctors, hospitals, drug makers and insurance companies will join President Obama on Monday in announcing their commitment to a sharp reduction in the growth of national health spending, White House officials said Sunday.

The officials said the plan could save $2,500 a year for a family of four in the fifth year and a total of $2 trillion for the nation over 10 years. That could make it less expensive for Congress to enact comprehensive health insurance coverage, a daunting challenge facing the Obama administration.

via Health Care Industry Is Said to Commit to Holding Down Costs – NYTimes.com.

Health and Human Services Secretary Kathleen Sebelius told members of the House Ways and Means Committee Wednesday that health reform is not contingent merely upon health IT adoption, but on health IT interoperability. 

In her first appearance before a Congressional committee,  Sebelius fielded questions on health reform legislation now brewing in Congress.

She told the panel that, “just shifting our paperwork to computers wont work, unless we make it so they can talk to each other.” She also expressed concern over including adequate privacy for interoperable data.

via Sebelius: Interoperability is imperative | Healthcare IT News.

A 15-centimeter wireless sensor, recently approved by the FDA, holds the promise of reducing hospitalizations by allowing automated early detection of heart failure. The noninvasive device, which costs a few hundred dollars and adheres to a patient’s chest, monitors indicators of heart health–including heart and respiration rates, levels of patient activity, and even the accumulation of body fluid–as patients go about their daily lives.

Part of a technology platform now being marketed by Corventis, a startup in San Jose, CA, the waterproof sensor beams data to a special cell-phone-like gadget in the patient’s pocket or home. From there, the data is wirelessly transmitted to the company’s servers. Algorithms detect anomalies and transmit data to physicians via the Web or a mobile device, drawing attention to patients who need immediate care.

“We can transmit data from a patient to servers that can process the data–all without the patient knowing about it–24-7,” says Ed Manicka, the company’s president. “Your patient could be in Singapore, could be in Brussels, or could be across the room from you. And you can look at data from a website, or from an iPhone. Our system allows the computer to watch a patient all the time, not requiring the physician to continually look at data and act on it.”

via Technology Review: Remote Monitoring of the Heart.

Cambridge Consultants has today unveiled technology to connect patients and their treatment devices, such as inhalers, with healthcare support professionals and a range of online applications.  This ‘connected patient’ technology can allow healthcare specialists to monitor medication adherence, reduce long-term treatment costs, and improve patient access to, and interaction with, healthcare providers.  Cambridge Consultants is displaying a Vena-enabled demonstration, implementing the standards selected by the Continua Health Alliance device, at the Respiratory Drug Delivery Europe 2009 (RDD Europe) conference in Lisbon on 19-22 May 2009. 

“The idea behind the ‘connected patient’ is to enable seamless data transfer using wireless technologies, from patient monitoring or treatment devices to a patient’s healthcare network – a physician’s office or online medical support applications, for example – to encourage patients to follow their planned treatment regime,” said David Blakey, Head of Drug Delivery at Cambridge Consultants.  “Using connected medical devices to close the loop between a patient and their healthcare provider can facilitate increased compliance, enable better therapy results, and may ultimately reduce long-term treatment costs.” 

To illustrate its connected patient concept, Cambridge Consultants is demonstrating an inhaler concept for improving compliance at RDD (Europe).  Enabled by the company’s Vena wireless healthcare device platform, the system connects through a personal computer or smart phone to an online personal healthcare application, and can remind the patient to take their treatment and send compliance information to the relevant personal healthcare portal.  Both patient and healthcare specialist can access the secure information to monitor progress and connect with one another. 

Non-patient-specific data from a population of users can also be aggregated to provide medical researchers, insurance providers and even policy makers with information to better evaluate a therapy’s efficacy, improve patient outcomes and lower costs.   Pharmaceutical companies with new therapies in Phase IV trials can directly access usage data to demonstrate and document compliance, correlating ongoing use with improved outcomes. 

via Cambridge Wireless – News article.

The impact of the economic downturn and the ever-growing cost burdens the healthcare industry have taken on, has had somewhat of a positive effect on driving opportunities for the use of wireless technologies within the healthcare industry forward. By investing in telehealth opportunities, a new positive pro-active approach, offers potential cost and time saving benefits when monitoring patients who are suffering from chronic diseases and/or ageing independently.

A number of medical device and mobile handset manufacturers are beginning to invest in telehealth and associated services, which could provide the support that is needed to drive these cost saving initiatives. Even Apple’s iPhone is jumping on the healthcare bandwagon, by introducing a new revolutionary application which enables the user to monitor their blood pressure and glucose levels. Thus, with the support from a number of smart phone manufacturers, which are already Bluetooth enabled, it, seems inevitable that Bluetooth will become dominant in yet another industry.

However, alternative technologies being considered by the Continua Health Alliance are beginning to make headway within this market; Home health hub manufacturer AT&T have invested in Zigbee’s healthcare device application profile and ANT technologies are being used in a number of supporting heart rate monitors and mobile phone applications. With this in mind, Bluetooth technology may not have an easy ride as it first thought.

via MobileTechNews – Healthy Growth for Wireless Patient Monitoring.

ExpressMD(TM) Solutions, a joint venture formed by Authentidate Holding Corp. (Nasdaq: ADAT) and EncounterCare Solutions, Inc. (Pink Sheets: ECSL) to provide remote patient monitoring telehealth systems and services that improve care for patients with chronic conditions announced today that its remote patient health monitoring system has received 510(k) market clearance from the U.S. Food and Drug Administration (FDA). ExpressMD(TM) plans to initiate manufacturing and sales of its Electronic House Call(TM) monitoring devices and services immediately.

The Electronic House Call System will be used by healthcare professionals who manage patients with chronic conditions, such as heart disease, COPD (Chronic Obstructive Pulmonary Disease) and diabetes. Patients are able to use the monitoring devices located in their home to measure their vital signs and to motivate them through education and reminders. The Electronic House Call monitor securely transmits this information to its data center making it conveniently available to each licensed care provider via a secure website. By remotely receiving patient data daily, licensed care providers can adjust treatment accordingly and provide an enhanced level of care.

Information collected and transmitted by the Electronic House Call remote monitoring system can include answers to questions about a patient’s health, certain vital signs collected by the system’s connected peripheral devices, including a patient’s weight, temperature, pulse and blood pressure, and other specific patient data such as blood glucose levels. The data is collected wirelessly and transmitted using several methods of transmission including cell phone technology. Data collected by the system’s peripherals is automatically entered into the system and does not require patients to enter the data manually. The physician can easily modify all aspects of the patient’s care plan program including the frequency of sessions to collect vital signs and other information. Additionally, the physician can modify and sign the care plan remotely thereby providing better patient care and reducing administrative costs using the integrated Inscrybe(TM) Healthcare software from Authentidate(R).

Ronald Mills, Managing Director at ExpressMD Solutions stated: “Now that we have received FDA approval for the ExpressMD telehealth solution, Electronic House Call, we can move forward with the next phase of our sales and marketing strategy, and selling systems into the market. Part of this effort will be supported through a non-exclusive distribution agreement already in place with Cyntrist, which covers the Southeastern U.S. region. We believe that remote patient monitoring has the power to effectively change the landscape of the patient care model by lowering costs and improving patient care. We anticipate that the benefits of the Electronic House Call System will quickly be recognized by patients, patient’s families, physicians and insurance carriers that take advantage of this robust and exciting telehealth monitoring capability.”

About ExpressMD(TM) Solutions

ExpressMD(TM) Solutions is a joint venture formed by Authentidate Holding Corp. (Nasdaq: ADAT) and EncounterCare Solutions, Inc. (Pink Sheets: ECSL). ExpressMD combines EncounterCare’s Electronic House Call(TM) patient vital signs monitoring system and specially designed web-based management and monitoring software, and Authentidate’s Inscrybe Health Management Software. This joint venture will provide in-home patient vital signs monitoring systems and services to improve care for patients with chronic illnesses and reduce cost of care by delivering results to their healthcare providers securely via the Internet. The ExpressMD solution is designed to aid wellness and foster preventative care, and deliver better continuity of care to specific patient segments such as the elderly, special needs or pediatric patients with chronic illnesses who require regular monitoring of serious medical conditions.

For more information about ExpressMD Solutions, visit www.expressmdsolutions.com.

About Authentidate Holding Corp.

Authentidate Holding Corp. (Nasdaq: ADAT) is a worldwide provider of secure Health Information Exchange and workflow management services. The company’s software and web-based services enable healthcare organizations and other enterprises to increase revenues, improve productivity and reduce costs by eliminating paper and manual work steps from clinical, administrative and other processes and enhancing compliance with regulatory requirements. The web-based services are delivered as Software as a Service (SaaS) to customers. These solutions incorporate rules-based electronic forms, intelligent routing, transaction management, electronic signatures, identity credentialing, content authentication and automated audit trails. Both web and fax based communications are integrated into automated and trusted workflow solutions. The company has offices in the United States and Germany. In the United States, Authentidate offers its patent pending content authentication technology in the form of the United States Postal Service(R) Electronic Postmark(R) (EPM).

For more information, visit the company’s website at www.authentidate.com.

About EncounterCare Solutions, Inc.

EncounterCare Solutions, Inc. (Pink Sheets: ECSL), headquartered in Palm Beach Gardens, Florida is an integrated healthcare company that operates its business through two divisions, the Healthcare Technology Division and the Healthcare Services Division. EncounterCare’s operating businesses offer a broad range of proprietary healthcare technology, products and services that address several substantial target markets, including: the Healthcare Information Technology market, the Healthcare Telemedicine market and the Homecare market.

For more information, visit www.encountercare.com.

via ExpressMD(TM) Solutions’ Remote Patient Health Monitoring Device Receives 510(K) Market Clearance Approval From FDA .

St Jude Medical, Inc. (NYSE:STJ) has received European CE Mark approval of its Merlin.net Patient Care Network (PCN). Merlin.net PCN is a secure, Internet-based remote care system that gathers and stores data from the implant procedure, a clinic follow-up visit or from remote follow-up transmissions of patients with implanted cardiac devices.

The system includes a range of features designed to improve clinic efficiency and to enhance patient care by giving physicians better and more immediate access to information. With its open architecture and standards-based interface, Merlin.net PCN can be fully integrated with all standard electronic health record (EHR) systems in hospital or clinic settings.

Until recently, the only way for physicians to check on their patients’ devices was for a patient to come to their clinic in person. Now, information from a patient’s implanted device can be transmitted remotely from the comfort of a patient’s home. St Jude Medical patients with compatible devices can use the Merlin@home transmitter to send data directly from their devices to Merlin.net PCN. Physicians can even use Merlin.net PCN to schedule the remote follow-up to take place at night, while the patient is sleeping.

Remote monitoring provides daily checks on the patient’s device. If the check reveals an event that may require timely intervention, an alert will be posted on Merlin.net PCN and transmitted to the physician via email, fax or SMS text. Merlin.net PCN offers a set of flexible tools that allow the physician to choose when, where and how alerts are communicated during off-clinic hours, including the transfer of alerts to after hours support services.

via MTB Europe – St Jude Medical gains EU approval for remote care system for implantable cardiac devices.

Tunstall’s RTX3371 Wireless Telehealth Monitor follows the trend of many of the telemedicine solutions we saw on display at the American Telemedicine Association event earlier this week: 2G radios. If a device is simply transmitting biometric data into the cloud en route to online portals for physicians and other caregivers, who needs high-speed 3G networks? Most telemedicine companies seem to agree.

Tunstall’s monitoring hub, which runs over GPRS data networks, wirelessly connects to compatible peripheral medical devices like Bluetooth weight scales and blood pressure monitors and then transmits the data to caregivers over the cellular network. The FDA just greenlit the device so Tunstall can now market in the U.S. Interestingly, the hub is also outfitted with voice technology so doctors can call patients via the hub to do a quick check-up over the phone. 

via Seems 2G is enough for telehealth hubs | mobihealthnews.

Tunstall Healthcare has announced the launch of its RTX3371 telehealth monitor – an interactive telehealth device with in-built GSM/GPRS mobile phone technology that collects vital signs wirelessly from a range of external devices such as weight scales and blood pressure cuffs.

The launch further expands Tunstall Healthcare’s range of telehealth products and solutions available to healthcare organizations and providers in USA, which have been designed to effectively monitor patients with chronic diseases in the home.

In addition, the RTX3371 telehealth monitor’s spoken voice functionality allows it to collect subjective patient information from patient questionnaires, and to automatically transmit the data to a clinical backend software application based on an open architecture interface.

According to Anthony Taroni, Director of Sales at Tunstall: “The availability of GSM/GPRS cellular coverage in the USA and the rapid increase in the number of people replacing regular phone lines with wireless and mobile phones has set new standards for home hubs and the way they provide connectivity in order to ensure effective telehealth delivery”. Anthony Taroni continues: “With the introduction of the RTX3371 GSM/GPRS-enabled telehealth monitor, Tunstall Healthcare has taken an important step forward in meeting today’s and tomorrow’s demand. This truly wireless device offers service users the freedom to place the device anywhere in the home independent of phone plugs, increasing user satisfaction and acceptance.”

Tunstall Healthcare supplies healthcare organizations and providers with telehealth products, solutions and know-how based on a flexible business model. In addition to the telehealth monitors, Tunstall can deliver complete turnkey kits including vital sign monitors.

Tunstall also offers flexible clinical triage software applications designed to simplify the clinical workflow for healthcare organizations performing remote monitoring of patients with chronic diseases. The clinical triage applications effectively allow nurses or physicians to analyze trending data, manage patient care plans, and create reports and exchange data with clinical information systems.

About Tunstall

Tunstall Healthcare Group is the market leading provider of telehealthcare solutions, with over 2.5 million users globally. Tunstall’s solutions support older people and those with long-term needs, to live independently, by effectively managing their health and well-being. Tunstall provides technology, expertise and advice to millions of people enabling them to lead independent more fulfilling lives. For more information on how telehealthcare can improve quality of life, visit http://www.tunstallhealth.com

via Tunstall Healthcare A/S :: Tunstall Receives FDA 510(k) Clearance to Market Wireless Telehealth Monitor With Built-in GSM/GPRS Mobile Phone Technology in USA.

The Sixth Annual Healthcare Unbound Conference & Exhibition, organized by The Center for Business Innovation (TCBI), will feature the coming together of consumer and healthcare technologies to facilitate participatory medicine. The Conference will take place at the Seattle Airport Marriott in Seattle, WA on June 22-23, 2009. Attendees will include a diverse representation of the many business segments that will be impacted by these innovative technologies, including health plans and health insurance companies; healthcare providers, including hospitals, home care agencies and other postacute care facilities; chronic care management and disease management companies; long-term care facilities and retirement communities; pharmaceutical and medical device companies; healthcare IT companies; consumer technology companies; wireless companies; ehealth and social media companies; the financial community; academics; and government officials.

Healthcare Unbound Defined

Consumer and healthcare technologies are driving opportunities to serve patients in new ways and in new settings. Forrester Research coined the term “Healthcare Unbound” to encompass the trends toward technology-aided self-care, mobile care and home care, defining it as “technology in, on and around the body that frees care from formal institutions.” This rapidly evolving technology field includes sensor technology, wearable computing, home-based health monitoring solutions, and wellness and lifestyle support solutions.

About the Conference

“For the past 150 years, the U.S. healthcare system has been defined by ‘place’ — primarily doctors’ offices and hospitals. 2009 is shaping up to be a year of tremendous change for the U.S. healthcare system, and it’s clear that every day we are getting closer to achieving Healthcare Unbound. This conference attracts the technical, clinical, and business leaders who are making Healthcare Unbound a reality,” said Vince Kuraitis, JD, MBA, Principal, Better Health Technologies, LLC, a chairperson, conference advisory board member and keynote speaker.

The Conference will include over 80 speakers participating in panel discussions, case studies, workshops and keynote addresses. Sessions will include in-depth coverage of technology-enabled chronic care management and wellness promotion, impact of the economic stimulus bill on the marketplace, legal/regulatory and reimbursement issues, payer perspectives, wireless technologies, the medical home model and its technology implications, social media, ehealth and much more. The Conference will feature an Aging Services educational track that is co-sponsored by the American Association of Homes and Services for the Aging (AAHSA) and the Center for Aging Services Technologies (CAST).

Nationally Recognized Speakers Drive Discussion

Keynote speakers include high-level representatives from Aetna, American Association of Homes and Services for the Aging, Continua Health Alliance, Critical Mass Consulting, Group Health Cooperative, Humana, Inc., Office of the National Coordinator for Health IT, The Kibbe Group, The Regence Group and WellDoc, Inc.

via Sixth Annual Healthcare Unbound Conference to Focus on Remote Monitoring, Home Telehealth & eHealth for Chronic Care Management & Wellness Promotion .

At a certain time in our lives, we will be faced with a struggle against age and disease. We can learn to manage our diseases, we can accept the inevitability of aging. But very few of us — or our family members — will be comfortable with the fact that disease or age means leaving our homes and entering a long-term care facility.

At Winona Health (WH), there are people working to implement a program that will allow patients to remain in their homes for much longer than they have in the past. The program, TeleHealth, would also help to lessen the number of visits those with chronic diseases must make to the emergency department and even to the doctor’s office.

Mary Miller-Hyland, Director of Senior Services, and Pam Slocum, Director of Home Care and Hospice, are leading the project, called TeleHealth, towards implementation. Their hope is to keep patients in their homes longer and to enlarge Winona Health’s already established community based care.

TeleHealth is the beginning of Winona Health’s answer to the question that currently is front and center in the entire nation: How can we reduce health care costs? Miller-Hyland says that at WH, part of the answer is to ask more questions: How can we use technology to support our patients more comfortably and cheaper at home? How can we help our patients to manage their diseases and avoid visits to the ER?

The WH plan will begin with two types of patients suffering from chronic disease — chronic obstructive pulmonary disease (COPD) and congestive heart failure. Both diseases may make patients short of breath and easily taxed by such things as a trip to the doctor’s office to have their vital signs monitored. Home health visits can help such patients, but such visits can be costly.

via Winona Health’s TeleHealth could keep you in your home.

The Department of Homeland Security is dismantling a next-generation biological attack warning system in New York City subways because of technical problems, U.S. officials said.

Robert Hooks, a deputy assistant secretary, said the department no longer believes it is necessary to expand the pilot program, as he told Congress in July, because of resource and technology limits. Hooks said a long-planned alternative sensor system, set for initial deployment late next year, also will not be available nationwide until 2012, to allow for more testing.

The deactivation of the pilot program in late March marks a setback in U.S. efforts to detect biological weapons, and its disclosure comes as the Obama administration is unveiling new security priorities as part of its 2010 budget today.

The federal government installed air samplers in more than 30 U.S. cities in 2003 to detect the release of potential bioweapons such as anthrax spores, plague bacteria and smallpox viruses. The BioWatch program, which cost about $500 million, was meant to speed up the response before disease could spread.

via U.S. Halts Pilot Program in New York to Detect Biological Attacks – washingtonpost.com.

The head of the largest medical technology trade group in the US told Massachusetts medical device executives today he is optimistic about the prospects for healthcare reform in the first year of the Obama administration.

Stephen J. Ubl, chief executive of the Advanced Medical Technology Association, known as AdvaMed, said White House officials “have made a calculation that healthcare has more of a political payoff than energy in the short term.” They’ve also “paid a lot of attention to the Clinton reform debacle” of the early 1990s so as not to repeat the mistakes of the last Democratic administration, Ubl said.

Key components of the Obama health plan, many of them mirroring steps taken in Massachusetts, incdlue universal health coverage, subsidies to assure affordability, insurance reform, and measures to encourage prevention and better management of chronic diseases, Ubl said.

via Medical tech group optimistic on healthcare reform – Daily Business Update – The Boston Globe.

With federal stimulus programs waving a $20 billion carrot in front of health care providers, it’s a sure bet that many more hospitals and medical practices will be deploying e-medical record systems over the next several years. But many health-care organizations will likely discover that implementing these systems is one thing; keeping the technology performing to the satisfaction of clinicians is another.

E-medical record systems require doctors and nurses to make huge changes in the workflow habits involved with patient care. That in itself is a tough sell. But if systems performance problems prevent clinicians from accessing crucial patient data or ordering drugs or tests in a timely way, that can become a matter of life or death.

Performance monitoring tools that help IT staff quickly identify and diagnose application, infrastructure, and other systems performance problems before the trouble impacts users can greatly boost clinicians’ satisfaction, say health care IT leaders who have deployed e-medical records and other health IT systems.

via Monitoring Tools Can Boost E-Health Record Systems Performance — Health IT — InformationWeek.

In an effort to defuse the most explosive issue in the debate over comprehensive health care legislation, a top Senate Democrat has proposed that any new government-run insurance program comply with all the rules and standards that apply to private insurance.

The proposal was made Monday by Senator Charles E. Schumer of New York, the third-ranking member of the Senate Democratic leadership, in a bid to address fears that a public program would drive private insurers from the market.

Calls for a new public plan have provoked more political passion than any other issue in discussions of how to revamp the nation’s $2.5 trillion health care system. The Senate Finance Committee begins to wrestle with the idea at a meeting on Tuesday, where it will examine ways to expand coverage.

via Schumer Offers Middle Ground on Health Care – NYTimes.com.

Hackers last week broke into a Virginia state Web site used by pharmacists to track prescription drug abuse. They deleted records on more than 8 million patients and replaced the sites homepage with a ransom note demanding $10 million for the return of the records, according to a posting on Wikileaks.org, an online clearinghouse for leaked documents.

Wikileaks reports that the Web site for the Virginia Prescription Monitoring Program was defaced last week with a message claiming that the database of prescriptions had been bundled into an encrypted, password-protected file.

Wikileaks has published a copy of the ransom note left in place of the PMP home page, a message that claims the state of Virginia would need to pay the demand in order to gain access to a password needed to unlock those records:

“I have your [expletive] In my possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :For $10 million, I will gladly send along the password.”

via Security Fix – Hackers Break Into Virginia Health Professions Database, Demand Ransom .

As Obama administration officials look to thwart a swine flu pandemic, the influx of political and public attention coming to disease tracking could help energize the administrations health information technology priorities, several experts say.

The Bush administration responded to anthrax attacks and Severe Acute Respiratory Syndrome SARS outbreaks in 2001 and 2002 with a rush of funding for public health disease-tracking, detection and surveillance IT systems. Public health agencies also got money for communications and logistics systems. But once the immediate threats passed, development slowed.

Now, with swine flu making headlines worldwide and the White House seeking $1.5 billion in supplemental funds to fight it, some health policy experts are recommending fusing public health IT goals with the broader electronic health record agenda.

via Swine flu response elevates health IT — Federal Computer Week.

Continua Health Alliance: The Next Generation of Personal Telehealth is Here. A non-profit, open industry alliance of the finest healthcare and technology companies in the world joins together in collaboration to improve the quality of personal healthcare. The Continua Health Alliance: “Our Mission is to establish an eco-system of interoperable personal health systems that empower people & organizations to better manage their health and wellness”. 

Data mining can be the foundation for meaningful changes in the practice of medicine. Inova Health System has evidence that proves this is far more than just a hypothesis. The Falls Church, Va.-based system, which owns five hospitals, is using the information pinpointed by data mining to help devise new clinical processes. Then it’s using its electronic health records system to guide clinicians on how to follow those processes, providing rules and alerts to steer them on the right path.

The result? Serious safety events-those that cause serious harm or even death-declined by 60% from May 2005 to February 2009 at Inova’s hospitals. Hospital-acquired infections declined 60% during the same period. And the mortality rate has substantially declined.

Inova is using Web-based data mining software called Quality Manager from Premier Inc., a Charlotte, N.C.-based purchasing alliance. It’s a participant in Premier’s Quest, a quality improvement benchmarking project. The alliance recently announced that it will expand the project beyond the original 166 hospitals.

via Using Data to Change Processes.

Plenty of consultants, analysts and software vendors are urging physician group practices to begin work immediately on selecting an electronic health records system. Thats because clinics need to have a qualifying EHR system in place by the start of 2011 to qualify for maximum incentive payments under the federal economic stimulus package.

But the head of the trade association for group practice administrators is advising members to take a “wait and see” attitude before plunging into planning. And some group practice administrators want to learn far more details about the incentives before they plot a strategy.

Because so many questions about the stimulus packages details remain unanswered, clinics should wait to see all follow-up regulations before plotting a strategy, says William Jessee, M.D., president and CEO of the Medical Group Management Association., Englewood, Colo. “Its one of those deals where the devil is in the details,” he adds.

The American Recovery and Reinvestment Act of 2009 includes $17.2 billion in Medicare and Medicaid financial incentives for hospitals and doctors using qualifying electronic health records systems. Group practices must apply for either Medicare funding or Medicaid funding, not both.

via Will the EHR Incentives Work?.