Health Informatics and Aging Services

Agenda• LeadingAge and the Center for Aging

Services Technology (CAST)

• State of Technology in Aging Services

• Aging Technology Ethical Issues

• TeleHealth Overview

• Case Study: The VA and TeleHealth

• Continua Health Alliance

• Reflections

LeadingAge Imperatives

• Strengthen not-for-profit leadership• Engage consumers• Create the new financing paradigm• Lead innovation• Cultivate talented people• Pioneer technology

– Technology is potentially the single most important phenomenon that can synergize the other driving forces to assure value for all concerned

CAST FUTURECASTS

• Holistic Approach

• Simplified Coordination

• Person-Centered Service

• Hands On Case-Management

CAST FUTURECASTS

• Transparency

• Person-Centered Follow Through and Feedback

• Connectivity

• Technology Enabled Services and Supports

10 Aging Services Technologies

• Intuitive computer interfaces

• Wireless data communication networks

• Electronic health record (EHR) systems

• Electronic records sharing

• Telemedicine/Telehealth

10 Aging Services Technologies

• Behavioral/activity monitoring systems• Fall prevention/detection systems • Tracking/wander management systems • Medication adherence systems• Brain and physical fitness technologies

State of Technology in Aging Services

• Potential of Aging Services Technology– Help older adults maximize their

independence – Support the needs of professional and family

caregivers – Improve quality of care and quality of life– Reduce our nation’s health care costs– Increase aging services provider efficiency

Open Letter from Andy Grove• The average American spends $440,000

on health care in his lifetime, and $280,000 will be spent after age 65.

• 50% of that post-65 outlay goes to assisted-living facilities and nursing homes.

• Keep elderly patients in their own homes longer, without degrading quality of care a cheaper and better system.

Open Letter from Andy Grove

• Using everyday, low-cost technology - the sensors, microchips, small radios you'd find in today's PCs, in cell phones, and in Bluetooth earpieces.

• Endorsement and reimbursement by Medicare is critical

• The savings achieved by keeping just 10% of the aging population in their homes can amount to $30 billion a year.

State of Technology in Aging Services

• Barriers to Implementation– Negative Experience and Misconceptions– Privacy and Security– Usability– Provider Workflow and Interoperability– Liability– Lack of Consensus on Value– Lack of Financial Incentives

AARP Healthy@Home 2.0

• Home Safety Devices– Roughly 80% believe the devices would make

them feel safe, and be a comfort to family/friends

– Roughly 80% are concerned about the costs to install and maintain the devices

– 54% would be willing to pay $1 to $50 per month for the devices and 41% would not be willing to pay anything

AARP Healthy@Home 2.0

• Personal Health and Wellness Devices– 70% believe that devices would make them

feel safer, and benefit family but, 80% are concerned about costs to install and maintain

– 50% or more are concerned about stigma and privacy

– 51% would be willing to pay $1 to $50 per month for the devices and 42% would not be willing to pay anything

State of Technology in Aging Services

• Recommendations– Raise Awareness of Benefits– Support Research on Value Equation– Provide Investment Incentives– Develop Technology Infrastructure– Incorporate Older Adults in Design– Promote Collaboration Among Technology

Firms

Three Types of Technologies

• Health and Wellness

• Safety

• Social Connectedness

Health and Wellness Technologies

• Health Management Programs

• Robots

• Medication Adherence Devices

• HD Audio and Video

Polycom Healthcare Delivery Technology

• Lockable Drawer

• Available over Ultimate HD architecture

• Two monitor functionality with one monitor– Send images while simultaneously showing

participants

• Easy connectivity to Medical Peripheral Devices– Otoscopes, Handheld camera, Stethoscopes,

Dermascope, etc

• End to end encryption• Based on AES (the strongest possible encryption

algorithm)

• Stereo sound provides high quality audio for medical interactions HDX / VSX

Practitioner Cart

Safety Technologies

• Remote Monitoring

• Bio-Sensor Systems

• Smart Homes http://www.harris.cise.ufl.edu/gt.htm

High Technology for Low Vision

• Customizing a computer LowBrowse

• Cellphone with camera and feedback KnfbReader Mobile

• GPS system Trekker Breeze

• Mini magnifiers

• Prosthetic contacts

Social Connectedness Technologies

• Wii http://us.wii.com/– Best Wii Games for Seniors

• Brain Fitness http://www.positscience.com/

• Jitterbug Cell Phone http://www.greatcall.com/

Aging Technology Ethical Issues

• Privacy of Information

• Privacy of Person/Place

• Informed Consent

• Equity of Access

Aging Technology Ethical Issues

• Autonomy Versus Dependence

• Paternalism

• Patient and Provider Relationship

• “Medicalization” of Home

Telehealth Leadership Initiative

• What are the Different Types of Telehealth?– Tele-Dermatology – Tele-Radiology – Tele-Nursing or Ask-a-Nurse – Tele-Psychiatry – Tele-Dental – Tele-Ophthalmology– Tele-education / Continuing Education

Telehealth Leadership Initiative

• Telehealth can:– Reduce unnecessary delays in receiving Rx– Reduce or eliminate travel expenses– Reduce or eliminate the separation of families

during difficult or emotional times– Provide MD services in underserved areas– Allow patients to spend less time in waiting

rooms

Value of Remote Monitoring

• There is increasing evidence to support the value of remote monitoring for individuals with chronic conditions, including:– 35-56% reduction in mortality– 47% reduction in risk of hospitalization– 6 days reduction in length of hospital admission– 65% reduction in office visits– 40-64% reduction in physician time for checks– 63% reduction in transport costs

Agency for Healthcare Research and Quality: Telehealth

• Telehealth can improve patient safety and quality of care.

• Guidelines for reimbursement of telehealth are necessary for sustainability.

• Telehealth systems should be integrated with electronic health record (EHR) systems to promote continuity of care across clinical settings.

Medicare Payment for Telehealth

• Medicare reimbursement for telemedicine or telehealth services is divided into three areas:– Remote patient face-to-face services seen via

live video conferencing– Non face-to-face services that can be

conducted either through live video conferencing or via store and forward telecommunication services

– Home telehealth services

The VA and Telehealth

• Telehealth/Telemedicine:“The use of electronic information andcommunications technologies to provide and support health care when distance separates the participants.”

• Types of Telehealth– Synchronous: Real-time– Asynchronous: Store-and-forward

VISN 8 Sunshine Network

Synchronous TeleHealth

• Telemental health

• Telesurgery

• Telerehabilitation

• Telecardiology

Asynchronous Telehealth

• Teledermatology

• Telepathology

• Teleradiology

• Teleretinal imaging

Home Telehealth Technologies

Flexible Sensor Connectivity

Blood sugarBlood sugar

Blood pressureBlood pressure

ThermometerThermometer

StethoscopeStethoscope

ECGECG

Pulse O2Pulse O2

CameraCamera

Digital ScaleDigital Scale

VA Telehealth Outcomes: Patient Census Growth

Year Census Change

FY03 2,000 Base Year

FY04 4,430 121%

FY05 8,922 101%

FY06 21,572 142%

FY07 31,570 46%

Use Reductions

Condition # of Patients % Decrease in Utilization

Diabetes 8,954 20

Hypertension 7,447 30

CHF 4,089 25

COLD 1,963 21

Depression 337 56

Continua Health

• Continua Health Alliance was established June 6, 2006 with 22 member companies. More than 240 companies are members today.

• Mission: to establish an eco-system of interoperable personal connected health systems that empower individuals and organizations to better manage their health and wellness.

• Market segmentation: Living independently longer, wellness, and managing chronic conditions

Continua Health

• Continua member companies will select connectivity standards and publish Guidelines for strict interoperability.

• Continua is establishing a test and certification program with a recognizable logo signifying the promise of interoperability with other certified products.

• Interfaces and standards set for:– personal devices (weight scale, glucose meter, pulse

oximeter)– health records (E H R, PHR, NwHIN, HIE)

AST Research Opportunities• How aging services technologies can be

incorporated into the structure of ACOs and patient centered medical homes

• Translational research that examines the efficacy and cost-effectiveness of technology

• Demonstrate that in-home technologies preserve health, independence and dignity

• Produce practical implementation guides that providers could use to replicate tested strategies and create sustainable business models