hit and positive aging
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Health Information Technology and Positive Aging
Agenda
• Public Policy Issues• State of Technology in Aging Services• Telehealth Overview• The VA and Telehealth• HIMSS Telemedicine Survey• Aging Technology Ethical Issues• Continua Health Alliance• Reflections
Public Policy Overview
• 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.
Public Policy Overview
• 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 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 March 2008
• Vision: Using Integrated Information Technology Systems to Support and Enhance the Health, Safety, and Social Connectedness of Older People Living in Their Own Homes– Center for Aging Services Technologies
(CAST)
Three Types of Technologies
• Health and Wellness Technologies
• Safety Technologies
• Social Connectedness Technologies
Types of Technologies
• Health and Wellness Technologies– Telemedicine– Robots– Medication Adherence Devices
Home Telehealth Technologies
Hb_demo.exe
Recommended Links: Health and Wellness Technologies
• Health Hero Network https://www.healthhero.com/
• Gecko Systems http://www.geckosystems.com/
• ZumeLife http://www.zumelife.com/index.php
Polycom Healthcare Delivery
Solutions for all Healthcare Environments
Clinicians
PatientsHealthcare
Admin Education
PrivateNetworks
National Networks
HDX 4000 HDX 8000HDX Telehealth Cart
Mobile Responder
Polycom Ultimate High Definition
• Provides most life like experience possible • Comprehensive, free flowing conversations with
HD Video and Audio • Sharing of medical content and images in HD
provides high resolution image’s (MRI, CT Scans…etc)
• Read body language clearly; don’t miss subtle details
• View skin tones, color and depth perception with clarity
Polycom Healthcare Delivery Technology
Polycom provides full integration of video, voice, multimedia content, bridging, recording/archiving/streaming, and support.
• 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, Dermascopes…
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
Types of Technologies
• Safety Technologies– Remote Monitoring– Embedded Microchips for Alzheimer’s
Patients – Smart Homes http://
www.harris.cise.ufl.edu/gt.htm
Recommended Links: Safety Technologies
• Quiet Care http://www.quietcare.com/
• VeriChip Corporation http://www.verichipcorp.com/
• Smart House http://www.harris.cise.ufl.edu/gt.htm
Types of Technologies
• Social Connectedness Technologies– Wii http://us.wii.com/– Virtual Communities– Brain Fitness– Simple Cell Phone
Recommended Links: Social Connectedness Technologies
• Wii http://us.wii.com/
• Life Raft Group http://www.liferaftgroup.org/about.html
• Brain Fitness http://www.positscience.com/
• Jitterbug Cell Phone http://www.jitterbug.com/Home.aspx
High Technology for Low Vision
• Customizing a computer (LowBrowse)
• Cellphone with camera and feedback (KnfbReader Mobile)
• GPS system (Trekker Breeze)
• Mini magnifiers
• Prosthetic contacts
State of Technology in Aging Services March 2008
• Barriers to Implementation– Negative Experience and Misconceptions– Lack of Consensus on Value– Lack of Financial Incentives– Inadequate Infrastructures
State of Technology in Aging Services March 2008
• Recommended Actions– 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
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– Use MD services in underserved areas– Allow patients to spend less time in waiting
rooms
Telehealth Leadership Initiative
• The use of advanced telecommunications technologies to exchange health information and provide health care services across geographic, time, social, and cultural barriers:– Telephone, radio, other voice modalities; – Picture phones, teleconferencing; – Fax, Emails; – Computers for data/imaging; – Interactive video; and, – Virtual reality, tele-robotics.
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; and, – Tele-education / Continuing Education.
Agency for Healthcare Research and Quality: Telehealth
• Telehealth can improve patient safety and quality of care.
• Implementing telehealth is not easy.
• Guidelines for reimbursement of telehealth are necessary for sustainability.
• AHRQ-funded grantees say technical support must be available around the clock to ensure patient safety.
Agency for Healthcare Research and Quality: Telehealth
• Telehealth systems should be integrated with electronic health record (EHR) systems to promote continuity of care across clinical settings.
• Telehealth systems can support the provision of team-based care.
• The AHRQ-funded laboratory of telehealth projects is producing valuable, informative lessons for the Nation.
New Ways of Transforming Home Care
• Three Imperatives– Provide patients with feedback systems – Create models where population-based care
is practiced and rewarded financially. – Move care out of institution-owned physical
spaces.
New Ways of Transforming Home Care
• The re-conceptualization of home care telehealth can be done through the use of technology to improve:– Clinical decision-making– Patient self-monitoring– Both can be done through the collection of
data through remote monitoring
New Ways of Transforming Home Care
• Benefits of Remote Monitoring– Permits continuous rather than episodic
measurement– Measures symptoms in the environment in
which they occur– Permits individualization of the disease
process since what is normal is individual (e.g. blood pressure)
New Ways of Transforming Home Care
• Home Telehealth Technologies– Personal Emergency Response System
(PERS)– Monitored medication technology– Medical device monitoring– Therapy tele-management
Harry Wang, Director, Digital Health Research, Parks Associates
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
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
Home Telehealth Technologies
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
HIMSS Vantage Point (September 2008)
• Time Towards Widespread Telemedicine Adoption– 4+ Years or More
• Barriers to Telemedicine Adoption– Lack of Reimbursement
• Telemedicine Benefits– Improved Access to Care
• Cost Impacts Of Telemedicine– Home Management of Chronic Diseases
Aging Technology Ethical Issues (Janice M. Blanchard)
• Privacy of Information
• Privacy of Person/Place
• Informed Consent
• Equity of Access
Aging Technology Ethical Issues (Janice M. Blanchard)
• Autonomy Versus Dependence
• Paternalism
• Patient and Provider Relationship
• “Medical-ization” of Home
Continua Health
• Formed in 2006 by a group of major companies from areas such as healthcare, information technology, medical devices and wireless
• Create a system of standards to allow homecare devices to function together seamlessly
• By 2008 you should see products available with the Continua Health Alliance symbol and certification
HIT and Positive Aging Reflections
Reflections
• Keep Seniors at Home for as Long as Possible
• Telehealth/Telemedicine has Been Around for Years: Has It’s Time Finally Come?
• Telehealth Can Improve Patient Safety and Quality of Care
• Continua as a “Good Housekeeping” Seal of Approval
Reflections
• Medicare Reimbursement is Critical, But is it Likely in Near Term?
• Incredible Array of Devices from Wide Range of Vendors
• Senior Resistance to Invasion of Privacy and “Medicalization” of the Home
• VA as a Model for Telehealth Use
Reflections
• Incorporate Older Adults in Product Design
• Leadership Roles Taken By Google and Microsoft
• Telehealth systems should be integrated with electronic health record (EHR) systems to promote continuity of care across clinical settings
Recommended Links
• Center for Aging Services Technologies http://www.agingtech.org/index.aspx
• Telemedicine Buyers Guide http://www.atmeda.org/news/buyersguide.htm
• Medgadget: Journal of Emerging Technologies http://www.medgadget.com/archives/
geriatrics/