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/