© 2010, center for technology and aging tele home care: current trends and emerging opportunities...
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© 2010, Center for Technology and Aging
Tele Home Care: Current Trends and Emerging Opportunities
David Lindeman, PhDDirector, Center for Technology and AgingCo-Director, Center for Innovation and Technology in Public HealthAging Means BusinessGerontological Society of America November 22, 2010
© 2010, Center for Technology and Aging
– VHA Community Care/ Health Technology: $1,600/pt/yr
– vs. Home-based primary care: $13,121/pt/yr,
– vs. Nursing home care: $77,745/pt/yr
– 43,430 patients enrolled
– “Systems Approach”
Age Distribution of all CCHT Patients
The Early Adopter Experience: Veterans Health Administration
© 2010, Center for Technology and Aging
Today’s Environment: Mobile, HIT, Telehealth
Technologies that address Chronic Disease and Maintain Independence
Examples from Diffusion Grants Program: Medication OptimizationRemote Patient MonitoringCare Transitions
Emerging Trends and Future Opportunities
© 2010, Center for Technology and Aging
57% of Americans age 65 and older have a cell phone
More than 80 percent of U.S. physicians will have smartphones by 2012--up from 64 percent in 2009
4.6 billion mobile subscribers end of 2009
Mobile Technologies
© 2010, Center for Technology and Aging
US putting $19 Billion into HIT Spending on HIT rapidly increasing by
201280 percent of physicians and 58 percent of non-
users plan to implement Electronic Health Record programs
72 percent of hospitals increasing HIT implementation
Health Information Technology
© 2010, Center for Technology and Aging
American Reinvestment and Recovery Act of 2009 - $7 BillionBroadband ExpansionDistance Learning and Telemedicine Expansion
e-visits and 24x7x365 nurse call centers in every state
2008: over 200 telehealth networks connecting 2000 institutions
Broadband and Telehealth
© 2010, Center for Technology and Aging
Technology Trends: Maintaining the Independence of Older Adults
– Medication Optimization– Remote Patient Monitoring– Assistive Technologies– Remote Training and
Supervision– Cognitive Fitness and
Assessment– Social Networking– mHealth TechnologiesSee the Center for Technology and Aging’s
Briefing Paper for more information at:
www.techandaging.org/briefingpaper.pdf
© 2010, Center for Technology and Aging
Medication Optimization
– Medication reconciliation, dispensing, adherence, and monitoring.
– Medication use is ubiquitous among older adults, with 90% of older adults using one or more prescription medications per week.
– New England Healthcare Institute: $290 billion in healthcare savings
Medication Optimization
© 2010, Center for Technology and Aging
– Remote collection of patient information using a device: physiological, emotional, location
– RPM benefits:•support patient self-management•early diagnosis•reduce ED and hospital services •shift responsibilities to non-clinical providers•improve care coordination•built in patient education programs•improve patient and provider satisfaction
Remote Patient Monitoring
© 2010, Center for Technology and Aging
Center for Technology and Aging: Diffusion Grants Program
• Improve efficiency of care delivery• Improve health and independence• Reduce the cost and burden of care• Improve chronic disease self-management• Improve rate of diffusion, adoption, and scaling
© 2010, Center for Technology and Aging
Veterans Administration of Central CA
– Home self-management and medication adherence– Veterans that are home-based with Congestive Heart Failure– Remotely located internists and allied health professionals– 5 central California rural and medically underserved counties – The Health Buddy® system plus weight scale, blood
pressure monitor, assessment algorithms and clinician alerts – Telehealth coupled with care coordination (RCT)
Health Buddy
MedOp Diffusion Grants Program
© 2010, Center for Technology and Aging
Connecticut Pharmacists Foundation
– Culturally and linguistically appropriate Medication Therapy Management (MTM) services
– Community health workers and remotely located pharmacists serving Cambodian-American older adults
– Long Beach, CA and Connecticut– Use of videoconferencing, Electronic Health Records, and
spoken format technology to deliver MTM services
MedOp Diffusion Grants Program
© 2010, Center for Technology and Aging
– CAHSAH - 556 members / 850 offices that are direct providers of health and supportive services and products in the home
– Use of the Intel Health Guide to monitor patients with CHF– Outcomes: Reduce hospital/ED visits; improve patient
activation, QOL & satisfaction (RCT)– Medi-Cal adoption of/reimbursement for RPM technologies
© 2010 Center for Technology and Aging
California Association Health Services at Home
RPM Diffusion Grants Program
© 2010, Center for Technology and Aging
– Collaboration with Administration on Aging (AoA) and Centers for Medicare & Medicaid Services (CMS) - $68 million
– Use of remote technologies to enable care transition models– Evidence-based programs: Coleman, Naylor, Counsell, etc.– Outcomes: Reduce avoidable hospital admissions/ED visits;
improve patient health outcomes; reduce costs– Five states through their Aging and Disability Resource Center
© 2010 Center for Technology and Aging
Technologies for Improving Post Acute Care Transitions
Tech4Impact Diffusion Grants Program
© 2010, Center for Technology and Aging
Barriers to Diffusion
– Limited experience of many providers with technology
– Poor preparation for adopting such technologies – Lack of financial models document Return on
Investment – Limited awareness by patients/clients – Provider concerns privacy– Information technology barriers lack of interoperability
– Lack of business models
Barriers to Technology Diffusion/Scaling
© 2010, Center for Technology and Aging
Emerging Technologies for Tele Home Care: Trends and Opportunities
Courtesy of Ravi Nemana
© 2010, Center for Technology and Aging
Many Inventions, Few Innovations
• Innovation = Invention + Value– Not just a new way of doing something– Need to show Value too !!
• DOING something of value (Services) is the key
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Many Inventions, Few Innovations
© 2010, Center for Technology and Aging
Services Platforms: Remote Care
• Remote, but tethered• Extension of sight & sound• All care at the device• Challenging workflow• Limited “presence”• Low knowledge mobilization• No analytics• No context sensitivity• Scaling problems
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Services Platforms: Remote Care
© 2010, Center for Technology and Aging
Service models combine monitoring, help desk, telecare and notification. A hybrid Telecare + Alarm company.
SCOTLAND: Service models combine direct delivery of care to reduce impact on institutions.
Advances in Telecare
© 2010, Center for Technology and Aging
Platforms: CellScope
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DYES
ACQUISITION & PREP
MICROSCOPE
DIAGNOSIS
CURRENT CLINICAL DIAGNOSTIC PROCESS
PATIENT#510
- BLOOD -04/09/2009
PATIENT#510
Cell Phone Screenshowing magnified
red blood cells, some infected with
malaria
Microscope Attachment
Courtesy:
Dr. Dan FletcherDavid Bresslauer
Cell PhonePatient Sample/ Slide
Services: distributed work, sensing, remote collaboration, feedback, decoupling dx / tx
NextGen Diagnostics
© 2010, Center for Technology and Aging
“Programmable Rehab”
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Courtesy: Filippo Tempia, Telecom Italia
performance arm position
Responsiveness evaluation
GATEWAY
SENSORS
Services: “programmable rehab”, distributed work, embedded intelligence, collaboration, feedback
NextGen Rehab
© 2010, Center for Technology and Aging
Courtesy CardioNET, Inc.
Proteus Biomedical (Raisin).
Courtesy VG-BioI.
Platforms Continued NextGen Platforms
© 2010, Center for Technology and Aging
The Center for Technology and Aging
www.techandaging.org