© 2010, Center for Technology and Aging Tele Home Care: Current Trends and Emerging Opportunities David Lindeman, PhD Director, Center for Technology and.

© 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


– 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


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


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


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


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


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


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


– 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


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


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


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


– 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


– 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


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


Emerging Technologies for Tele Home Care: Trends and Opportunities

Courtesy of Ravi Nemana


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

17

Many Inventions, Few Innovations


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


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


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


“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


Courtesy CardioNET, Inc.

Proteus Biomedical (Raisin).

Courtesy VG-BioI.

Platforms Continued NextGen Platforms


The Center for Technology and Aging

www.techandaging.org

© 2010, Center for Technology and Aging Tele Home Care: Current Trends and Emerging Opportunities David Lindeman, PhD Director, Center for Technology and.

Documents

aging center

aging technology trends

aging us

public health aging

telehealth slide

aging tele home care

mobile technologies

aging codirector