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Tele Home Care: Current Trends and Emerging Opportunities. David Lindeman, PhD Director, Center for Technology and Aging Co-Director, Center for Innovation and Technology in Public Health Aging Means Business Gerontological Society of America November 22, 2010.

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tele home care current trends and emerging opportunities

Tele Home Care: Current Trends and Emerging Opportunities

David Lindeman, PhD

Director, Center for Technology and Aging

Co-Director, Center for Innovation and Technology in Public Health

Aging Means Business

Gerontological Society of America November 22, 2010

© 2010, Center for Technology and Aging

slide2

The Early Adopter Experience: Veterans Health Administration

Age Distribution of all CCHT Patients

  • 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”

© 2010, Center for Technology and Aging

slide3
Today’s Environment:Mobile, HIT, Telehealth
  • Technologies that address Chronic Disease and Maintain Independence
  • Examples from Diffusion Grants Program:
    • Medication Optimization
    • Remote Patient Monitoring
    • Care Transitions
  • Emerging Trends and Future Opportunities

© 2010, Center for Technology and Aging

slide4

Mobile Technologies

  • 57% of Americans age 65and older have a cell phone
  • More than80 percent of U.S. physicianswill have smartphones by 2012--up from 64 percent in 2009
  • 4.6 billionmobile subscribers end of 2009

© 2010, Center for Technology and Aging

slide5

Health Information Technology

  • US putting$19 Billioninto HIT
  • Spending on HIT rapidly increasing by 2012
    • 80 percentof physicians and58 percentof non-users plan to implement Electronic Health Record programs
    • 72 percentof hospitals increasing HIT implementation

© 2010, Center for Technology and Aging

slide6

Broadband and Telehealth

  • American Reinvestment and Recovery Act of 2009-$7 Billion
    • Broadband Expansion
    • Distance Learning and Telemedicine Expansion
  • e-visits and 24x7x365 nurse call centers in every state
  • 2008: over 200 telehealth networks connecting 2000 institutions

© 2010, Center for Technology and Aging

technology trends maintaining the independence of older adults
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 Technologies

See 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 Optimization

Medication Optimization
  • Medication reconciliation, dispensing, adherence, and monitoring.
  • Medication use is ubiquitous among older adults, with90% of older adultsusingone or more prescription medicationsper week.
  • New England Healthcare Institute:$290 billion in healthcare savings

© 2010, Center for Technology and Aging

slide9

Remote Patient Monitoring

  • 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

© 2010, Center for Technology and Aging

center for technology and aging diffusion grants program
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
Veterans Administration of Central CA

MedOp Diffusion Grants Program

  • Home self-managementandmedication 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

© 2010, Center for Technology and Aging

connecticut pharmacists foundation

MedOp Diffusion Grants Program

Connecticut Pharmacists Foundation
  • Culturally and linguistically appropriateMedication 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

© 2010, Center for Technology and Aging

slide13

RPM Diffusion Grants Program

California Association Health Services at Home

  • 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

© 2010 Center for Technology and Aging

slide14

Tech4Impact Diffusion Grants Program

Technologies for Improving Post Acute Care Transitions

  • 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

© 2010 Center for Technology and Aging

barriers to diffusion

Barriers to Technology Diffusion/Scaling

Barriers to Diffusion
  • Limited experienceof many providers with technology
  • Poor preparationfor adopting such technologies
  • Lack of financial modelsdocument Return on Investment
  • Limited awarenessby patients/clients
  • Provider concerns privacy
  • Information technology barriers

lack of interoperability

  • Lack of business models

© 2010, Center for Technology and Aging

emerging technologies for tele home care trends and opportunities
Emerging Technologies for Tele Home Care: Trends and Opportunities

Courtesy of Ravi Nemana

© 2010, Center for Technology and Aging

many inventions few innovations
Many Inventions, Few Innovations

Many Inventions, Few Innovations

  • Innovation = Invention + Value
    • Not just a new way of doing something
    • Need to show Value too !!
  • DOINGsomething of value (Services) is the key

© 2010, Center for Technology and Aging

17

services platforms remote care
Services Platforms: Remote Care

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

© 2010, Center for Technology and Aging

18

slide19

Advances in Telecare

SCOTLAND: Service models combine direct delivery of care to reduce impact on institutions.

Service models combine monitoring, help desk, telecare and notification. A hybrid Telecare + Alarm company.

© 2010, Center for Technology and Aging

platforms cellscope
Platforms: CellScope

CURRENT CLINICAL DIAGNOSTIC PROCESS

PATIENT

#510

DYES

Cell Phone Screen

showing magnified red blood cells, some infected with malaria

ACQUISITION & PREP

Microscope Attachment

MICROSCOPE

DIAGNOSIS

Patient Sample/ Slide

Cell Phone

Courtesy:

Dr. Dan FletcherDavid Bresslauer

NextGen Diagnostics

PATIENT

#510

- BLOOD -

04/09/2009

Services: distributed work, sensing, remote collaboration, feedback, decoupling dx / tx

© 2010, Center for Technology and Aging

20

programmable rehab
“Programmable Rehab”

performance arm position

Responsiveness evaluation

GATEWAY

NextGen Rehab

SENSORS

Services: “programmable rehab”, distributed work, embedded intelligence, collaboration, feedback

Courtesy: Filippo Tempia, Telecom Italia

© 2010, Center for Technology and Aging

21

slide22

Platforms Continued

NextGen Platforms

Courtesy VG-BioI.

© 2010, Center for Technology and Aging

Proteus Biomedical (Raisin).

Courtesy CardioNET, Inc.

slide23

The Center for Technology and Aging

www.techandaging.org

© 2010, Center for Technology and Aging

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