© 2010, Center for Technology and Aging 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 –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 Optimization Remote Patient Monitoring Care 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 up from 64 percent in 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 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 $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 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 Technologies See the Center for Technology and Aging’s Briefing Paper for more information at:

© 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 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 17 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 18 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 20 DYES ACQUISITION & PREP MICROSCOPE DIAGNOSIS CURRENT CLINICAL DIAGNOSTIC PROCESS PATIENT #510 - BLOOD - 04/09/2009 PATIENT #510 Cell Phone Screen showing magnified red blood cells, some infected with malaria Microscope Attachment Courtesy: Dr. Dan Fletcher David Bresslauer Cell Phone Patient Sample/ Slide Services: distributed work, sensing, remote collaboration, feedback, decoupling dx / tx NextGen Diagnostics

© 2010, Center for Technology and Aging “Programmable Rehab” 21 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