Tele Home Care: Current Trends and Emerging Opportunities

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Emerging Technologies for Tele Home Care: Trends and Opportunities Courtesy of Ravi Nemana © 2010, Center for Technology and Aging

17. 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

18. 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

19. 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

20. 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

21. “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

22. Platforms Continued NextGen Platforms Courtesy VG-BioI. © 2010, Center for Technology and Aging Proteus Biomedical (Raisin). Courtesy CardioNET, Inc.

23. The Center for Technology and Aging www.techandaging.org © 2010, Center for Technology and Aging