2. Agenda
• Public Policy Issues
• State of Technology in Aging Services
• Telehealth Overview
• The VA and Telehealth
• HIMSS Telemedicine Survey
• Aging Technology Ethical Issues
• Continua Health Alliance
• Reflections
3. Public Policy Overview
• The average American spends $440,000
on health care in his lifetime, and
$280,000 will be spent after age 65.
• 50% of that post-65 outlay goes to
assisted-living facilities and nursing
homes.
• Keep elderly patients in their own homes
longer, without degrading quality of care
a cheaper and better system.
4. Public Policy Overview
• Using everyday, low-cost technology - the
sensors, microchips, small radios you'd
find in today's PCs, in cell phones, and in
Bluetooth earpieces.
• Endorsement and reimbursement by
Medicare critical
• The savings achieved by keeping just 10%
of the aging population in their homes can
amount to $30 billion a year.
5. State of Technology in Aging
Services March 2008
• Vision: Using Integrated Information
Technology Systems to Support and
Enhance the Health, Safety, and Social
Connectedness of Older People Living
in Their Own Homes
– Center for Aging Services Technologies
(CAST)
6. Three Types of Technologies
• Health and Wellness
Technologies
• Safety Technologies
• Social Connectedness
Technologies
7. Types of Technologies
• Health and Wellness Technologies
– Telemedicine
– Robots
– Medication Adherence Devices
9. Recommended Links: Health and
Wellness Technologies
• Health Hero Network
https://www.healthhero.com/
• Gecko Systems http://
www.geckosystems.com/
• ZumeLife
http://www.zumelife.com/index.php
10. Polycom Healthcare Delivery
Solutions for all Healthcare Environments
Clinician
s
Patients
Healthcare
Admin
Education
Private
Networks
National
Networks
HDX 4000 HDX 8000
HDX Telehealth Cart
Mobile Responder
11. Polycom Ultimate High Definition
• Provides most life like experience possible
• Comprehensive, free flowing conversations with
HD Video and Audio
• Sharing of medical content and images in HD
provides high resolution image’s (MRI, CT
Scans…etc)
• Read body language clearly; don’t miss subtle
details
• View skin tones, color and depth perception
with clarity
12. Polycom Healthcare Delivery
Technology
Polycom provides full integration of video, voice, multimedia content, bridging,
recording/archiving/streaming, and support.
• Lockable Drawer
• Available over Ultimate HD architecture
• Two monitor functionality with one monitor
– Send images while simultaneously showing participants
• Easy connectivity to Medical Peripheral Devices
– Otoscopes, Handheld camera, Stethoscopes, Dermascopes…
etc
• End to end encryption
• Based on AES (the strongest possible encryption algorithm)
• Stereo sound provides high quality audio for medical interactions
HDX / VSX
Practitioner Cart
13. Types of Technologies
• Safety Technologies
– Remote Monitoring
– Embedded Microchips for Alzheimer’s
Patients
– Smart Homes http://
www.harris.cise.ufl.edu/gt.htm
14. Recommended Links: Safety
Technologies
• Quiet Care http://www.quietcare.com/
• VeriChip Corporation http://
www.verichipcorp.com/
• Smart House http://
www.harris.cise.ufl.edu/gt.htm
16. Recommended Links: Social
Connectedness Technologies
• Wii http://us.wii.com/
• Life Raft Group
http://www.liferaftgroup.org/about.html
• Brain Fitness
http://www.positscience.com/
• Jitterbug Cell Phone
http://www.jitterbug.com/Home.aspx
17. High Technology for Low Vision
• Customizing a computer (LowBrowse)
• Cellphone with camera and feedback
(KnfbReader Mobile)
• GPS system (Trekker Breeze)
• Mini magnifiers
• Prosthetic contacts
18. State of Technology in Aging
Services March 2008
• Barriers to Implementation
– Negative Experience and Misconceptions
– Lack of Consensus on Value
– Lack of Financial Incentives
– Inadequate Infrastructures
19. State of Technology in Aging
Services March 2008
• Recommended Actions
– Raise Awareness of Benefits
– Support Research on Value Equation
– Provide Investment Incentives
– Develop Technology Infrastructure
– Incorporate Older Adults in Design
– Promote Collaboration Among Technology
Firms
20. Telehealth Leadership Initiative
• Telehealth can:
– Reduce unnecessary delays in receiving Rx
– Reduce or eliminate travel expenses
– Reduce or eliminate the separation of families
during difficult or emotional times
– Use MD services in underserved areas
– Allow patients to spend less time in waiting
rooms
21. Telehealth Leadership Initiative
• The use of advanced telecommunications
technologies to exchange health information and
provide health care services across geographic,
time, social, and cultural barriers:
– Telephone, radio, other voice modalities;
– Picture phones, teleconferencing;
– Fax, Emails;
– Computers for data/imaging;
– Interactive video; and,
– Virtual reality, tele-robotics.
22. Telehealth Leadership Initiative
• What are the Different Types of
Telehealth?
– Tele-Dermatology;
– Tele-Radiology;
– Tele-Nursing or Ask-a-Nurse;
– Tele-Psychiatry;
– Tele-Dental;
– Tele-Ophthalmology; and,
– Tele-education / Continuing Education.
23. Agency for Healthcare Research
and Quality: Telehealth
• Telehealth can improve patient safety and
quality of care.
• Implementing telehealth is not easy.
• Guidelines for reimbursement of telehealth
are necessary for sustainability.
• AHRQ-funded grantees say technical
support must be available around the
clock to ensure patient safety.
24. Agency for Healthcare Research
and Quality: Telehealth
• Telehealth systems should be integrated
with electronic health record (EHR)
systems to promote continuity of care
across clinical settings.
• Telehealth systems can support the
provision of team-based care.
• The AHRQ-funded laboratory of telehealth
projects is producing valuable, informative
lessons for the Nation.
25. New Ways of Transforming
Home Care
• Three Imperatives
– Provide patients with feedback systems
– Create models where population-based care
is practiced and rewarded financially.
– Move care out of institution-owned physical
spaces.
26. New Ways of Transforming
Home Care
• The re-conceptualization of home care
telehealth can be done through the use
of technology to improve:
– Clinical decision-making
– Patient self-monitoring
– Both can be done through the collection of
data through remote monitoring
27. New Ways of Transforming
Home Care
• Benefits of Remote Monitoring
– Permits continuous rather than episodic
measurement
– Measures symptoms in the environment in
which they occur
– Permits individualization of the disease
process since what is normal is individual
(e.g. blood pressure)
28. New Ways of Transforming
Home Care
• Home Telehealth Technologies
– Personal Emergency Response System
(PERS)
– Monitored medication technology
– Medical device monitoring
– Therapy tele-management
30. The VA and Telehealth
• Telehealth/Telemedicine:
“The use of electronic information and
communications technologies to
provide and support health care when
distance separates the participants.”
36. VA Telehealth Outcomes:
Patient Census Growth
Year Census Change
FY03 2,000 Base Year
FY04 4,430 121%
FY05 8,922 101%
FY06 21,572 142%
FY07 31,570 46%
37. Use Reductions
Condition # of Patients % Decrease in
Utilization
Diabetes 8,954 20
Hypertension 7,447 30
CHF 4,089 25
COLD 1,963 21
Depression 337 56
38. HIMSS Vantage Point
(September 2008)
• Time Towards Widespread Telemedicine
Adoption
– 4+ Years or More
• Barriers to Telemedicine Adoption
– Lack of Reimbursement
• Telemedicine Benefits
– Improved Access to Care
• Cost Impacts Of Telemedicine
– Home Management of Chronic Diseases
39. Aging Technology Ethical Issues
(Janice M. Blanchard)
• Privacy of Information
• Privacy of Person/Place
• Informed Consent
• Equity of Access
40. Aging Technology Ethical Issues
(Janice M. Blanchard)
• Autonomy Versus Dependence
• Paternalism
• Patient and Provider Relationship
• “Medical-ization” of Home
41. Continua Health
• Formed in 2006 by a group of major companies
from areas such as healthcare, information
technology, medical devices and wireless
• Create a system of standards to allow homecare
devices to function together seamlessly
• By 2008 you should see products available with
the Continua Health Alliance symbol and
certification
43. Reflections
• Keep Seniors at Home for as Long as
Possible
• Telehealth/Telemedicine has Been Around
for Years: Has It’s Time Finally Come?
• Telehealth Can Improve Patient Safety
and Quality of Care
• Continua as a “Good Housekeeping” Seal
of Approval
44. Reflections
• Medicare Reimbursement is Critical, But is
it Likely in Near Term?
• Incredible Array of Devices from Wide
Range of Vendors
• Senior Resistance to Invasion of Privacy
and “Medicalization” of the Home
• VA as a Model for Telehealth Use
45. Reflections
• Incorporate Older Adults in Product
Design
• Leadership Roles Taken By Google and
Microsoft
• Telehealth systems should be integrated
with electronic health record (EHR)
systems to promote continuity of care
across clinical settings
46. Recommended Links
• Center for Aging Services Technologies
http://www.agingtech.org/index.aspx
• Telemedicine Buyers Guide
http://www.atmeda.org/news/buyersguide.htm
• Medgadget: Journal of Emerging
Technologies
http://www.medgadget.com/archives/
geriatrics/
Editor's Notes
"The cost of caring for the elderly is huge and will only grow as our population ages. Of the $440,000 the average American spends on health care in his lifetime, $280,000 will be spent after age 65.Probably 50% of that post-65 outlay goes to assisted-living facilities and nursing homes. So it stands to reason that if there were a way to keep elderly patients in their own homes longer - without degrading quality of care - we'd have a cheaper and better system.And we can do just that using technology. I'm talking everyday, low-cost technology - the sensors, microchips, small radios you'd find in today's PCs, in cellphones, and in Bluetooth earpieces. It's not too difficult to use this stuff as monitoring tools. Not to spy, but to detect trouble. For example, did the patient go outside to get the newspaper or did she wander away? Has the patient taken his meds? The same technology that brings us HBO can watch over the patient and trigger human intervention when needed.A critical step to make this happen is to have it blessed - and reimbursed - by the dominant health-care supplier to the aged, Medicare. Candidates, I hope to see a phrase in your inauguration speech that starts like this: "I will have Medicare define specifications for electronic equipment that allows the average aging citizen to stay home two years longer than today."As for affordability, Grove claims "As for the elder-care plan, the savings achieved by keeping just 10% of the aging population in their homes can amount to $30 billion a year."
Fortune June 11.2007 Open Letter from Andy Grove
Zume Life, of San Jose, Calif., for example, is testing a small hand-held device, the Zuri, that prompts users to take their pills on schedule and to keep track of health-related matters like diet and exercise.
“We’re going after users who are mobile, social, active people” who need to follow a health routine in the midst of busy lives, said Rajiv Mehta, the chief executive of Zume Life.
All of the data from this pocket-size electronic minder, which beeps or flashes when it’s time to take a pill, are uploaded to a Web portal. There, users can inspect, for example, graphs or charts of their exercise or other activities of the last few days or week. And, if the users wish, a caregiver can do so, too.
The Zuri will cost about $200 when it is released in the spring, Mr. Mehta said. Users will also pay about $40 to $50 a month for Web services. A software version of the device that will run on an iPhone is also in the works.
NYT 10/11/2008 (Delicious)
Each segment corresponds to technology that fits in a particular environment (e.g. patients home, clinicians office, clinic…etc) or could be utilized for applications that are pertinent to that segment.
Dr. Deborah A. Jeffries, Director Healthcare Americas
Polycom
Remote Consultation ppt
Presented at ASPEC Telehealth conference
October 4, 2008
Ultimate HD
Provide a simple overview so clinicians and healthcare professionals can visualize how UltimateHD would work in the clinical setting… Also want them to know the benefit for normal meetings…decreased video fatigue. Explain 4-CIF benefits at 384kbps/lower bandwidth calls
Examples: Dermatologist would be able to better visualize the color of a lesion; Teaching Hospital or Medical Schools would be able to share live video of a surgical procedure to remote sites and the distant site could still visualize the subtle details. Be able to see high resolution CT Scans or MRI scans.
Signature Healthcare Benefits
Key Message: PLCM is the only company who provides true unified collaborative communication (voice, video, and content over a single infrastructure).
The October 23-November 5 issue of the Florida Medical Business News featured a story about a joint venture between VeriChip and the Alzheimer's Community Care of West Palm Beach. VeriChip is offering free VeriMed radiofrequency implantable microchips to 200 patients with the disease. There are two goals for the undertaking. The first is to demonstrate that the product and the data base can raise care standards and improve the efficiency of care delivery. The second goal is to help persuade health insurance companies and CMS to provide reimbursement for the service. If one of the 200 patients is found wandering, law enforcement officials can take the patient to one of 12 hospitals with chip readers located in Palm Beach, Martin or St Lucie Counties. The chip contains a 16 digit number which enables medical personnel to access information stored by VeriChip. The patient database includes identification, next of kin contact information, allergies, medications, advance directives, and other pertinent material.
Welcome to the University of Florida Gator-Tech Smart House: moving technology from the drawing board into the home. In this laboratory-house, our research and development is designed to assist older persons in maximizing independence and maintaining a high quality of life.. A virtual tour is provided to introduce you to the smart house's current and future smart features (or as we call them hot spots).
WSJ 9.9.08 by Melinda Beck More than 16 million Americans report some form of visual impairment even when wearing glasses or contacts. That number is expected to double by 2030 as the aging population brings rising rates of macular degeneration, glaucoma, diabetic retinopathy and other eye diseases. An ever-growing array of devices can help people maximize their remaining vision and in many cases, compensate for what they've lost.
Free Software from Lighthouse-The software lets you select the type size, style, color and spacing of the text that appears in the banner.
a cellphone with a camera. Take a photo of any text, and the phone reads it back to you aloud or via headphone.
a global-positioning system that announces the names of streets and intersections as you are walking or riding.
Desktop devices that magnify reading material, photographs -- even your hands as you sew or write checks
Custom contact lenses -- fit to thousands of reference points on the eye -- can sometimes correct problems that off-the-shelf contacts can't, including corneas damaged by trauma.
AHRQ Decision Maker Brief on Telehealth
AHRQ Publication No: 08-0045 August 2008
Technical issues: One project indicated that vendor-supplied home monitoring devices failed to work on a
regular basis. As a result of this failure, approximately one-third of the patients who were
enrolled in the study became frustrated with the devices and stopped using them.
Several AHRQ-funded projects reported that integrating their telehealth systems with EHR systems offered many critical benefits.
Integration of systems allowed these projects to capture patient data using telehealth equipment and transmit that information to clinicians at the point of care.
Outcomes from these projects have the potential to change the U.S. health care system, and they offer valuable insight for others who
look to use telehealth applications in their own organizations to produce similar results.
New Ways of Transforming Home Care
Susan L. Dimmick, PhD
Intel Corporation
Presented to:
Eckerd College
Academy of Senior Professionals October 4, 2008
Jay Shore, MD, MPH, Univ of Colorado
Patricia Ryan MS RN Associate Chief Consultant
Director VISN 8 Community Care Coordination Service
ASPEC Conference 10.4.08
Synchronous: same material and same time
Asynchronous: same material and different times
Uses videoconferencing
Uses VISTA Imaging
Stand alone color video phone
Patient Census in VISN 8
1. When asked to identify how long it will be until telemedicine reaches widespread
adoption, nearly two-thirds of respondents indicated that this would take four years or
more.
2. By and large, respondents were most likely to report that the lack of reimbursement
for offering technology services was the biggest barrier to the adoption of
telemedicine.
3. Nearly all of the respondents believe that telemedicine will improve healthcare in
the United States. Three-quarters believe that the biggest benefit that telemedicine will provide is improved access to care.
4. Nearly half of respondents (41 percent) indicated that telemedicine would be beneficial as it will allow for home management of chronic diseases.
(1) Privacy of information. Who has access to data and how it will be used? Can it be bought and sold? How will privacy, confidentiality, and security of user information be assured?(2) Privacy of person/place. Can user control monitoring system (e.g., turn it off and on, or establish a monitor-free zone)? How is the privacy of others in the home maintained?(3) Informed consent. What constitutes informed consent, particularly with a technologically naïve or cognitively impaired person?(4) Equity of access. How do we develop equal access when technology use presupposes some technological sophistication, skills, and basic comfort level? Who will pay for services? Will it develop into a two-tier system of medical service delivery?
(5) Autonomy versus dependence. Does home monitoring foster autonomy or dependence? What will be the consequences of perceived non-compliance?(6) Paternalism. Does the desire to “keep a better watch" over aging parents actually reveal or underscore a paternalistic attitude on the part of service providers, adult children, and/or the medical establishment towards elders?(7) Patient and provider relationship. What is the overall effect on quality of care? How are empathy, compassion and trust maintained via telecommunication?(8) Medicalization of home. Will long term monitoring change the character of home? How do we maintain the separation of public and private sphere?
People who are monitoring their health at home may also take advantage of new online data-storage services being developed by Google, Microsoft and other companies. HealthVault (www.healthvault.com) by Microsoft lets users upload data directly to their account from about 50 devices, including many blood pressure and heart rate monitors, blood glucose meters and weight scales, said Sean Nolan, a computer scientist and chief architect of the Microsoft Health Solutions Group in Redmond, Wash.
Keeping Your Own Health Chart, Online By ANNE EISENBERG
New York Times, October 12, 2008
