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”
The cost of the VHA Community Care/ Health Technology program is $1,600/pt/yr
Compares to direct cost of home-based primary care services of $13,121/pt/yr, and nursing home care market rate average of $77,745/pt/yr
43,430 patients enrolled by 2008
VHA attributes its “systems approach” to the rapid adoption and value gain
© 2010, Center for Technology and Aging

3. © 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
There are a number of platforms and technologies that benefit older adults as well as the broader population of persons with chronic conditions. There are also several major changes occurring in platforms and information communications technology for health care in general.
© 2010, Center for Technology and Aging

4. © 2010, Center for Technology and Aging
Mobile Technologies
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 2009
4.6 billion mobile subscribers end of 2009
Cell ownership drops off after age 50: 82% of those ages own a cell phone, and 57% of those 65 and older own one. Cell ownership over time ...
Younger people are more likely to embrace technology. About 75 percent of adults 18 to 30 went online daily, compared with 40 percent of those 65 to 74 and about 16 percent for people 75 and older. The age gap widened over cell phones and text messaging. About 6 percent of those 65 and older used a cell phone for most or all of their calls; 11 percent sent or received text messages. That’s compared with 64 percent of adults under 30 for cell phone use and 87 percent for texting.
More than 80 percent of U.S. physicians will have smartphones by up from 64 percent in and half of that group will use their phones for patient care, administrative functions like charge capture and even continuing medical education, according to a new report from Manhattan Research that drills deeper into data first released last fall. Read more: 
International ubiquitous use of mobile
The International Telecommunication Union estimated that mobile cellular subscriptions worldwide would reach approximately 4.6 billion by the end of 2009.
© 2010, Center for Technology and Aging

5. © 2010, Center for Technology and Aging
Health Information Technology
US putting $19 Billion into HIT
Spending on HIT rapidly increasing by 2012
80 percent of physicians and 58 percent of non-users plan to implement Electronic Health Record programs
72 percent of hospitals increasing HIT implementation
The ARRA provides substantial stimulus expenditures in the health care industry — over $20 billion — for the development and adoption of HIT. The largest allocation of funding — approximately $17 billion — is for incentive payments through the Medicare and Medicaid reimbursement systems to encourage providers and hospitals to implement EHR technology systems.
Spending on health IT to increase by 2012 due to federal mandate  Purchase of health information technology and electronic health record (EHR) systems are expected to rise sharply over the next two years because of federal usage requirements, according to a pair of industry surveys. Accenture and Harris Interactive’s survey shows that 80 percent of responding physicians under the age of 55 and 58 percent of non-users plan to implement EHR programs within the next two years to take advantage of federal incentives. Meanwhile, 72 percent of the hospitals and other healthcare organizations surveyed by the Healthcare Information and Management Systems Society (HIMSS) expect to increase their spending on health IT in response to the government’s “meaningful use” criteria for incentives. Under the economic stimulus plan passed in 2009, healthcare providers and doctors qualify for incentives if they implement EHRs and can demonstrate meaningful use of such systems beginning in 2011.
HIT is projected to save any where between 7 to 30% of health care costs (Daniel, DHHS, 2005 from multiple studies in 2002, 2003, 2005)
The ARRA establishes incentive payments through Medicare for the “meaningful use of certified EHR technology” by eligible professionals and hospitals. As specified in the legislation, an eligible professional will receive incentive payments for the first five years (2011 through 2015) for demonstrating a meaningful use of EHR technology and demonstrated performance during the reporting period for each payment year.
Thus, to achieve the maximum incentive payment amount, eligible professionals must adopt a meaningful use of EHR technology in 2011 or 2012, thereby qualifying for five annual payments ending in 2015 or 2016, respectively, for an aggregate maximum payment of $44,000. However, if a professional first adopts EHR technology in 2014, the maximum annual payments are $15,000, $12,000 and $8,000, for an aggregate maximum payment of $35,000.
Incentive payments for eligible professionals are based on the amount of Medicare-covered professional services furnished during the year in question. The total possible amount of the incentive payment will decrease over time. The law provides a rolling period for implementation and associated payments. For example, incentives that start in 2011 will continue through 2015, while those that begin in 2012 run through For the first year, the maximum payment amount is $18,000 if the eligibility criteria are met in 2011 or 2012 (and $15,000 if implemented in 2013 or 2014). The highest annual payment amount for subsequent years decreases each year to $12,000, $8,000, $4,000, and $2,000, with no payments being made after 2016.
© 2010, Center for Technology and Aging

6. © 2010, Center for Technology and Aging
Broadband and Telehealth
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
© 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:
© 2010, Center for Technology and Aging

8. 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
Technologies designed to help manage medication information, dispensing, adherence, and monitoring.
Medication Optimization refers to a wide variety of technologies designed to help manage medication information, dispensing, adherence, and tracking. Technologies range from the more complex, fully integrated devices to the simpler, standalone devices with more limited functionality.
Medication use is ubiquitous among older adults, with 90% of older adults using one or more prescription medications per week. 41% of older adults take five or more medications per week. 11% take 10 or more medications per week.
New England Healthcare Institute: $290 billion of healthcare expenditures could be avoided if medication adherence were improved.
© 2010, Center for Technology and Aging

9. © 2010, Center for Technology and Aging
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
RPM has been shown to support patient self-management, shift responsibilities to non-clinical providers, reduce the use of emergency department and hospital services, and improve patient and provider satisfaction.
Early diagnosis
Intervene early (inform providers of changes in health status to intervene early to prevent hospitalizations)
Improve Care Coordination
© 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
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
© 2010, Center for Technology and Aging

12. Connecticut Pharmacists Foundation
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
© 2010, Center for Technology and Aging

13. © 2010, Center for Technology and Aging
RPM Diffusion Grants Program
California Association Health Services at Home
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
© 2010 Center for Technology and Aging

14. © 2010, Center for Technology and Aging
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. © 2010, Center for Technology and Aging
Barriers to Diffusion
Barriers to Technology Diffusion/Scaling
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
© 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
Innovation = Invention + Value
Not just a new way of doing something
Need to show Value too !!
DOING something of value (Services) is the key
© 2010, Center for Technology and Aging 17

18. 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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19. © 2010, Center for Technology and Aging
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 19

20. Platforms: CellScope
NextGen Diagnostics
PATIENT
#510
- BLOOD -
04/09/2009
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
DYES
ACQUISITION & PREP
MICROSCOPE
DIAGNOSIS
CURRENT CLINICAL DIAGNOSTIC PROCESS
Services: distributed work, sensing, remote collaboration, feedback, decoupling dx / tx
© 2010, Center for Technology and Aging 20

21. “Programmable Rehab”
NextGen Rehab
Services: “programmable rehab”, distributed work, embedded intelligence, collaboration, feedback
performance arm position
Responsiveness evaluation
GATEWAY
SENSORS
Courtesy: Filippo Tempia, Telecom Italia
© 2010, Center for Technology and Aging 21

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

23. © 2010, Center for Technology and Aging
The Center for Technology and Aging
© 2010, Center for Technology and Aging