aging services technologies: today and the near future majd alwan, ph.d., vp cast leadingage 19th...
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Aging Services Technologies: Aging Services Technologies: Today and the Near Future Today and the Near Future
Majd Alwan, Ph.D., VP CASTMajd Alwan, Ph.D., VP CASTLeadingAgeLeadingAge
19th Annual Cellar Conference on Technology and Aging19th Annual Cellar Conference on Technology and AgingAging 2.0 -- Technology, Trends and TransitionsAging 2.0 -- Technology, Trends and TransitionsFriday, April 8Friday, April 8thth, 2010 , 2010
What is CAST?
The Center for Aging Services Technologies is a national coalition of more than 400 organizations working together to improve the aging experience through technology
Providers ofAging Services
University Researchers
AssociationsCAST
Tech Industry Partners
The The
TrendsTrends
““Shift Left” through Shift Left” through TechnologyTechnology
$1$1 $10$10 $100$100 $1,000$1,000 $10,000$10,0000%0%
100%100% Healthy, Healthy, Independent LivingIndependent Living
Chronic Chronic Disease ManagementDisease Management
Doctor’s Doctor’s OfficeOffice
Community Community ClinicClinic
HOME CAREHOME CARE
Assisted LivingAssisted Living
Skilled Skilled Nursing FacilityNursing Facility
RESIDENTIAL RESIDENTIAL CARECARE
Community Community HospitalHospital
ICUICU
Specialty Specialty ClinicClinic
ACUTE ACUTE CARECARE
COST of CARE/DAYCOST of CARE/DAY
QUALITQUALITYY
of LIFEof LIFE
Technology-Enabled CareTechnology-Enabled Care
Older AdultData
Service Provider
Adult Child
HealthcareProfessional
ServicesPersonal Health Maintenance
Preventive Interventions
Improved Communications
Analysis&
Archiving
CAST Focus Areas
– Pilots: Identifying needs that can be addressed by technology and accelerating applied research with older adults and aging service providers
– Policy: Identifying barriers to the proliferation of proven and appropriate technologies and advocating to remove these barriers (Federal and State)
– Standards: Promoting development of standards to ensure interoperability and widespread access to aging services technologies
– Education: Disseminating information and resources
State of Aging Services Technologies
Home for LifeHome for Life
Safety Wellness Health Socialization
Physical Environment
Supportive Services
Senior(Quality of Life)
Safety TechnologiesSafety Technologies
Wearable devices: (PERS, automatic fall detectors, fall prevention patches, tracking)
Safety TechnologiesSafety Technologies• Environment/Passive (motion-based
sensor monitoring systems, embedded fall-detection systems, stove use detectors, temperature/smoke monitors, safe lighting technologies)
Physical, Behavioral & Physical, Behavioral & Mental Health/WellbeingMental Health/Wellbeing
• Wearable devices (activity monitors, cardiac monitor, ambulatory blood pressure monitors)
• Environment/Passive (motion sensors based activity monitors, sleep/bed sensors)
Physical & Mental Physical & Mental Health/WellbeingHealth/Wellbeing
• Telemedicine/ Tele-health (biometrics: pulse, BP, glucose, temperature, weight; daily wellness check; 2- way video health consultations care coordination; medication compliance)
Physical & Mental Physical & Mental Health/WellbeingHealth/Wellbeing
• Medication Reminder systems – Portable (wrist watch,
pager), cell phones with pill reminders, dispensers (mostly unmonitored).
– Monitored dispensers
Reminder Systems/ Cognitive Orthotics
• Assisted way-finding using indoor localization data or GPS (CMU, Rochester, Michigan)
• Cueing on handheld devices (Rochester and Michigan)
• Coaching in activities of daily living (Toronto)
Social ConnectednessSocial Connectedness• Phones (amplified
phones, easy to use cell phones)
• Two-way video conferencing phone
• Entertainment/ Theraputainment (Cognitive and/or Physical exercise)
EHRs & Point of Care EHRs & Point of Care TechnologiesTechnologies
• EHRs• Point of Care
systems; Electronic clinical charting; Documentation systems; Shared care planning systems; e-Prescribing; e-MAR systems; bedside medication dispensing; Wound care applications.
Trends and RecommendationTrends and Recommendation• Convergence between different technologies
• Push for standardization:– Interconnectivity – Interoperability
• Providers are looking to adopt technologies that:– Are Versatile– Are Expandable (multiple peripherals from the same
vendor/ product pipeline) – Use open or known interconnectivity/ accepted
interoperability standards.
Results of Expert Results of Expert InterviewsInterviews
BarriersBarriers
• Perverse payment system
• Liability exposure for providers
• Shortage of workforce • Lack of cross state
licensure
• Shortage of funding
• Perceived intrusiveness- overemphasis on privacy
• Inverse relationship between the need for, and the ability to use, technology
• Lack of information systems’ interoperability and device interconnectivity.
RemediesRemedies
• Effective advocacy
• Evangelization of the vision
• Tapping into untraditional funding sources
• Better understanding of seniors attitudes towards technology
• Designing better technologies
Critical GapsCritical Gaps
• Lack of Awareness
• Technical Uncertainty
• Limited Evidence of Value
• Absence of Business Models
Business Model RealitiesBusiness Model Realities
• Stuck in legacy reimbursement/ payment mechanisms
• Critical need for integrated socio, cultural, economic model of care; may evolve more quickly in other countries
• Promising aspects of current models (VA, Kaiser, PACE, P4P, etc.), exist but hard to generalize to other systems
• Medicaid related programs may evolve more quickly due to extreme pressure.
• Introduced senate bill S.908, amendments to H.R. 6357, and provisions to the stimulus bill (ARRA)
• Participating in EHR standardization efforts on the national level
• Launched state technology policy initiative
• Launched pilots initiative to help providers objectively evaluate technologies, compile evidence to change reimbursement
• Creating knowledge and raising awareness: State of Technology reports, EHR in NH & HH
• Sharing provider stories, experiences and case studies.
CAST ActivitiesCAST Activities
• Definition of Health Care Providers inclusive of LTC
• Broad definition of Health Information Technologies (HIT)
• Study of the need for payment incentives for LTC providers
• Grants to States/ State-designated entities Requests for Proposals already issued
• Loans to care providers (uncertain)
• Study of Aging Services Technologies.
ARRA HIT ProvisionsARRA HIT Provisions
• Advocating to shape Grant RFPs to encourage active participation from LTC providers
• Advocating to ensure that any investment in the national infrastructure is inclusive of LTC
• Prepared a state advocacy template letter and Guide for LeadingAge States Affiliates and members:
– Get informed– Partner with acute care providers– Identify Health Information Exchange facilitators and
explore partnership on grants– Push the state to obtain stimulus funds and provide loans
to LTC providers
• http://www.LeadingAge.org/article_cast.aspx?id=10200
Now What?Now What?
Healthcare Reform BillHealthcare Reform Bill• Certified EHR Grant Program for Long-term Care
Facilities • Demonstration Project for Use of HIT in Nursing
Homes• Development of Medicare Part D Prescription
Dispensing Techniques in LTC Facilities • New Models of Care that leverage Technology
– The ‘‘Community Living Assistance Services and Supports Act’’ (CLASS Act)
– Use of Technology in New Cost Efficient Payment Models-Center for Medicare and Medicaid Innovation
– Use of HIT in Health Homes for Enrollees with Chronic Conditions
– Use of Technology in New State Options for Long-Term Services and Supports
Next Steps
Follow through on the agency level
The Near Future…The Near Future…
Robotic Assistive Robotic Assistive Devices Devices
• Robotic household• Smart robotic walkers• Robotic wheelchairs
(touch screen, voice, and even thought controlled wheelchair)
Robotic Doctor/ Nurse/ Robotic Doctor/ Nurse/ Assistant/ CompanionAssistant/ Companion
Robotic suitsRobotic suits
Advanced Materials and Advanced Materials and Smart Things!Smart Things!
……it’s closer than you it’s closer than you might think!might think!
Concluding Remarks- IConcluding Remarks- I• Technology is a tool that can increase staff
efficiencies, improve care coordination, improve accuracy and timeliness documentation (and hence impact the bottom line) in different care settings
• It has the potential to enable providers to deliver levels of services equivalent to assisted-living in the home cost-effectively and efficiently
• Keep your development projects grounded in reality and in the context of other systems
• Pursue interconnectivity and interoperability to facilitate integration with other systems
Concluding Remarks- IIConcluding Remarks- II• Conduct the research in partnership with the
target users in community settings
• Conduct objective assessment of the technology with focus on quality measures the ROI to the provider, as well as the payers
• Focus on translation aspects including: – Produce practical implementation guides – Explore new care delivery and sustainable business
models that may be feasible with today’s technologies, including financing options
– Effective dissemination with large provider communities: Peer to Peer, effective storytelling, social networking, etc.
• CAST and LeadingAge can help with dissemination among LTPAC providers.
u
Used two-way video to talk to her son and the grand children.
Wearable sensors transmit health vitals to healthcare professional.
Instrumented walker assesses gait and balance.
Electronic medication
caddy notified son she took
her medicine, so he did not have to nag
her.
Her senior-friendly cell phone has a
GPS chip, and an emergency
alert button.
Telemedicine helped her
send a picture of a scrape to
her doctor, avoiding a trip to the office.
I will wintoday.
Questions?Questions?Majd Alwan, Ph.D., VP CAST
(202) 508-9463www.LeadingAge.org/CAST.aspx