Health Monitoring Technologies
Written by Majd Alwan, Ph.D., Senior Vice President of Technology, LeadingAge, and Executive Director of the LeadingAge Center for Aging Services Technologies (CAST).
The majority of the increasingly older adult population in the U.S. requires some degree of formal and/or informal care due to loss of function as a result of failing health. About 80% of older adults suffer from one or more chronic diseases, according to the Centers for Disease Control and Prevention (CDC, “Healthy Aging: Helping People to Live Long and Productive Lives and Enjoy a Good Quality of Life,” 2011).
The cost and burden of caring for older adults is steadily increasing, yet 92% of these older adults live alone. The trend of the desire to remain at home for as long as possible remains strong with 88% of adults age 65+ expressing this desire, according to an AARP survey (AARP, “Home and Community Preferences of the 45+ Population,” November 2010).
Aging Services Technologies (ASTs) is a term used to describe technological approaches and innovations that help older adults achieve and maintain maximum physical function, to live as independently as possible, to study and learn, and to participate in and contribute to society. This can include such technology as electronic health records, fall monitoring systems, technology-enhanced wheelchairs and canes, memory-targeted electronic games, and technologies to help overcome sensory impairments. All these ASTs are designed to help older adults maintain their independence and reduce burden on caregivers and the health care system.
Technology has become an indispensable aspect of modern life. In addition to common technologies such as computers and cellular phones that improve the efficiency and quality of our lives, technology can also support older adults and people of all ages with disabilities, as well as those who provide care, services, and supports to these individuals. Aging Services Technologies (ASTs) in particular hold promise for addressing a number of key care issues that affect the elderly and individuals with disabilities, and their formal and informal providers of care and support. These technologies have the potential to improve care quality and health outcomes, to support safety and independence, and to enhance social connectedness and quality of life for older adults. At the same, they have the potential to reduce caregivers’ burdens and stresses while enhancing their efficiency. The pressures on reimbursement for care services and the shift from pay for service to pay for performance, for example, are leading aging-services provider organizations to revisit their strategic plans and many are considering how technology can help achieve organizational goals to deliver higher care quality at lower costs.
To illustrate Aging Services Technologies, LeadingAge’s Center for Aging Services Technologies (CAST) produced a video in 2012 entitled “High Tech Aging: Improving Lives Today.” The video follows Alma, age 83, who lives independently in senior housing on a modest income. Like many older adults, Alma has multiple chronic conditions including hypertension, diabetes, and arthritis. A retired home health nurse, she uses a few affordable technologies that are commercially available today, including a personal health record and a medication dispenser.
One day Alma has a stroke and is rushed to the emergency room. Because the hospital care team has access to Alma’s electronic health record and her personal medication adherence record, they know exactly what conditions she has, the medications she is taking, and when she last took them. Having this information at the clinicians’ fingertips leads to a quicker diagnosis, the right interventions, a shorter hospital stay and a better outcome for Alma.
After treatment, Alma is discharged to a skilled nursing provider for short-term rehabilitation. Upon discharge, the hospital team works with the nursing home staff on a rehabilitation and care plan and shares all the needed information electronically so the nursing home is ready for her when she arrives. There, an engaging occupational therapy protocol makes Alma’s therapy sessions not only more effective in helping her regain functional abilities, but also fun.
When Alma is discharged and returns to her apartment, the nursing home shares her information and coordinates with a home care agency to provide clinical and supportive services. The agency uses telehealth remote monitoring to help Alma keep her chronic conditions in check. In the apartment, an activity monitoring system and a bed monitor gauge Alma’s wellness and functioning so the agency can deliver services as she needs them. To ensure that she feels safe as she recovers from the stroke’s residual effects, Alma is given a personal emergency response system that automatically summons help if she falls or needs emergency medical care. She also uses a home computer with video conferencing capabilities to consult with her doctor and to participate remotely in exercise classes at a senior center.
The video presents a vision of the long-term services and support that AST providers can bring to other care partners, including hospitals, physicians, accountable care organizations, and payers. This vision of technology-enabled long-term and post-acute care is not only possible but also within reach, since all the technologies featured in Alma’s story are moderately priced and commercially available today.
Research on Aging Services Technologies
In 2012, CAST partnered with the National Opinion Research Center at the University of Chicago and conducted the Aging Services Technology Study which explored application of ASTs to a number of care issues that were deemed to be: (1) highly relevant to older adults and people with disabilities, (2) highly prevalent, (3) costly, and (4) that could benefit from technology. The study examined the role of technology and evidence of efficacy and cost-effectiveness of technology solutions for the following care issues:
- Falls (e.g., fall detection devices)
- Chronic Disease Management (e.g., remote patient monitoring devices)
- Medication Management (e.g., electronic medication ordering and dispensing)
- Cognitive Impairments (e.g., home-based activity monitoring)
- Sensory Impairments (e.g., speech-equipped or visually-oriented “smart” devices)
- Depression (e.g., social networking applications and computer activity monitoring)
- Mobility Impairments (e.g., wheelchairs that can ascend stairs).
In addition, the study explored the interplay between ASTs and health information technology (health IT), specifically electronic health records, and the barriers and potential strategies to the development, adoption, and use of ASTs.
The AST Study revealed that ASTs are as numerous and varied as the care issues they address. Some technologies that are currently available have single, straightforward functions, such as detecting falls; others, like activity monitoring systems, perform multiple functions. Some ASTs are designed to aid patients; others are designed to be used by health care professionals or caregivers, But in general, ASTs have been shown to provide both clinical and economic benefits, suggesting that specific ASTs can help improve health outcomes, preserve individuals’ ability to continue living independently in the community, improve care coordination, and reduce the cost of care. In some cases, ASTs can also improve the quality of life of informal caregivers by relieving certain physically and emotionally burdensome caregiving duties, and improve quality of care by increasing providers’ access to accurate, timely, and relevant health information.
The interface between health information Technology (health IT) and ASTs that collect important heath data offers additional promise for improved care that has the potential to benefit consumers, caregivers, and providers alike. Health IT ensures that the data can be properly shared and leveraged in the context of other health information. For example, when data generated by ASTs are incorporated into an electronic health record, the result is a permanent medical record that can be shared among providers and that offers a more complete view of patients’ health and treatment history. Thus, the interplay of health IT and ASTs can facilitate communication, support clinical decision-making, and enhance quality of patient care, regardless of geographic location or institutional setting.
The development and adoption of ASTs is hampered by various important barriers. An important barrier is the widespread lack of awareness of ASTs, not only among consumers, but also among professional care providers (physicians, social workers, and discharge planners) which results in underutilization among consumers, caregivers, and providers. Among those who are aware of these technologies, AST use is limited by concerns about evidence of effectiveness, stigma, privacy and security, usability, impact on workflow, difficulties with interoperability, liability, and affordability. Despite these challenges, all of these issues are being addressed gradually as ASTs garner increased attention among consumers, researchers, payers, and policy-makers alike.
The full report on the AST Study is available online.
Philanthropic Support of Aging Services Technologies
Funding for ASTs has been generally scarce and has focused primarily on the efficacy of specific devices or approaches. The use of telehealth and remote patient monitoring technologies for chronic disease management has substantial evidence of efficacy, especially for conditions like heart failure, hypertension, and diabetes. However, cost-effectiveness evidence has been limited to integrated care delivery networks, like the Veterans Administration’s Health System.
Grantmakers have funded several health technology initiatives aimed at the older population:
- The Blue Shield of California Foundation funded CAST to produce the State of Technology Report, which provided a vision for technology-enabled care and examined the value proposition of safety, health and wellness, and social connectedness technologies, and examined barriers to their development, adoption, and use.
- The CEA Foundation links seniors and people with disabilities with technologies to enhance their lives. It has contributed to the development of the CAST video, which raises awareness of the value of technology, and the importance of technology-enabled long-term and post-acute care providers to other health care partners. The foundation also funded Selfhelp’s Virtual Senior Center project, which developed an easy-to-use computer-based social connectedness platform that allows home-bound seniors to remotely participate in senior center activities, and awarded a grant to Older Adults Technology Services to open the nation’s first tech-themed senior center.
- The Helmsley Trust is funding the Evangelical Lutheran Good Samaritan Society and the University of Minnesota to conduct one of the largest studies evaluating the efficacy and cost-effectiveness of safety, telehealth, and wellness monitoring technologies in seniors’ homes in the community as well as assisted living facilities.
- The Robert Wood Johnson Foundation funded Project Health Design, which is designed to spark innovation in personal health technology. The program advances a vision of personal health records as springboards for action and improved health decision-making.
- The SCAN Foundation funded a number of small evaluation pilots of telehealth and medication adherence technologies through the Center for Technology and Aging, as well as the development of tools that leveraged the findings of the funded pilots.
- The California Healthcare Foundation funded the Center for Technology and Aging and the Partners Healthcare’s Center for Connected Health to develop a tool to determine the return on investment of online telehealth and remote patient monitoring technologies.
- The Commonwealth Fund has funded a number of health IT-related projects that examined the impact of deploying and using electronic health records in skilled nursing facilities.
More work needs to be done on technology development, the use of technology in health care, business model development, information dissemination, and awareness raising.
Areas of focus grantmakers may consider for future funding include:
User-centered technology development projects: Any technological innovation, especially those related to health care, must be relevant, useable, and affordable to the end user. Development of such technologies should focus on user-centered design and should engage all stakeholders (older adults, caregivers, and care providers) to ensure that the solutions developed are not only beneficial and usable, but are also feasible from an economic and business model standpoint to warrant adoption.
Grantmakers could help support projects that target relevant, prevalent, burdensome and/or costly care issues and should overcome the shortcomings of existing technologies. Technology development and application design contests, competitions, and rapid prototyping based on real-life scenarios drawn from users could be one way to encourage the development of technologies that make it to market. Grants to promote key enabling technologies in areas such as health information exchange, telehealth, remote patient monitoring, medication management/adherence, activity/wellness monitoring, care coordination, wellness, caregiver engagement, and social connectedness tools have the potential to make a significant societal impact.
- Pilot and larger-scale demonstration projects that aim to evaluate the efficacy and cost-effectiveness of Aging Services Technologies: Such projects should focus on innovative, technology-enabled care models that involve multiple care providers, including acute and long-term and post-acute care, and focus on not only efficacy but also cost-effectiveness under innovative care delivery and payment models. Payers should be engaged and must be encouraged to test new payment/incentive models. Electronic health records, health information exchange, telehealth and remote patient monitoring, medication management, activity/wellness monitoring, and care coordination tools are key enabling technologies that should be included in these evaluations.
Awareness campaigns to accelerate the adoption of Aging Services Technologies that have been proven efficacious and cost-effective: Dissemination of information about the results of evaluations of ASTs should not be limited to peer-reviewed journals, but rather, broadly disseminated to reach an array of stakeholders including health and care professionals, front line staff (e.g., discharge planners), care providers, caregivers, and older adult consumers.
Creative approaches to disseminating information from published, peer-reviewed research about the efficacy and cost-effectiveness of many of these technologies should be encouraged. Research results could be efficiently disseminated through existing mechanisms and resources of diverse professional, national, and community organizations that are relevant to AST stakeholders. For example, as part of their scientific meetings and scholarly publications, professional organizations and associations could be encouraged to develop continuing education and other professional shared learning activities that focus on increasing members’ awareness of ASTs and the interplay between ASTs and health IT. Materials should be formatted in ways that foster wide reach through the internet and social media. Such formats may include short videos, case studies, appealing short stories, online how-to guides, and online tools.
- Advocacy at the agency and legislative levels to influence public policy with respect to technology and technology-enabled care and payment models: This will ensure that public policy leads to changes in regulations and payment models to make proven technology-enabled models sustainable and widely adopted.
Source: LeadingAge September 2013
Resources and Links from CAST
U.S. Administration on Aging, “Harnessing the Power of Technology To Support Care Transitions,” (Powerpoint presentation), June 2012.
Grantmakers In Aging thanks Carol Kratz of Virginia G. Piper Charitable Trust for her review of this material.