Published on October 15, 2014
1. Health Informatics and Aging Services
2. Agenda • LeadingAge and the Center for Aging Services Technology (CAST) • State of Technology in Aging Services • Aging Technology Ethical Issues • TeleHealth Overview • Case Study: The VA and TeleHealth • Continua Health Alliance • Reflections
3. LeadingAge Imperatives • Strengthen not-for-profit leadership • Engage consumers • Create the new financing paradigm • Lead innovation • Cultivate talented people • Pioneer technology – Technology is potentially the single most important phenomenon that can synergize the other driving forces to assure value for all concerned
4. CAST FUTURECASTS • Holistic Approach • Simplified Coordination • Person-Centered Service • Hands On Case-Management
5. CAST FUTURECASTS • Transparency • Person-Centered Follow Through and Feedback • Connectivity • Technology Enabled Services and Supports
6. 10 Aging Services Technologies • Intuitive computer interfaces • Wireless data communication networks • Electronic health record (EHR) systems • Electronic records sharing • Telemedicine/Telehealth
7. 10 Aging Services Technologies • Behavioral/activity monitoring systems • Fall prevention/detection systems • Tracking/wander management systems • Medication adherence systems • Brain and physical fitness technologies
8. State of Technology in Aging Services • Potential of Aging Services Technology – Help older adults maximize their independence – Support the needs of professional and family caregivers – Improve quality of care and quality of life – Reduce our nation’s health care costs – Increase aging services provider efficiency
9. Open Letter from Andy Grove • 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.
10. Open Letter from Andy Grove • 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 is critical • The savings achieved by keeping just 10% of the aging population in their homes can amount to $30 billion a year.
11. State of Technology in Aging Services • Barriers to Implementation – Negative Experience and Misconceptions – Privacy and Security – Usability – Provider Workflow and Interoperability – Liability – Lack of Consensus on Value – Lack of Financial Incentives
12. AARP Healthy@Home 2.0 • Home Safety Devices – Roughly 80% believe the devices would make them feel safe, and be a comfort to family/friends – Roughly 80% are concerned about the costs to install and maintain the devices – 54% would be willing to pay $1 to $50 per month for the devices and 41% would not be willing to pay anything
13. AARP Healthy@Home 2.0 • Personal Health and Wellness Devices – 70% believe that devices would make them feel safer, and benefit family but, 80% are concerned about costs to install and maintain – 50% or more are concerned about stigma and privacy – 51% would be willing to pay $1 to $50 per month for the devices and 42% would not be willing to pay anything
14. State of Technology in Aging Services • Recommendations – 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
15. Three Types of Technologies • Health and Wellness • Safety • Social Connectedness
16. Health and Wellness Technologies • Health Management Programs • Robots • Medication Adherence Devices • HD Audio and Video
17. Polycom Healthcare Delivery Technology • 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, Dermascope, 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
18. Safety Technologies • Remote Monitoring • Bio-Sensor Systems • Smart Homes http://www.harris.cise.ufl.edu/gt.htm
19. High Technology for Low Vision • Customizing a computer LowBrowse • Cellphone with camera and feedback KnfbReader Mobile • GPS system Trekker Breeze • Mini magnifiers • Prosthetic contacts
20. Social Connectedness Technologies • Wii http://us.wii.com/ – Best Wii Games for Seniors • Brain Fitness http://www.positscience.com/ • Jitterbug Cell Phone http://www.greatcall.com/
21. Aging Technology Ethical Issues • Privacy of Information • Privacy of Person/Place • Informed Consent • Equity of Access
22. Aging Technology Ethical Issues • Autonomy Versus Dependence • Paternalism • Patient and Provider Relationship • “Medicalization” of Home
23. 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 – Tele-education / Continuing Education
24. 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 – Provide MD services in underserved areas – Allow patients to spend less time in waiting rooms
25. Value of Remote Monitoring • There is increasing evidence to support the value of remote monitoring for individuals with chronic conditions, including: – 35-56% reduction in mortality – 47% reduction in risk of hospitalization – 6 days reduction in length of hospital admission – 65% reduction in office visits – 40-64% reduction in physician time for checks – 63% reduction in transport costs
26. Agency for Healthcare Research and Quality: Telehealth • Telehealth can improve patient safety and quality of care. • Guidelines for reimbursement of telehealth are necessary for sustainability. • Telehealth systems should be integrated with electronic health record (EHR) systems to promote continuity of care across clinical settings.
27. Medicare Payment for Telehealth • Medicare reimbursement for telemedicine or telehealth services is divided into three areas: – Remote patient face-to-face services seen via live video conferencing – Non face-to-face services that can be conducted either through live video conferencing or via store and forward telecommunication services – Home telehealth services
28. 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.” • Types of Telehealth – Synchronous: Real-time – Asynchronous: Store-and-forward
29. VISN 8 Sunshine Network
30. Synchronous TeleHealth • Telemental health • Telesurgery • Telerehabilitation • Telecardiology
31. Asynchronous Telehealth • Teledermatology • Telepathology • Teleradiology • Teleretinal imaging
32. Home Telehealth Technologies Flexible Sensor Connectivity BBlloooodd ssuuggaarr TThheerrmmoommeetteerr BBlloooodd pprreessssuurree SStteetthhoossccooppee CCaammeerraa EECCGG PPuullssee OO22 309 DDiiggiittaall SSccaallee
33. 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%
34. 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
35. Continua Health • Continua Health Alliance was established June 6, 2006 with 22 member companies. More than 240 companies are members today. • Mission: to establish an eco-system of interoperable personal connected health systems that empower individuals and organizations to better manage their health and wellness. • Market segmentation: Living independently longer, wellness, and managing chronic conditions
36. Continua Health • Continua member companies will select connectivity standards and publish Guidelines for strict interoperability. • Continua is establishing a test and certification program with a recognizable logo signifying the promise of interoperability with other certified products. • Interfaces and standards set for: – personal devices (weight scale, glucose meter, pulse oximeter) – health records (E H R, PHR, NwHIN, HIE)
37. AST Research Opportunities • How aging services technologies can be incorporated into the structure of ACOs and patient centered medical homes • Translational research that examines the efficacy and cost-effectiveness of technology • Demonstrate that in-home technologies preserve health, independence and dignity • Produce practical implementation guides that providers could use to replicate tested strategies and create sustainable business models
Mitos y realidades de las sustancias psicoactivas
Mitos y realidades de las sustancias psicoactivas.
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