Omron home blood pressure monitor 786N: Good hardware, bad app design

omron home blood pressure monitorIf there is one device that I think most older people should have at home, it’s a home blood pressure monitor. So a few years ago, I wrote an article for the Geriatrics for Caregivers blog with tips on choosing and using a home BP monitor.

At the time, I didn’t recommend a specific device because I hadn’t tried any. But recently I decided it would be much better if I could suggest a specific device to patients and families.

So I looked on Amazon and looked for a home BP monitor that could meet my specifications:

  • Measures BP at the arm
  • Easy to store, review, and share BP readings, which means some type of wireless data transmission capability
  • Smartphone/tablet not mandatory to use the device

When I wrote a blog post in April 2014 about my specifications, Omron did not seem to offer a device with wireless data transmission.

But earlier this year I noticed a Bluetooth-enabled Omron monitor on Amazon.  So I bought an Omron 786N earlier this summer and have been trying it out.

Pros & Cons of the Omron 786N Home Blood Pressure Monitor with Bluetooth

Here are my thoughts so far: [Read more…]

Still In Search of a Personal Health Record & Trying Healthvault

Recently I completed a consultation on a new patient. This person had moved to San Francisco a few years ago, and was not sure he was satisfied with the care he was obtaining from his new PCP.

The consultation was a bit challenging for me, because I had no past medical records available to review. Nothing from the old cadre of doctors on the East Coast, nothing from the current PCP, not even anything from a recent hospitalization. No laboratory results, no studies.

(In truth, I usually decline to schedule an initial consultation until some of this information is available. I need this type of information in order to do my work assessing the person’s health and the current medical management plan.)

As I often do, I encouraged this patient and his family to start maintaining a personal health record (PHR): some kind of collection of his key medical information, all in one place and under their control. I explained that this would be a huge help if they wanted to

  • Obtain second opinions when necessary
  • Transfer to a new PCP
  • Be able to check on how the chronic conditions were being managed and consider other options
  • Get better medical care in the event of an emergency or possibly even while traveling

In its simplest form, a PHR is a collection of papers kept in a binder or perhaps file cabinet. Paper can be hard to keep organized, however, and can only be searched effectively if everything was first filed in an organized fashion.

So a digital approach would seem to be in order. Digital information is easier to search, and often more portable than paper information.

But I was annoyed to find that yet again, after recommending this family set up and maintain a PHR, I couldn’t actually recommend a specific product or service. This was surprising to me, because it was almost three years ago that I wrote this article for the Geriatrics for Caregivers Blog: Tools for Caregivers: Keeping & Organizing Medical Information.

Yet today, I still cannot recommend a tool that will do the following: [Read more…]

Getting & transferring a person’s health information: still slow and inefficient

I have been thinking again about people’s medical information recently.

First of all, most people have no copy of their own health information. Recently a family member went for an annual physical, and the clinician dutifully addressed the question of colonoscopy. My relative thinks she had one in the past few years, but the doctor doesn’t have a record, and no one is sure how to find it.

I told my relative that when they do locate the results, she should get a copy and keep it. And keep copies of her laboratory results too, for that matter. “Why would I do that? Doctors keep those things.” was her response.

Sigh. Hasn’t she noticed how often doctors can’t find something, or don’t have it?

When I take my car to the shop to have something serviced, I keep a record of what was done. Same goes for any work done on my home. And many people I know do the same.

However, those same people generally don’t think to keep records of what was done to their bodies. Even though it’s arguably more important than what was done to their cars.

Furthermore, if you decide to take your car to a new mechanic — maybe you weren’t sure about the old one, or maybe you moved to a new town — would you show up with no records of the work done on your car so far?

Well, you might, but it’s not a great idea. When assessing the state of a car — or a person’s health — it’s extremely useful to know what has happened in the past, and what other professionals have done or attempted, when it comes to diagnostics and treatment plans.

So really, why don’t more people maintain at least a rudimentary personal health record? [Read more…]

GeriTech’s Take on AARP’s 5th Health Innovation @50+ LivePitch

On Wednesday April 27, 2016, AARP hosted its fifth Health Innovation@50+ LivePitch event, an event that allows 10 chosen start-ups to pitch to a consumer audience and a panel of venture capitalists.

This year the event’s description seemed a bit different than in prior years, with a new emphasis on caregiving: “Innovation@50+ is a one day pitch competition for emerging startups in the healthy living space with a focus on caregiving.”

As in prior years, there did not seem to be much judging or input from anyone whose primary work and expertise is to improve the health of people aged 50+, or to improve the lives of family caregivers for that matter.

In this post, I’ll list brief descriptions of the finalists, comment on how promising they seem to me — in terms of improving the healthcare of older adults and the lives of family caregivers— and tell you which products I’m most interested in. To see what I’ve thought of past LivePitch finalists, here’s my coverage of the first, second, third, and fourth cohorts.

GeriTech’s quick take on the AARP LivePitch finalists

Here are the AARP descriptions of the companies/products presented at the LivePitch event, along with my initial reactions. I took a quick look at everyone’s websites, and for certain web-based products tried them out for a little bit, but have not tried any of these products in depth.

Cake: “Cake is the easiest way to do end-of-life planning. We break down a daunting and difficult task into simple, bite-size chunks, and provide experts who can answer your questions. Your online CAKE profile is a living document of your end-of-life preferences that is easy to access, update, and share.”

GeriTech’s comments: [Read more…]

Care Coordination Around Hospitalization, Part 2

You may be wondering what happened with Ken, whom I wrote about in my last post.

Well, he stayed in the hospital for 4 days. At the end of his first day, a palliative care consultant called me and left me a voicemail with recommendations related to pain and constipation. He left me a cell phone number. He didn’t answer when I called him back, so I left a brief message and thanked him for the update.

But no hospitalist ever called me and no updates were faxed to me. On the fourth day (a Monday), I called the floor and again asked to speak to his doctor. His nurse came to the phone, explained to me the discharge plans, and then asked if there was anything else I needed.

Well, yes. I need to know what happened to him medically, not just what facility they were planning to discharge him to. Why did they keep him for so many days? Ken himself had left me messages saying the doctors were doing a lot of tests but not telling him the results. (Patient-centered hospital care, where art thou?)

The nurse was unable to answer these questions. I said that I wanted results of the tests faxed to me, and that I’d also like to talk to his doctor.

Several hours later, a doctor finally called me. He sounded young and harried. “So, what do you need to know?” he asked me. [Read more…]

Care coordination when patients go to ED or hospital

My patient, who lives in assisted-living, went to the Emergency Dept and then was hospitalized last night. (We’ll call him Ken.)

So once again I get to see what works well and what works less well, when it comes to care coordination. As usual, I’m not impressed, although things could be worse.

In part, they are not so bad because I’m the one who urged Ken to go the ER. Whereas my patients are often sent to ER without anyone even calling me first, in this case, I knew he was going, and was even able to take action to smooth the process.

An added bonus: Ken has a  long-time care manager who I connect with regularly, and she arranged for the transportation there and stayed with him for the first few hours.

Furthermore, to help Ken get the right care from the ER and to facilitate coordination of care, yesterday I wrote a note for the ER doctors. Ken’s care manager brought this with them to the ER, along with a medication list from the facility.

In my note, I summarized:

  • The most important aspects of Ken’s past medical history
  • Recent changes to his health — including recent lab and radiology results — and why we were sending him to the ER
  • Information on Ken’s background, including the fact that he’d been living at the facility for a few years, that he’d had the same care manager for years, and that he’d been homebound due to a psychiatric condition, which caused him to refuse to leave the facility to see his assigned PCP
  • Information regarding Ken’s preferences for medical care, including the fact that he’d consistently refused medical care meant to extend his life, and had repeatedly emphasized a desire to have pain and comfort addressed
  • Information regarding Ken’s usual mental capacities and decision-making capabilities
  • My contact information (phone and fax)

In short, Ken arrived at the ER better equipped than most to facilitate care coordination.

Now here is what has happened so far:

  • I have heard nothing from the ED, by phone or fax. It was Ken’s care manager who sent me an update last night, and then this morning informing me he’d been admitted.
  • I called the hospital this morning and left a message saying I wanted the nurse or doctor to call me. That was over 4 hours ago and nothing yet.

I’m not surprised by this, but it’s still disappointing. If I send a patient to the ER, with a note that includes my fax number, is it crazy to expect the clinicians to fax me something about what they found and did??

How I did get an update on my patient’s ER course and hospitalization

[Read more…]

New PCAST Report on Independence, Technology & Connection in Older Age

Yet another major report was released this month: “Report to the President: Independence, Technology, and Connection in Older Age,” from the President’s Council of Advisors on Science and Technology (PCAST).

PCAST convened a blue-ribbon working group for this report, which included several prominent experts who have done terrific work in improving the health and wellbeing of older adults.

So I was a bit surprised to find myself a bit disappointed by the report and the recommendations. Every now and then I read something that leaves me thinking “Wow, this really clarifies what’s happening, what’s important, and points towards solutions that are viable and likely to improve the problems we face.”

This report did not leave me with that feeling. But perhaps it will do more for you? In this post I’ll summarize some key highlights from the report, and then I’ll share a few thoughts on what I’m hoping to see in future expert reports.

How PCAST framed its report

PCAST identified four areas of change in aging, which offer opportunities for technology to help: [Read more…]

Aging in Place: What are the problems to solve?

I came across a thought-provoking report recently, titled “Technology for Aging in Place 2016,” by Laurie Orlov, a market analyst for aging technology. The report seems to be an update to her 2014 report on aging and technology, which I commented on in this post.

As always, I’m interested in how business people conceive of needs and approaches to solutions, and how that compares to our view of the needs and issues as aging health professionals.

A striking fact which I hadn’t previously appreciated is that many older adults remain in their homes while aging because they can’t afford to move elsewhere. Per Orlov:

Median net worth of the 75+ age range is now $156,000, inclusive of home equity (see Figure 1). This is deferring moves to assisted living – its move-in age now a mid-80’s and frailer demographic. But boomers are right behind them – and even less able to move in. They have simply not saved enough – holding an average retirement savings portfolio of only $136,000 – enough for just two years of a private assisted living community like Brookdale.

Orlov also cites this AoA data summary, which reports that

  • About 28% (12.5 million) of noninstitutionalized older persons live alone (8.8 million women, 3.8 million men).
  • Almost half of older women (46%) age 75+ live alone.

In short, we have a growing population of older adults, many of whom have limited financial resources, and many of whom live alone in the community.

What percentage of older adults are living in their own homes was unclear to me; Orlov states “Eighty percent of older adults today live in their own homes,” however the reference provided does not address this particular statistic.

To me, “living in your own home” means you own the home. I did find a very good report on aging and housing from Harvard’s Joint Center on Housing Studies, which notes:

Among those aged 80 and older in 2011, fully 60 percent had lived in the same residence for 20 or more years. Another 18 percent had occupied their homes between 10 and 20 years.

However this data is from the American Housing Survey, so presumably it is referring to older adults who are already in community housing, as opposed to all older adults.

The NIA report “Growing Older in America” does provide data on living situations and says 79% of older Americans live in their own homes, however this report is based on Health and Retirement Study data from 2002, and 2002 is starting to feel like a long time ago. Hence, I am still left wondering just where older adults are living, and it would be nice to see updated data addressing this issue.

The most important questions to ask, to address aging-in-place

[Read more…]

The geriatrician & social media: On goals & motivations

Social media

Patricia Bach, a geriatric psychology colleague who is active in social media, recently emailed me a question: how to encourage more clinicians in geriatrics and long-term care to use social media?

In particular, she asked me “What do you feel is the ROI for geriatricians to use social media/networking in their professional roles?”

This is an interesting question to consider. After all, we have a limited number of geriatricians available for a growing older population. We also each have only so much time and energy in every day.

So how should each of us be spending our time? How much should be on social media, and do we all need to be using it?

I myself really like blogging — obviously — but was a reluctant adopter of shorter-form social media. To this day, I have a minimal personal social media presence. I only got going on Twitter because I started this blog in the fall of 2012. For me, Twitter was a good way to learn about digital health and connect with others interested in tech and aging.

Then I started using Facebook in 2014, mainly because I was focusing more on my geriatrics content for the public, and at that time Facebook seemed to be a better platform for interacting with the general public, compared to LinkedIn or Twitter. (I would say this is still true.)

In adopting social media for these reasons, I was manifesting something that is very important to consider when it comes to physician behavior — or really any person’s behavior — with a respect to engaging in a certain activity:

  • What are the most important motivators and interests for the person? What are they most eager to accomplish? How does the activity address those?
  • What are the demotivators? What are the downsides to engaging in the activity?
  • How much friction or difficulty is involved in engaging in the activity?

You can also consider an activity in terms of “Return on Investment” (ROI), however, this term doesn’t usually take into account how soon the return is going to arrive. And we know that people are much more motivated by concrete returns that happen fast — and are related to something currently of great interest/appeal/fear to them — whereas they discount returns that are coming way off in the future.

Social media is about communication and networking

Back to social media itself. It is fundamentally about communicating and networking. So to use it sensibly, I recommend individuals — or larger entities — consider the following: [Read more…]

How many phone calls & faxes does it take to evaluate a common complaint in assisted living?

If we are going to provide compassionate and effective care to an aging population, at a cost we can all afford, we are going to have to get better at dealing with health concerns that come up often.

I am perpetually struck by how much effort and friction is involved, when I have to address certain common health issues.

Today I’m going to share a recent example: new confusion in a 90-year-old elderly woman who lives in assisted-living. Goals of medical care are to avoid hospitalization, and to focus on optimizing function and comfort.

Brief backstory: this elderly woman has Parkinson’s disease, but generally has very good cognition. She has private 24-hour caregivers because she can’t get up out of chairs on her own, needs stand-by supervision when she gets around her apartment with a walker, and needs to be taken by wheelchair to the dining hall and other locations within the facility. She also needs help with continence care. And, she’s been getting home health services for the past few months, for a sacral pressure sore.

As you can see, lots of people involved in her health and care: private home aides, home health agency RN, assisted-living facility staff (which includes their own RN), and an attentive adult child who visits often. This lady is essentially home-bound but very occasionally gets out to see her neurologist or another healthcare provider.

And now for what happened with confusion. For me the story started when the woman’s son sent me a message, saying his mother was now having delusions and crazy thoughts, and that her paid caregiver said she hasn’t been herself for the past 36 hours.

So this sounds like delirium: worse than usual mental functioning, generally brought on by an illness, stress on the body, or sometimes by a medication side-effect.

In other words, this is a common concern that comes up for many older adults, especially if they have a chronic condition that can cause cognitive impairment, such as Parkinson’s.

And cognitive impairment is apparently very common among assisted-living residents. Here’s what a 2014 Health Affairs paper says:

Estimates derived from national data indicate that seven out of ten residents in these residences have some form of cognitive impairment, with 29 percent having mild impairment, 23 percent moderate impairment, and 19 percent severe impairment. More than one-third of residents display behavioral symptoms, and of these, 57 percent have a medication prescribed for their symptoms. Only a minority of cognitively impaired residents reside in a dementia special care unit, where admission and discharge policies are more supportive of their needs.

Given this data, delirium must be very common in assisted-living, and you’d hope that a clinician would be able to evaluate and manage without too much hassle. But let’s see what happened in my case.

Evaluating a worsened confusion complaint in the real world

[Read more…]