Today is not only the last day of 2012, but also marks the three month anniversary of the GeriTech blog. This is the 36th post, all written so far by your faithful practicing geriatrician (atypical practice, to be sure, but real practice nonetheless).
So it seems like a good time to look back at what’s been posted, and try to summarize what this blog is about.
I’ll admit that when I launched this blog, it wasn’t with the intention of being the sole author. I was rather looking forward to hearing about what technologies other clinicians had found to be helpful in the care of older adults.
However, so far the clinicians have been rather quiet on the blog (although they tell me very interesting things about technology when I talk to them in person, and I hope to get some of this on the blog in time).
For now, GeriTech = Leslie Kernisan’s professional interests, and hence reflects my personal priorities, interests, experiences, and discoveries about innovation and the future of healthcare.
Here’s what this specifically means:
Geritech is about addressing the nation’s most important healthcare question
No false modesty here! This blogger believes that her interests dovetail with the most important healthcare question facing the country, which is this:
How can we, as a society, provide effective compassionate healthcare to an aging population, at a financial cost that the nation can sustain?
(Do you disagree? Post a comment asap.)
Better primary care for older adults is the answer
The answer to the question above, of course, is that we must meaningfully improve primary care for older adults. This is a no-brainer conceptually. First of all, it’s what patients say they want: to receive care that is comprehensive, coordinated, person-centered, prevention-oriented, as upstream as feasible, and as outpatient as possible. Second, it’s what is cost-effective, compared to managing health problems later when they become health crises requiring hospital care.
(Again, if you disagree with the above, I’m eager to hear your case.)
Just about everything I’m professionally interested in tracks back to this essential issue: how to support and implement better primary care for older adults.
The problem is that it’s very hard to figure out just how to improve primary care for older adults. Still, it must be somehow done.
GeriTech’s key points and discoveries so far
All in the service of fostering better care for medically complex older adults, here’s what I’ve found myself saying on GeriTech:
- Doing my clinical job is much harder than it should be. Care coordination is time-consuming. Important information takes ages to pry out of hospitals, specialists, and Quest Diagnostics. It’s hard to find patient education resources for crucial geriatrics problems such as delirium, or tapering dangerous benzodiazepines. Medication reconciliation is labor-intensive and error-prone. No wonder it’s hard to provide quality primary care to older adults.
- Managing the health needs of older people is about much more than prevention and lifestyle. I’ve been genuinely surprised at how much emphasis some leaders in healthcare innovation (like Robert McCray of the Wireless- Life Sciences Alliance, or TEDMED’s Managing Chronic Diseases expert team) have put on prevention and lifestyle changes. Many older adults — namely the ones who generate significant healthcare costs — need much much more: they need help actively managing their multiple chronic diseases and their significant symptom burden.
- Most tech tools seem poorly suited to improving the health care of older adults. As far as I can tell, most tools are not designed for use by clinicians caring for complex older patients with multiple medical problems. This is a big problem, as we really need effective tech tools that do one or more of the following:
- 1) help clinicians like me do our work better, faster, or more thoroughly;
- 2) help patients and families do their healthcare work better, faster, or more thoroughly;
- 3) support the collaboration between clinicians, patients, and caregivers.
I posted a list of likely obstacles to senior health tech innovations here.
- Effective tools for older adults should be developed with the help of practicing generalist clinicians and geriatricians, i.e. generalist clinicians who have real-world experience managing whole older patients, not just specific diseases. (For instance, I might say that I don’t particularly need continuous monitoring of blood electrolytes, but I do need help collecting data on symptoms.) We need the involvement of people who have experience with the space in which the rubber meets the road.
- Patient engagement requires clinician engagement. I believe that ideal health care is grounded in constructive collaborative relationships between patients, caregivers, and clinicians, in which clinicians serve as expert consultants in helping patients meet their healthcare goals. This means that solving for patient engagement means solving for clinician engagement.
- We should rethink how we are trying to engage and motivate PCPs. Meaningfully improving healthcare for older adults in large part means helping PCPs change what they are doing. We will both need them to adopt new ways of practicing (including new technological tools), and we need many of them to change the way they engage and relate to patients, caregivers, and other clinicians. Also, most geriatric care will be delivered by PCPs (not nearly enough geriatricians to go around now, never mind in 20 years), so their working conditions should be of utmost interest to all those who want healthcare to get better. Right now I hear a lot of talk about incentivizing PCPs and tinkering with compensation. There is not nearly enough talk about nurturing clinicians’ internal motivation, and relieving their feelings of burnout. As a doctor who left conventional primary care practice due to burnout, I’m concerned. Smartphones and tablets alone will not help us care for our parents and grandparents, even if they have the world’s best computer algorithms behind them. We need clinicians to be ready and able to partner with us.
- If you are serious about solving the healthcare crisis, you should focus on solving for the needs of the Medicare population. Almost all of the Great Challenges identified by the TEDMED crowd occur disproportionately in older adults, and in a more complex format than in younger people. Whatever healthcare problem it is, if you can develop a solution that works for a fairly typical older adult with multiple chronic conditions and caregiver involvement, then your solution will probably work for younger less complex patients. For instance, the Office of the National Coordinator for Health IT recently sponsored a Managing Meds Video Challenge, but the winning videos did not include tools for seniors, or really for anyone taking more than a few medications. Disappointing! This blog therefore encourages all innovators and leaders to step it up and design solutions for more complex patients, rather than for younger (and often highly motivated) people.
In a nutshell
This GeriTech blog is fundamentally about the pursuit of better healthcare for older adults, especially the frailer and more complex adults who have the most need (and who happen to be my patients). Improving primary care for this population is essential. We will need suitable tech tools and suitable systemic changes to achieve this.
Through this blog, I’ve been documenting the practical challenges that I find myself, my patients, and their families facing as we work together to improve their primary care. I hope that this information will help develop others develop better technological solutions, which can improve geriatric care.
Much of the ongoing conversation about improving healthcare doesn’t have nearly enough focus on the particular needs of older adults and their families, or on equipping the average PCP to handle those needs. Hopefully this will change soon.
The most pressing healthcare problem our society needs to solve asap is how provide effective compassionate care to an aging population. This blog will continue to encourage clinicians, innovators, developers, and thought leaders to work on this problem, with a special focus on how technology can be part of the solution(s).
