GeriTech

In Search of Technology that Improves Geriatric Care

aging health needs

Thoughts on two tech innovation reports & a real family in need

From pg 4 of “Challenging Innovators”

Recently I read two reports on developing technology innovations to help us care for older adults:

“Challenging Innovators: Matching offerings to the needs of older adults” by Laurie Orlov, sponsored by AARP’s Thought Leadership group, and

 

From pg 2 of “Catalyzing Technology”

“Catalyzing Technology to Support Family Caregiving” by Richard Adler and Rajiv Mehta, sponsored by the National Alliance for Caregiving (NAC).

Both reports are based on expert opinion (as opposed to survey data), and seem to be primarily geared towards helping entrepreneurs develop better solutions related to the care of aging adults. (Note: the NAC report isn’t specifically about caring for older adults, but acknowledges that much family caregiving activity is driven by the needs of older adults.)

Although these reports are worth reading, I’ll admit that they both left me a bit perplexed and dissatisfied.

Undoubtedly this is partly because the authors — and the primary intended audience — are not “people like me.”

Meaning they aren’t practicing clinicians or academic experts embedded within geriatrics divisions, or even healthcare improvement circles.

The AARP report is very “business-y”, and the NAC report seems to have purposefully excluded the perspective of healthcare professionals. (Perhaps to counter the way that healthcare professionals have historically dominated conversations about aging and caregiving?)

But let’s set the needs of doctors and quality improvers aside for now. In the end, this is supposed to be about helping people, right? As in, helping patients, helping older adults, and helping the families and friends and many others — like front-line clinicians — who help them.

So, I tried to think of older adults and their caregivers as I read these reports. And I found myself still struggling to see just how these ideas and approaches were going to turn into materially better experiences for the patients and caregivers I work with.

Failure of my imagination? Or weakness of the proposed ideas and conceptual foundations?

Janny: A real boomer who could use tech help for aging and caregiving

Personally, when I find myself getting confused by concepts and improvement ideas, I resort to the concrete.

As in, I think of people I know who have common problems, and need help. And then I try to follow a mental path from some entrepreneur’s ideas to actual help for an older person, and/or the family.

This week I read about a family caregiver, whose problems are very common. Her handle is “Janny57” and I read about her situation on the AgingCare.com caregiver forum. (Now there is a GREAT way to learn about what family caregivers are struggling with: read the questions they post on active forums.)
Last week, Janny57 posted asking if anyone else had left husband and kids to care for a parent.
When another forum user asks her to share more details about her caregiving situation, Janny57 mentions that her 85 year-old widowed father

  • has memory problems,
  • isn’t taking his blood pressure meds (and was recently prescribed more BP meds to take, which sounds like sub-optimal healthcare management to me),
  • is having difficulty managing his finances,
  • is likely depressed,
  • drinks beer every night,
  • has been put on an antibiotic for high PSA,
  • has dental problems,
  • has a shoulder that is “killing him” due to bursitis/tendonitis,
  • has had some driving incidents,
  • is putting dirty dishes in cabinets and refusing to throw out rotten food,
  • is refusing to pay to have someone help him,
  • has not had a dementia evaluation and does not go to the doctor much, although he did go recently since his shoulder was killing him and the doctor noticed that his patient didn’t remember their conversation the day prior.

Other caregivers responded with a wealth of advice on helping a parent with dementia, on balancing family and work and marriage and caring for a parent, on surviving the experience, on moving a parent into your home, on moving into your parent’s home, and so forth.

This peer-to-peer caregiver support is good stuff, and I’ve actually been telling families to look for a suitable online forum.

But of course it’s not enough to tell someone like Janny to get help from a forum. She’s having serious problems, her dad is having serious problems, and as a society we need to get better at helping people like Janny and her dad.

Now below are two ideas I have, which maybe could enhance future reports of this type.

Idea #1: More challenging personas

What if these reports were to include a persona similar to Janny, or to her dad? (Not sure what I mean by “persona”? Try this resource for information on how personas help in design.)

Personas are actually featured early on in Laurie Orlov’s report; right at the beginning it says “Age Doesn’t Matter — Personas Help Shape Scenarios that Inspire.”

And on page 4 of the report, there is even a nifty graphic, which she says are “three personas reflected throughout its publications that represent the AARP cohort of age 50+.” Here it is:

But I found myself rather dissatisfied by this graphic.

Obviously, when you are a hammer everything looks like a nail. So, since I’m a physician, I’m oriented towards health problems. And since I’m a geriatrician, I’m especially prone to think about how almost every problem an older person has tracks back to an underlying problem with health, or healthcare.

So I admit I am biased to thinking of health and healthcare. Still, I wonder if many non-clinicians out there might not agree with me, and find it a flaw that this graphic says exactly zero about the role of health problems in each personas life.

After all, what do you suppose it is that moves people from one stage to the next? (Er…health problems, no?)

What is a major cause of caregiver involvement in an older person’s life? Health problems. What do caregivers spend a significant portion of time doing? Helping an older person interface with the healthcare system, and helping an older person with his or her “self-healthcare.”

Why is Janny about to leave her husband and kids behind, to help her father? Because of his health problems.

Speaking of Janny’s father, which persona represents him??

Maybe someone can answer that in the comments below. Suffice to say that I have come across many, many people like Janny’s dad, and as the population ages, more and more families will be in this position.

And Janny herself, if she gets more involved in caring for her father, is at high risk for developing or exacerbating her own health problems. (We should care just on moral/ethical reasons, but her employer and health insurer should also be very concerned about this.)

So, I think we need to expand the persona selection. Designers for caregivers and aging adults: consider following the caregiving forums. You might get some good ideas there.

Idea #2: Make sure you always consider the role of health problems and healthcare

As I said above, I realize my geriatrician background means I’m likely to be biased in favor of attention to health and healthcare.

Still, when it comes to caring for aging adults, I don’t see how you can create truly useful — and usable — solutions without giving serious consideration to health, and healthcare issues.

And I mean solutions that are useful to older adults and their caregivers, not just solutions that are useful to doctors. (Although really, our fates are intertwined! Healthcare is a partnership!)

At a minimum, I think some bar representing “health & healthcare problems” needs to be added to the Personas graphic.

For instance, among the “Independent Persona” people who are highly functioning, a fair proportion of them have chronic health problems that they need help managing. They need this help in order to maximize their current quality of life, and they need this help in order to reduce the chance of progressing to “Transitioner” or “Struggler.”

Their health problems usually can’t be managed without interfacing with the healthcare system. Supporting an effective partnership with the system is important. (Which means to some extent helping people compensate for the system’s deficiencies and dysfunctions, but that’s a topic for another post.)

Those who are “Transitioners” are presumably even more likely to have health problems. They are also more likely to have others — whether family, friends, or residential facility staff — concerned about these health problems.

Furthermore, the status of — and approach to managing — health problems often affects how much daily help an older person needs. (For example, it’s often possible to streamline or simplify a medical care plan.) This is especially true for the “Strugglers,” and the NAC report quite correctly cites Carole Levine and the 2012 AARP/United Hospital Fund survey which found that over half of caregivers are “‘performing medical/nursing tasks for care recipients with multiple chronic physical and cognitive conditions,’ which involved such tasks as managing multiple medications, wound care, giving injections or intravenous therapy, incontinence support, and/or serving as care coordinators.”

So, if you are trying to design solutions to meet the care needs of aging adults — whether you are trying to help older adults or whether you are focusing on helping caregivers — it would seem that health and healthcare are important factors to consider.

But if you take a closer look at Frog Design’s “Aging by Design Innovation Map,” which is where the 3 Persona graphic comes from, you’ll note that there is precious little about health and healthcare concerns.

Shouldn’t “Help me feel well” be a core need?

Yes, it should.

Summing it up

Many of the challenges that older adults — and their family caregivers — face are heavily influenced by issues related to ongoing health problems, as well as healthcare encounters.

To develop and offer effective solutions that help us care for aging adults, innovators should consider the relevant health and healthcare issues. Although specialists are obviously very useful, innovators should also seek out good generalists, whose job it is to help patients develop an overall comprehensive plan for their care. (Examples: Dr. Allan “Chip” Teel has developed a tech-enhanced approach to help his older patients in Maine remain independent. OnLok and other PACE clinics have found ways to effectively work with family caregivers, to keep nursing-home eligible seniors in their homes. Figure out what they are doing right and build on it.)

“Help me feel well” is a core need that often requires attention, when it comes to older adults. That need, and what it takes to address that need, should be on the innovators’ radar.

It would probably help to develop personas that factor in some key health issues, and I hope Frog Design will consider revising their Aging by Design Innovation Action Map.

I recommend innovators consider how their conceptual frameworks might help them with the story of Janny57 and her father. Consider the problems she needs to solve, for herself and for her dad. How will your solution help? What else needs to happen for it to help? I’d also encourage innovators and designers to read many other real caregiving stories in online caregiving forums.

If you’re part of that frontline of care for older adults — an older patient, a family caregiver, or a practicing clinician — what do you think of these latest reports? I hope you’ll post a comment below.

ISO A More Practical Way to Define Geriatrics

As I mentioned in my last post about health and aging, I’ve found over the past few years that many people aren’t quite sure of what geriatrics is, or how a geriatric approach might be relevant to their work in health or in aging.

This is understandable. After all, the term “geriatrics” is not widely used outside of healthcare. And even within healthcare, many doctors believe they are practicing geriatrics…when in fact they are just taking care of the elderly, in much the same way as they would take care of any adult.

And herein lies the rub. Geriatrics is not just about taking care of the health of aging people, it’s about how you provide such care.

The problem with explaining geriatrics as the health care of aging adults — or older adults — is that this definition is vague about what is different about this form of health care, and why it needs to be different.

So, I’ve been trying to find a way to be more specific about what geriatrics is, as I write for family caregivers and for the tech community.

Here’s how I explained geriatrics to an audience at the recent Health Technology Forum event about older adults.

A More Specific Definition of Geriatrics

What-is-geriatrics-slide-2.19.14

I then presented a list of “issues that come up as people age.” This list emerged as I thought through two questions:

  • What kinds of problems are very common when it comes to the healthcare of aging adults?
  • What kinds of things trigger the need for a “geriatric approach”? By which I mean, what kinds of issues require healthcare professionals to provide care that is different from what we provided to people when they were younger?

[Read more…] about ISO A More Practical Way to Define Geriatrics

How to Develop Better Primary Care for Seniors

[Extra-special treat today! This clinician guest post is by Dr. Griffin Myers, whose innovative primary care clinic for Medicare patients, Oak Street Health, just opened its doors this month in Chicago.]

Nationwide seniors are up against a wall when it comes to primary care, and this is particularly true in Chicago, home of our new approach to integrated geriatrics care called Oak Street Health. We recognized the need and are now on a journey to fix it.

In 2012, I (an emergency medicine resident) and two colleagues (an attorney and a financial engineer) launched what we believe is a truly innovative approach to caring for seniors. Your blog host, Dr. Leslie Kernisan, has been an email-mentor to me through this process and has now invited me to be a guest blogger on GeriTech. Over the coming weeks and months, I have the honor of blogging to you about what we’ve built, how, why, and what’s coming next for us in our mission to build the right kind of care model for seniors. I hope you enjoy the posts, and please: feedback and suggestions are welcome. We’re a humble bunch, and we hope to learn from these conversations as well.

Chicago is a city of over 1 million seniors. The primary care infrastructure is anecdotally thin: patients tell us appointments require weeks of notice, wait times are long, and many doctors aren’t taking new patients. Furthermore, most primary care providers are either (a) employed by a large hospital system or (b) a part of a large multi-specialty practice; from an economic standpoint, this means primary care exists not for its own sake but instead to serve as an aggregator for referrals to more highly reimbursed specialty services.

The typical Medical patient in Chicago has an unfortunate burden of disease:

  • 24% have diabetes
  • 17% have CHF
  • 12% with depression
  • 11% with COPD
  • 9% with CKD
  • 6% with cancer

Beyond the disease burden, the complexity of the care ecosystem is onerous; the typical Medicare patient in Chicago must manage the following:

  • He/she takes 11 medications a day, from 5 drug classes, prescribed by 2-3 providers, dispensed from 1-2 pharmacies.
  • He/she sees 7 physicians in a year, which includes 2 primary care providers, all across 4 different practice locations.

Furthermore, that same patient is not well equipped to manage his/her disease:

  • 73 years-old
  • 56% with high school diploma or less
  • 45% below twice the poverty level
  • 30% with a functional limitation

And it’s not just patients who face challenges; primary care providers have a daunting task as well:

  • Too much to know: there were roughly 900,000 medical journal articles published last year.
  • Too much to do: following recognized society guidelines would require 21.7 hours/day for a practicing primary care provider, excluding documentation (and eating, sleeping, etc.).
  • Too much to manage: there are 87 different categories of United States Preventive Services Task Force recommendations for management of preventive/maintenance care.
  • Too much to coordinate: a typical primary care provider in Chicago has a panel of 2,000-2,500 patients and must work with 299 other physicians across 117 practices over the course of the year to manage that care.

In our population in Chicago, a typical hospital admission costs $10,000. The reimbursement for CPT 99212, a medium complexity visit with an establish patiented, is $43.89. That means you can buy 228 clinic appointments if you avoid one hospitalization. (Just for comparison, there are around 250 business days in a year.)

How does all this add up for us? We’ve tried to build two things: (1) a primary care model that creates downstream savings in acute care and (2) an economic model that lets us capture the savings we create and reinvest them in even better primary care. One of the many tools we’re considered in developing the Oak Street Health model was the recent Institute of Medicine report “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” The report contains 10 recommendations in 3 broad categories for how to achieve “best care:”

Foundational Elements

Recommendation 1: The digital infrastructure. Improve the capacity to capture clinical, care delivery process, and financial data for better care, system improvement, and the generation of new knowledge.

Recommendation 2: The data utility. Streamline and revise research regulations to improve care, promote the capture of clinical data, and generate knowledge.

Care Improvement Targets

Recommendation 3: Clinical decision support. Accelerate integration of the best clinical knowledge into care decisions.

Recommendation 4: Patient-centered care. Involve patients and families in decisions regarding health and health care, tailored to fit their preferences.

Recommendation 5: Community links. Promote community-clinical partnerships and services aimed at managing and improving health at the community level.

Recommendation 6: Care continuity. Improve coordination and communication within and across organizations.

Recommendation 7: Optimized operations. Continuously improve health care operations to reduce waste, streamline care delivery, and focus on activities that improve patient health.

Supportive Policy Environment

Recommendation 8: Financial incentives. Structure payment to reward continuous learning and improvement in the provision of best care at lower cost.

Recommendation 9: Performance transparency. Increase transparency on health care system performance.

Recommendation 10: Broad leadership. Expand commitment to the goals of a continuously learning health care system.

Easier said than done, but over the coming posts, I’ll use this framework to explain our philosophy and our approach to what we think matters in achieving “best care.” Up first? Recommendations 1-2.

Until then, take a look at WGN’s coverage of the opening of our first center in Chicago’s Edgewater neighborhood, and please post any questions or suggestions for us in the comments!

Griffin Myers, M.D., M.B.A. is a founder and the Chief Medical Officer at Oak Street Health. He is currently in his final year as an emergency medicine resident in Boston. You can contact him at griffin (at) oakstreethealth (dot) com.

 

Disclosures: Dr. Myers wishes to disclose a financial interest in the primary care model discussed above. Furthermore, he is a trainee in a postgraduate clinical training program, and neither the program nor the affiliating university endorses, owns, or has any formal or informal relationship with the primary care model.

 

References & Links

–    U.S. Census Bureau

Centers for Medicare and Medicaid Services.

Schneider K, O’Donnell BE, Dean D, Prevalence of multiple chronic conditions in the United States Medicare population, Healthand Quality of Life Outcomes 2009, 7:82.

Choudhry NK, Fischer MA, Avorn J, Liberman JN,Schneeweiss S, Pakes J, Brennan TA, Shrank WH. The implications of therapeuticcomplexity on adherence to cardiovascular medications. Arch Intern Med. 2011May 9;171(9):814-22.

Lee TH, Mongan JM. Chaos and Organization inHealth Care, MIT Press, 2009.

Pham HH, Schrag D, O’Malley AS, Wu B, Bach PB.Care patterns in Medicare and their implications for pay for performance. NEngl J Med. 2007 Mar 15;356(11):1130-9.

National Research Council. Best Care at LowerCost: The Path to Continuously Learning Health Care in America. Washington, DC:The National Academies Press, 2012.

U.S. Preventive Services Task Force Recommendations for Adults

Pham, H. H., A. S. O’Malley, P. B. Bach, C.Saiontz-Martinez, and D. Schrag. 2009. Primary care physicians’ links to otherphysicians through Medicare patients: The scope of care coordination. Annals of Internal Medicine 150(4):236-242.

Oak Street Health analysis

Medication coordination & assisted living

Recently I’ve been trying to more intensively adjust medications for a few patients who live in assisted-living facilities.

Intensively, meaning that I might change the medication every 1-2 weeks, as the patient and I engage in a focused effort to figure out how best to manage a certain problem, such as pain, anxiety, insomnia, constipation, or falls.

Sometimes, I even have to change the medication after a day or two, if the most recent change seems to have made things worse instead of better.

All of this means lots of communication with the facility, the medication technicians, and the pharmacy. (And with the patient, but that’s often the easiest part.)

It has, for the most part, been a bit labor-intensive and challenging, especially when it comes to those facilities that use paper-based medication administration records (MARs). Hence, I’ve found myself thinking about how clinicians and facilities can coordinate and communicate regarding medications, in order to improve the care of patients.

The nice thing about having patients in assisted-living is that many of them use the facility’s medication management service, which means they will be reminded to take scheduled medication, and there will be a record of what has been taken. (For those elderly adults who live at home, figuring out what they take and how often can be quite a challenge.)

On the other hand, the facility’s involvement means there is an extra party involved in the communications. So as a clinician, you can’t just tell a patient to stop a medication. You also have to write an order for the facility.

Also, in most cases, if you prescribe a medication PRN (“as needed”), the patient will need to go ask the facility staff in order to get it. Many patients experience this as a barrier to access, and complain that they don’t get PRNs easily from their facility…it seems that they either are uncomfortable asking, or the med techs are hard to find, or something else seems to come up. Of course, the clinician may be able to authorize that the patient keep the PRN medication in his or her room, and self-administer. But in this case, it can be hard to determine just how much PRN medication the patient has taken.

To summarize, the main hitches I’ve run into are:

  • More effort required to prescribe medications or make changes, since the facility may require orders separate from the pharmacy prescription.
    • Orders and prescriptions usually have to be sent by fax.
    • Clarifications and questions are often sent back to me by fax.
    • Follow-up phone calls are often involved: either I call to make sure they got an order and have no questions, or they call me because they need more information.
  • Effort required to get a copy of the updated medication list, in order to make sure that all changes have been implemented correctly.
    • A copy of the most up-to-date medication list is also important if the patient is seeing other clinicians or specialists, who may have added or changed medications.
    • I usually have to call to request this information; faxing sometimes works but takes longer to get a response and sometimes there is no response. I also sometimes have to walk over to the facility’s med room, to get a copy of the list.
  • Extra effort often required to get a record of how often PRN medications were administered.
    • Some facilities chart this by hand, separately from a pharmacy-generated list of current prescriptions.
    • This information is often not included when a medication list is faxed to me.
  • Patients and families are often concerned that they won’t be able to get PRN medication promptly when it’s needed.
    • Cognitively impaired patients may have difficulty asking or recognizing their own need for medication.
    • Some patients complain that facility staff are slow to respond to PRN requests; I suspect that this is because the med techs tend to be very busy dispensing a lot of medications, and possibly also transcribing the latest changes to the orders.

 

What would help

For many of the issues listed above, a solution would be an electronic communication platform that included the providers, the pharmacy, the facility staff, as well as the patient and family.
Ideally:
  • Providers and families would be able to view the facility’s current medication orders in real-time.
  • Providers would be able to easily make changes, and it would only require one step to notify all parties of any change.
    • Changes should be made electronically, and no one would be copying prescriptions or orders into a binder.
  • Providers would easily see how often PRN medications had been administered. Families may also want to view this information, in order to participate more fully in the plan for managing a certain symptoms or problem.
  • Providers could easily copy or import the latest medication list, and PRN medication use, into their own electronic health records.
    • Families and patients may want to import this data into their own personal health records as well.
  • Patients and families would be easily able to give other providers access to this data.

Health innovation to the rescue! Some companies are working on just this kind of solution. (I mentioned one of them, Caremerge, in a post last fall.)

But it’s a long road from good idea to actual implemented solution with good usability. To begin with, it’s quite hard to design a comprehensive solution that works well for all parties involved. Then, there’s the challenge of getting providers and facilities and pharmacies to all use a single system. (Alternatively, we can each use our own system but then we need the systems to talk to each other easily…easy to wish for, hard to achieve.)

Just as physicians’ offices are slowly but surely moving from paper to electronic record-keeping, I’m sure that eventually all assisted-living facilities will have fully computerized medication management, along with electronic systems of care coordination and clinical communication. But how many different platforms will providers be willing to work with?

Many providers are already struggling with an EHR in clinic, and possibly another one for the hospital system they might be affiliated with. In such circumstances, providers might well balk at using a facility’s communication platform as well, and instead insist on continuing with the current system of faxing in orders. (Most providers, as best I can tell, don’t feel compelled to double-check the medication list as often as I tend to, so my problems are not quite their problems.)

As usual, we are left with some thorny issues to resolve as we work our way towards better communication and coordination.

For now, I am still waiting to be invited to a facility’s communication platform, and am hoping that a nearby facility tries something like Caremerge soon. (I’ve listed a few other issues I try to coordinate with assisted living facilities in this post.)

If you’re a clinician and have had any experience with a care coordination platform in assisted-living, I’d love to hear your thoughts on it.

 

AARP’s Top 10 Health Tech Innovations for 50+

A colleague at Caring.com tipped me off this week to AARP’s recent HealthInnovation@50+ LivePitch event, which took place on Sept 21st in New Orleans. (Thanks Kate Boyd!)

It is interesting stuff if you want to see what AARP’s team considered promising upcoming health tech innovations for the 50+ set.

Essentially, AARP invited companies with a new consumer-oriented health technology for the “50 and over” market to apply for one of ten spots at the LivePitch event. At the event, they got to present two pitches: one for investors, one for AARP consumers. The companies had to be fairly small (less than $5 million in funding so far) and prepared to launch their product within one year of the event.

The list of the ten finalists is here.

As an on-the-ground doctor focused on caring for elderly people, here’s my version of the list with short synposes of the service. My initial reactions are in purple:

  • 1 Doc way: Web-based platform for videochat and telemedicine; doctors pay small fee to use, free to consumer. Presumably doctors will adopt in order to do reimbursable telemedicine visits.
    • Meh. One, I’m not sure I can practice good geriatrics on patients I’ve never seen in person. Two, couldn’t I use Skype, or something free?
  • Abilto: Behavioral health therapy via video. According to the video on their site, they can provide a health coach and cognitive behavioral therapy(CBT), including in evenings.
    • I’m interested. I’ve had trouble getting patients and families in to CBT; this could help solve the access issues.
    • But does this team have experience coaching patients with cognitive impairment? Mild dementia and depression is a common combo. And how effectively can this team coach and counsel caregivers of people with dementia?
  • Carelinx: A service to help consumers and others find and manage paid caregivers. They offer a screened pool of caregivers, and then infrastructure to manage schedules, payment, etc.
    • I’m interested. I often recommend families consider getting paid help; a service that makes this easier for families to do would help hugely.
  • CareTree.me: Per their site “CareTree is the new communication and collaboration platform for
    Caregivers, family members, and services providers to keep each other in
    the loop.”

    • I’m a little skeptical. The goal is laudable, but unclear how they plan to convince service providers (like doctors) to participate. No busy provider wants to have to check in with an extra service unless there is a good financial incentive AND it’s pretty feasible from a workflow perspective.
  • Evermind: Technology that monitors the electronic appliances an older person is uses as part of daily routine. Presumably alerts family to a change. Not yet much info on their website.
    • Weird! Could be an interesting gizmo for families to know whether a loved one has deviated from routine.
  • GenieMD, LLC: Cloud-based iPhone app to track medications, vitals, emergency contacts, and provide prepackaged health info.
    • Meh. Hard to imagine this being used by a geriatric patient. Not at all clear how this interfaces with the doctor. I’ve not been impressed by similar products in the past.
  • GeriJoy: Tablet-based virtual talking pet! Responds to voice commands. Supposed to reduce social isolation by providing the benefits of pet ownership without the pooper-scooper.
    • Love the name! Does kind of sound like a gag gift, but maybe older people will like this a whole lot more than I realize.
  • LivWell Health: I confess I had trouble figuring out what this one does, here’s their own blurb: ” For about the cost of a coffee a day, subscribers can: Access a
    web-based care coordination system, book vetted service providers, and
    video-chat with their Concierge!” I think this may mean this is a type of virtual geriatric care manager?

    • Meh, probably not for my patients. Really seems to be more of a lifestyle support app; not clear that it will help much with medical issues.
  • MedClimate: Secure mobile “EHR-agnostic” patient portal system, includes e-prescribing, video conferencing, appointment scheduling, online billing, and integration with remote monitoring devices. Seems to be meant for doctors, as a mobile adjunct an existing EMR (you can write soap notes and export to EMR).
    •  Well, maybe. I expect physicians and patients will be more interested in portals over the coming years, and I believe portals are required for Stage 2 Meaningful Use.
    • Will providers want to use this, rather than the portal native to their own EMR?
  • QMedic: Next-generation personal emergency response system (PERS) based on a wristband; family can access activity remotely.
    • Sounds good, although I actually don’t know nearly as much about PERS options as I’d like to.

What I’m most interested in:

Definitely Carelinx. It’s a service that I can see trying out right away, as it meets a need that I have as a geriatrician (need to help families find paid help when it seems they need it). It also doesn’t require me to make much change to my own workflow.

Next most interesting to me is Abilto, especially if their coaches and therapists have any experience helping people with mild dementia, or dementia caregivers. This is a large area of inadequately met need, so I hope they’ll consider developing this expertise.

I’m also interested in QMedic, although before recommending a PERS to any of my patients or families, I’d probably need to find out more about how much it costs relative to more conventional options.

What strikes me about the LivePitch event:

I’m pleasantly surprised to see that even though the event was billed as health tech for the 50+ market, I can envision most of these being applied to geriatric patients. Possibly this is because many boomers are worried about aging parents.

However, I’m a little disappointed that the event involved pitching to investors and consumers, but not to geriatricians or geriatric care managers. The feedback of clinicians and eldercare providers would be useful, both because we’d be interfacing with most of these technologies, and because we are influential when we recommend things to our patients and clients.

And which companies won at LivePitch?
(Note: I did write my thoughts above before seeing who won.)

The investor judges voted for Abilto.

The consumers voted for Carelinx.

I will be keeping an eye out for these companies’ product for sure, I would love to give them a try. Which products could you envision working with?