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In Search of Technology that Improves Geriatric Care

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Aging 2.0: On Engaging Innovators & 11 Startups

[This post was first published on GeriPal on 11/25/13.]

If you are interested in the intersection between aging and innovation, these certainly are intriguing times.

Last Thursday I attended the kickoff event for Aging 2.0’s brand new GENerator program. This is “a new founders program that supports the most promising entrepreneurs working to enhance the lives of older adults and improve long-term care.” (Which I think means this is a business accelerator, but after only a year blogging about digital health innovations, I can’t promise to have mastered all the business lingo.) 
Despite the whopping size of the boomer market (see this terrific Bloomberg article on how business has so far struggled to tap it), this seems to be the first accelerator focused on serving the 50+ demographic.
I found myself impressed both by the growth of Aging 2.0 — an organization co-founded by a gerontologist only 18 months ago — and by the offerings of the eleven companies chosen. It’s encouraging to see the power of innovation and technology really focusing on the problems affecting older Americans, and those who serve them.
Of course, I also find myself with some reservations. I think of myself as a public-health geriatrician, and as such, my primary interest in these new innovations is less about whether there’s a good business market, and more about whether or not these offer good, practical solutions to the more important health and social problems affecting aging adults.
There is no question that entrepreneurs are great at innovation. But to succeed they also need to be great at selling their product. Businesses involved in healthcare or other socially-minded arenas always proclaim that they are doing good things for individuals and for society. Which sometimes is true but often it’s not quite as true as the business says it is, or as the business would like it to be. In the end, a startup must satisfy its investors. And an accelerator must satisfy its startups and investors.
So what does this mean for those of us professionals with expertise assessing social value and healthcare value? It means we should get in there and plan to constructively engage with two crucial groups. One group is the the innovators themselves, who will be interested in our expertise and feedback (although once they have a product at market they’ll probably be ambivalent when we raise concerns). 
The other group is the public to whom these products are being marketed. We can and should equip ourselves to help the public assess and understand the real health and social value (or at least, likely value) of these innovations that they are being invited to purchase. 
This public, needless to say, is quite a large group. It encompasses the 50+ demographic, as well as those offering services to this group, including long-term care and senior housing providers. And the sheer size and diversity of the 50+ age group is really something: the US Census data shows that in 2011, the 50+ population (civilian, non-institutionalized) was 98 million people. 
Of those people, many are family caregivers worried about an aging adult. Others are themselves in need of products and services to help cope with chronic illness, cognitive problems, or physical frailties. And of course, a large group of boomers is eager to maintain health and wellbeing for as long as possible. 

11 Startups chosen by Aging 2.0

For its inaugural GENerator program, Aging 2.0 chose eleven companies. I heard each give a short talk last week. Here are capsule summaries, based on what I heard, along with a few extra thoughts. 
  • BrainAid: smartphone or tablet app with patented software meant to help people compensate for executive dysfunction. Originally designed to help people with brain injury or stroke, the company believes its software can help people with early Alzheimer’s or other neurodegenerative cognitive impairment as well. Company has been working with the VA.
  • CareLinx: online marketplace allowing families to find, screen, hire, and pay in-home caregivers without going through an agency. (I wrote about CareLinx last year; still think it’s a promising idea although I have no idea how well it’s actually working out for the families and paid caregivers involved.)
  • CareSolver: a free online platform that provides customized tools to help family caregivers manage the needs of aging parents or other loved ones. This is right up my alley given my long interest in caregiver education, so I will probably try this soon. Of note, they apparently offer a Beer’s criteria med checker (something I’ve said we need in previous GeriTech posts).
  • Life2: predictive analytics company focusing on aging. From the short presentation provided, seems to me they might focus on helping LTC providers identify residents at increased risk, along with offering support in mitigating the risk. Suspect mitigating risk will end up being harder than identifying those at risk.
  • Lift Hero: “Medical Trips Made Easy,” says the website. Connects seniors who need rides with off-duty EMTs who provide door-through-door service to appointments. (Having seen elderly patients struggle to get to and from the curb, that “through” could be important.) This could be a very useful service although if the passengers are on average frail enough to benefit from EMT drivers, or have cognitive impairment, I certainly hope clinicians will have a way to connect with the care circle regarding the visit. (Often the person accompanying the older patient is instrumental in providing extra history, or in helping relay instructions to the care circle.)
  • MyGrove: This one flummoxed me a bit so I’ll just quote the blurb passed out at the event: “a multimedia marketplace and social engagement platform tailored for Active Adults and their communities.” If you, like me, aren’t sure what an Active Adult is, it’s apparently a term used to refer to people aged 55+. (What to call Active Adults when age and illness render them less active? I don’t know.) Whatever this product is, it sounds like they are targeting the “young old” who aren’t yet close to needing geriatric expertise.
  • OpenPlacement: platform designed to help seniors, families, and discharge planners find and choose among rehab or residential placements more easily. I assume this is modeled on OpenTable, although obviously placing seniors is more complicated than making a restaurant reservation. Should be helpful to families and discharge planners facing transitions in care, since right now families often find it’s a nightmare to figure out who accepts their insurance, has beds available, offers certain features, etc.
  • Sabi: Per Google, the “pill box and walking cane company.” Per Sabi, a creator of products that improve day-to-day life with “superior functionality and design.” The website reminds me of the dilemma many companies face: how to sell products to older adults without reminding them that they are older? Still, the products really are attractive and look quite functional too.
  • Tapestry: App for web and mobile which simplifies social media for older adults. Meant to help families stay connected, by creating an easy interface for seniors to view Facebook photos, email, photos, etc. Currently has a free basic plan or for $5/month offers unlimited messages and photo storage. In general I think this kind of service will ultimately very useful to many older adults. Almost every older person loves to get messages and pictures from family, but navigating a standard tablet can be overwhelming to some, either because they are not tech-savvy or because they are cognitively impaired.
  • True Link: A caregiver-managed debit card allowing personalized spending controls and with fraud-protection features. The founder said that every year seniors lose $52 billion to scams and fraud (!); True Link is meant to offer vulnerable seniors a way to spend without putting themselves at excess financial risk. Caregivers can block spending on certain merchants or types of merchants (i.e. sweepstakes.) I could see this being a great option for seniors with cognitive impairment, and wonder if it will be of interest to financial trustees and fiduciaries. For families, the hard part will be bringing up their concerns re finances to an older loved one; proposing this option likely will be dicey. 
So there you have it: eleven ideas meant to make life better for older adults and their caregivers. Will they take off? Will people use them? Will people like them? (And how will we know if people like them? Hopefully users will have some way of posting reviews.)
Last but not least, will these improve outcomes in terms of wellbeing, function, avoiding morbidity, and reduction of caregiver stress?
We should find out the answers to at least a few of these questions over the next year or two.

And we should think about giving the innovators, as well as the public, constructive feedback on these products. They surely aren’t perfect, but they are a step in the right direction and most of them are trying to meet real needs of aging Americans.

In the meantime, if you’re a clinician or work on healthcare for older adults, which of these ideas do you find most promising?

[Disclosure: I have no financial ties to any of these companies, or to Aging 2.0.]

Why We Can’t Leave It to Business to Educate Us

[This post was first published on The Health Care Blog on 4/5/13.]

Recently I came across yet another media article with suggestions as to how digital health products can gain more widespread adoption. The writer notes that “we can learn a lot from the pharma and healthcare industries,” and goes on to discuss the importance of engaging the doctor.

This article, like many I read, doesn’t acknowledge the downsides of using pharma’s tactics.

I have to assume that this is because from a business perspective, there aren’t a lot of downsides to pharma’s tactics. Pharma, along with many other healthcare industry players (hospitals, insurance companies, device manufacturers) has overall been extremely successful from a business standpoint.

So if the intent is to help digital health companies succeed as businesses, then by all means one should encourage them to copy pharma’s tactics.

But as we know, what works for business has often not worked well for serving the needs of individual patients, or to society from a health services and public health perspective.

This despite the fact that pretty much all businesses in healthcare proclaim that they are there to serve patients and society. Of course they will say this. This isn’t surprising at all.

What I have found a bit surprising, though, is the extent to which most of the media coverage of digital health is business-oriented and business-boosting. (I suppose this is because tech has always had a very close relationship with business and consumerism.)

Now, I do firmly believe that digital health innovations are absolutely essential to solving the country’s most pressing healthcare problems. I also believe that dynamic entrepreneurial energy is generally better at developing these innovations than are academic institutions or government entities.

But I worry about the extent to which business and entrepreneurs are directing the conversation on which innovations and approaches will best serve individual patients, and society. Business’ track record in this respect is really bad. Which makes sense: once a company has invested time and resources in bringing a product or service to market, they are going to try to sell it to the rest of us, whether or not it’s good for us.

In other words, although we need business innovations to help drive much-needed change in healthcare, I’m leery of letting business dominate the outreach to clinicians and society.

So, here are some related issues that I’ve been pondering lately:

  • How to encourage the media coverage of digital health to include a little more “in the interest of patients and the public” perspective?
  • How to help clinicians, academics, and health services experts learn about digital health, in a less marketing-directed way? (I’ve been informally polling my colleagues recently: most have never heard of e-patients and know very little about digital health. This means we have hardly anyone without financial ties to industry who can talk to tech journalists or others.)
  • How to foster more constructive interchanges between the digital health entrepreneurs, who have terrific new ideas, and health experts, who should be critiquing these new ideas and providing feedback on how the implications of adopting these products at scale, and how these products might be viewed in a broader health context?

For all these questions, it seems we would need to start by providing clinicians and healthcare experts with a way to keep current with digital health trends and technologies. And this way should not be unduly influenced by marketing efforts or entrepreneurial enthusiasm.

How should clinicians, academics, and non-profit experts learn about digital health?

It’s normal for the providers of these new technologies to volunteer to do the job (as pharma has historically done when it comes to new drugs), but we need viable alternatives that have fewer financial stakes in the education effort.

The problem, of course, is that our usual sources of more-objective-information-in-true-service-of-healthcare seem really unsuited to helping us understand emerging digital health technologies. For instance, by the time any high-quality peer-reviewed research is published, the technology studied is likely to be hopelessly outdated. Likewise, expert guidelines and panels take way too long to digest, process, and present their findings. So clinicians can’t keep current by relying on these time-tested methods of curating information.

Also, there is also a volume of information problem. I’ve been trying to learn about digital health for the past six months and it’s like trying to drink from a firehose.

Hence, I’ve been thinking that what I personally really need is a source of up-to-date commentary and information on digital health that is sensibly curated, and tailored to my clinical interests, i.e. the healthcare of medically complex older adults. To date, I’ve found sites that are related to caregiving, or consumer technology for seniors, or healthy aging, or evaluating assisted living. But none about technology for geriatric healthcare in particular.

So here is my latest idea: I’ve recently been wondering if something like the Journal Watch model could be adapted, to help clinicians keep up with key developments in digital health. (I subscribe to Journal Watch General Medicine.)

What I particularly like about Journal Watch is:

  • They review several key published articles every week, most of which are clinically relevant. (Occasionally there’s something about an exciting new bioscience breakthrough.)
  • They provide a nice concise summary of the research.
  • Each article summary is accompanied by a short comment written by a clinician-editor. The comment is by far the most valuable thing to read, since these editors tend to have an excellent grounding in the pragmatic aspects of clinical work, as well as a good understanding of the health-services implications of the study.

For comparison to the idea above, consider something like iHealthBeat.org. It is fantastic that the California Healthcare Foundation provides this service. And yet, I unsubscribed a while back.

Why? The snippets are too varied – nobody has selected items of special interest to clinicians and academics focused on medical care for older adults. Plus, the snippets themselves don’t feel like they’ve been selected and edited by someone who understands my needs and priorities – unsurprising since they aren’t chosen or commented on by another general internist.

Just as Journal Watch is intended to help clinicians keep up with “Medicine that Matters,” we need a Digital Health Watch service for clinicians, tailored for different specialties, to help clinicians and academics keep up with “Digital Health that Matters.”

Journal Watch, of course, isn’t free. But then again, most good sources of information aren’t.

If we had a good method for clinicians to learn about digital health, then we might see more healthcare experts constructively critiquing the efforts of the digital health entrepreneurs.

This might not be great for every company’s business, but could be very good for clinicians, individual patients and society.

Summing it up

It’s understandable that the entrepreneurial digital health community will want to engage and educate clinicians. However, as we’ve seen with pharma and other profit-oriented healthcare industries, there are significant downsides to letting business dominate and direct clinician education.

To date I’ve found that many of my colleagues in academia know little about digital health, or emerging technology innovations. This makes it difficult for medicine’s expert community to thoughtfully engage and critique the ideas of digital health entrepreneurs.

The overall healthcare needs of society would be much better served if clinicians and academics could learn about digital health via sources that have no significant financial conflict of interest. I would love to find a “Digital Health Watch” service similar to Journal Watch.

If you can recommend a high-quality, not-too-business-oriented source of information on digital health for me to follow, please comment or send me an email.