GeriTech

In Search of Technology that Improves Geriatric Care

healthcare technology

Technology predicted to replace 80% of what doctors do: challenges to overcome for senior health innovations

If you, like me, believe that technological innovations are key to providing better care to seniors at a reasonable cost, then Vinod Kholsa’s recent article on technology and doctoring is a must read.

Kholsa predicts that “computers will replace 80% of what doctors do and amplify their capabilities.”

I myself am all for getting technology to currently do — or help me do — many of the tasks that are involved in my line of doctoring: comprehensive high-quality primary care to seniors with multiple chronic medical problems, as well as to frailer elders with geriatric problems such as cognitive impairment, falls, and overall declines in function and independence.

I especially appreciate Kholsa’s emphasis on the very sensible ways technology can augment clinician’s capabilities (like capturing and processing data), and allow us to focus on what we might do best (the human relationships parts of medicine). I really can’t wait for the day when I can focus on relationships and helping families navigate their healthcare challenges, rather than getting bogged down in data chasing (how often is she agitated at night? when did she poop? what labs has she had? what meds is she taking?) and communication issues (what did the oncologist tell you? what medications have others prescribed for you?).

So my question is, when and how do we make this happen for the healthcare of older adults?

The challenge of getting technology to replace what doctors for seniors do

The thing is, it’s much easier to get technology to do 80% of what my doctor does, compared to getting technology to do 80% of what I do as a doctor.

I’m a healthy 36 year old woman. My doctor mainly needs to help me with prevention, healthy lifestyle choices, and family planning.

Whereas when I provide medical care to my patients, I do much much more. That’s because my patients have multiple chronic problems, many of them at advanced stages, plus often cognitive impairment and physical limitations.

It should go without saying that it’s by providing tech assistance in the care of the more medically complex patients that we collectively stand to gain the greatest benefits, both in terms of improving the quality of care for individual patients (and families!) as well as getting better value for the money society spends on healthcare.

There are certainly some very complicated pediatric patients, and younger adult patients. However overall, the bulk of illness (and healthcare spending) is concentrated in older adults.

Everyone agrees on the need to treat chronic illnesses upstream, and in the outpatient setting. But unfortunately, as best I can tell, most healthcare tech innovations are NOT geared towards facilitating high-quality outpatient care of seniors with multiple problems.

Why? I’ve been trying to figure this out, and here’s what I’ve come up with so far.

Why it’s hard to design useful healthcare tech innovations for the primary care of older adults with multiple chronic problems

  • Medicine emphasizes a disease-based focus, so technology has done the same. Even though primary care doctors must often deal with multi-morbidity (patients having several chronic illnesses), healthcare is still mainly organized and specialized along disease-based lines. Many healthcare tech innovations seem to be following suit, possibly because the developers tend to team up with a specialist in the clinical area. Also, a number of tech innovations are spearheaded by a young tech-savvy person with a given disease. (Will we have to wait until the tech developers hit their 60s and are suffering from multi-morbidity before we get tools designed for people with multiple illnesses? I hope not!)
  • A narrower focus is easier to design solutions for for than a broader one. We already have this problem in research: easier to design and conduct a good study when you focus narrowly on a certain population and exclude the messy complex people with additional health diagnoses (or trouble taking their meds). Unfortunately, in the real world of clinical care for older adults, many patients have messy and complex health needs. And/or don’t take their meds. This has made it hard to apply research findings to them, and is going to make it hard to apply many tech solutions.
  • Older people are perceived as less inclined to use technology. There is definitely something to this. I’m not even very old and I see a big difference in how people ten years my junior are integrating technology into their lives. So this adds to the design challenge for the innovators: designing solutions for seniors means figuring out how to meet them where they are technologically, and how to make things extremely user-friendly. Added twist: the way older people use technology is rapidly evolving, and partly depends on what kind of technology is available.
  • Technology for the health of older adults requires more interfacing with clinicians. In other words, if you design a tool meant to help an older adult manage a medical problem, you need to design something that works for the patient, AND the clinician. Two users is harder than one. Even if it’s a nominal clinical interface (like all the web portals for each app; please note that we doctors will probably not be willing to log into more than 1-2), it’s still more work than designing some wellness app for consumers to use on their own.
  • Technology for the health of older adults needs to be accessible to those with limitations, and accessible to caregivers. Specifically, many older adults have physical limitations (vision, hearing, finger dexterity) as well as cognitive limitations (dementia) which could affect their ability to use a technological health tool. Plus older adults with limitations are often being assisted by family or paid caregivers, so tech tools need to accomodate that as well. Add another two ticks to the list of design challenges.
  • The business case is trickier for the Medicare population. Who will pay for the use of the technology? Will it be the insurer? The patient/consumer? The family? The ACO? These questions seem to be especially uncertain when it comes to the Medicare population. As the perceived business case is very important to the innovators and entrepreneurs, this may be why they aren’t focusing as much on developing solutions for older adults.
  • Healthcare for seniors is perceived as less consumer-driven than healthcare for younger adults. This is probably a combination of insurance issues and cultural issues. More and more younger adults are either uninsured or under-insured for primary care; this means there is more of an opportunity to directly offer them technological solutions for their health needs. Whereas older adults obviously have Medicare. On the cultural side, older people are more likely to accept the old-fashioned model of medicine in which the doctor takes care of things, and you try to do what the doctor tells you. (I know this because my patients often ask me to tell them what to do.) As Kholsa points out, consumer-driven healthcare is a powerful partner for healthcare tech innovation. But since consumer demands tilts towards the young, innovative solutions are tilting towards them too.
  • Regulatory issues are trickier, the more medical a technology solution is. How these mobile health and other new technologies will be regulated by the FDA is up in the air. In the meantime, personalized medical information = protected health information, which means it’s subject to HIPAA. This presumably complicates things if you are trying to design an innovative solution meant to help older patients manage their health. For instance, I recently blogged about patients needing help implementing the multiple recommendations we clinicians usually have for them. Would a solution need to be HIPAA compliant? Probably.
  • Healthcare emphasizes hospitals and transitions more than regular outpatient care. Hospitals are where most of the healthcare dollars are spent, have more data on what’s going on, and are also more visible to most academics and other experts in healthcare. Guess where ACOs are going to be focusing their efforts (and sponsoring technology to support this)? It’s not on the average outpatient senior. It’ll be on the “high-utilizers,” i.e. the ones with frequent hospitals and transitions. In principle everyone wants to help people in the outpatient setting before they become high utilizers, but in practice the attention goes to where the money and clout is.

These are the main factors I’ve identified so far. Does anyone have additional ones to add to the list, or comments on these?

And how to work around these factors? Given the above factors, it seems fairly daunting for a tech start-up to create innovations for the primary care of seniors, unless foundations were to step in and provide a much needed boost. (Is there an RWJF Pioneer-like program for outpatient health innovations, for seniors with multiple medical problems?)

Now I don’t want to say that no one has thought about meeting the outpatient healthcare needs of seniors. But I do see the innovations tilting towards the younger and less medically complex. Which is understandable, but regrettable from a senior/geriatric public health perspective. (See last week’s post for my plea that mHealth help me help my patients, who need more than wellness and help making better lifestyle choices.)

 

In a nutshell:

Healthcare technology innovations are disproportionately oriented towards the needs of younger, more tech-adept individuals. Older adults have more complex healthcare needs. They (and us as a society) stand to gain the most from technology improving healthcare, and amplifying the capabilities of clinicians to provide care. But their healthcare needs are harder for the innovators to meet. So, if we want technology to help us with the healthcare of seniors, we will have our work cut out for us.

My latest list of why it’s hard to provide good tech tools to my patients is above. I’d love some help revising and refining it.

As always, comments and suggestions as to how to harness healthcare tech innovation in the service of better outpatient care for seniors will be much appreciated.

mHealth: We need more than prevention, information, and lifestyle

With smartphones and wireless technologies becoming ubiquitous, mHealth
(mobile health; also known as “connected health”) is one of the hottest areas for healthcare tech innovation.

What will this mean for primary care? Well, if you’re a clinician and want to know what many thought leaders in mHealth think is important (and think of us), I highly recommend you read this essay by Robert McCray, the President and CEO of the Wireless-Life Sciences Alliance.

Here’s a summary of the key points as I understand them:

  • The problems:
    • An epidemic of obesity and chronic diseases, in large part due to people’s behavior choices and lifestyles.
    • Individuals erroneously assuming that technology will save them from the consequences of their behavior.
    • People have ceded responsibility for fixing their health to institutions paid by third parties.
    • Physicians have focused on “transaction-based medicine” and have not focused enough on improving the health of patients through modifying harmful lifestyle choices.
    • Physicians have focused more on defending their turf, autonomy, and income, than on the health of patients.
    • Neither patient nor provider has responsibility for health outcomes.
  • The solutions:
    • People must “embrace the responsibility for their health and demand the tools to discharge it,” rather than assume someone else will take care of the problem.
    • Citizens and consumers must set expectations for the institutions that deliver healthcare services.
    • Physicians should “‘prescribe’ healthier living habits by directly addressing the harmful lifestyle choices that their patients present.”
    • mHealth tools will provide access to “all the knowledge that is needed to reduce the need for healthcare and to select the best healthcare approach when it’s necessary.”

In summary, a major problem is that people are making crummy lifestyle choices, and physicians aren’t doing enough to help them with this. People need to take responsibility and armed with the tools of mHealth, need to start ensuring that they get help making healthier living choices.

Well, maybe this could work if we’re talking about a population of younger educated Americans. But what about the millions of older people now struggling with multiple chronic health problems? Don’t they need much more than healthier living habits and prevention? And how much responsibility can we expect them to take on?

When consumers need more than lifestyle changes

McCray makes some good points in his manifesto. However, his proposed solutions aren’t enough to handle the most pressing health policy priority of the next 30 years: effectively managing the primary care of the Medicare population.

In particular, how well would these ideas work for the many older adults currently suffering from multiple chronic illnesses?

Consider the patient scenario I described in my recent post on managing multiple recommendations: an older adult diagnosed with diabetes, high blood pressure, arthritis, and glaucoma, and experiencing falls, urinary frequency, anxiety, social isolation, and difficulty managing medications.

Let’s say this person is a 70 year old overweight woman, and let’s call her Janet Doe.

How well do McCray’s analysis and proposed solutions fit with what I know of patients like Janet Doe?

Well, it’s true that poor eating and exercise habits, and obesity, are strongly correlated with developing and exacerbating diabetes, high blood pressure, arthritis, urinary complaints, and cognitive impairment (which could be why Janet’s struggling with her meds).

So maybe she made poor lifestyle choices. Or maybe she made the best choices she could in her life circumstance. Who knows? Public health professionals know that people’s health is often strongly affected by factors that individuals have difficulty controlling (like fast food advertising, access to safe parks, etc).

Otherwise, I wouldn’t be surprised if she didn’t get the best comprehensive primary care (so hard to provide good primary care under conventional practice circumstances!) or good behavioral interventions. And yes, she probably was assuming that the system would take best care of her.

Let’s move on and now talk shop about mHealth helping her out. I have four particular comments in response to McCray’s article:

  • Many patients need more from clinicians than the prescription of healthier living habits. A patient like Janet Doe needs high-quality outpatient medical care to manage her many medical problems. This should be grounded in a mutually respectful collaborative relationship with a clinician. Obviously we have a long way to go before clinicians routinely offer patients the engagement and patient-centeredness that everyone deserves. We do need patients and families to constructively demand more from their doctors and their healthcare. But let’s be clear about the outcome we need. It’s not doctors addressing harmful lifestyle choices. It’s doctors applying the full range of their medical expertise, in order to help patients and families achieve the best health outcomes possible given the medical circumstances and the patient’s preferences.
  • Many patients don’t want to be in charge or responsible. Hard for us educated control freaks to always appreciate, but in my experience true. I find patients and families especially prone to become overwhelmed once there are more than 1-2 chronic diseases to deal with. And of course, less educated patients generally struggle more than educated ones.
  • Many Medicare patients will develop cognitive impairment. Presumably in McCray’s vision, responsibility then devolves to the spouse or next of kin, as it does now for financial affairs. But these family caregivers are already struggling to manage medical responsibilities. We should only lay more responsibility upon them if we really are able to offer tools and resources that will make this added work manageable. 
  • Medically complex patients absolutely need a physician’s expertise to synthesize the ongoing care of multiple chronic conditions.  You can call it a quarterback, a navigator, an expert outpatient consultant (my current practice), or just a plain old-fashioned good PCP. Whatever you call it, it takes a live person with physician-level expertise. Patients need and want to talk to someone who can help them sort through the complexity and choose among the options. New technologies can offer much needed support to everyone involved. But if we want to improve the care of older people, we need to support that patient-clinician partnership, rather than imply that it can be replaced.

What we really need from mHealth, to care for the health of aging adults

My short(ish) answer to this question is that we need tools that 1) allow clinicians to do what they need to do, faster and more efficiently; 2) allow patients and families to do all the extensive self-management that they have to take on, and 3) facilitate effective collaboration, communication, and shared decision-making between clinicians, patients, and care circle.

Here’s a wish list with some specifics that could help me with my daily clinical practice:

  • Tools to manage the multiple recommendations we generate when we see patients like Janet Doe.
  • Tools to help clinicians and families manage medications, especially when multiple providers are involved.
  • Tools to help patients and families gather the daily data we all need to manage their chronic problems, i.e. tools that collect the symptom information as easily as possible, and then make this data digestible and actionable for patient, caregiver, and clinician.
  • Tools to help multiple involved parties communicate. Older patients have family caregivers, private caregivers, home health agencies, hospitals, facility staff, and other clinical specialists involved. Need help keeping everyone in the loop and coordinated.
  • Decision-support tools. Do you want us to discuss the risks and benefits of a certain medication or procedure? Make that data easier for the clinician to access quickly. Make it easy for families to find suitable decision guides for common medical decisions.
  • Better personal health records. Patients should be able to easily access their medical information. They need meaningful summaries. They need access to their labs and other diagnostic data. They need to be able to easily share this with the clinicians of their choosing, so that they can help coordinate their care, get the right care in an emergency, or easily ask for a second opinion.

I could go on, but I’ll stop there for now.  Clinicians, what’s would be on your own mHealth wish list?

To Mr. McCray and his colleagues, I applaud their much needed efforts to change healthcare, and I do think mHealth technologies have wonderful potential to improve the health of the elders and families I work with. The questions to keep discussing, of course, are how to apply these technologies, how to redefine the roles of patients and families, and how to enable clinicians to do their best work in partnership with patients.

In a nutshell

An approach relying on consumer-directed health and mHealth-powered lifestyle management could work for the educated and relatively healthy American. But many seniors with multiple medical problems will not be able to take on primary responsibility for their health outcomes.

Most older adults need more than prevention and healthier living habits. When people have multiple chronic illnesses, they have substantial ongoing primary care medical needs. These older adults will need physicians to help them synthesize the care of multiple conditions, and to navigate complex medical decisions. mHealth can’t replace this partnership, but can certainly support it, by creating tools that facilitate effective collaboration and communication between clinician, patient, and caregivers.

When multiple problems lead to multiple recommendations; how to help patients succeed?

How to help patients and caregivers keep track of and follow through on the many things we ask them to do?

I found myself thinking about this yet again last week, after the group of UCSF students I was teaching brought up the following concern:

“We’re worried about the patient getting overwhelmed by our making too many recommendations.”

Good point, learners.

I had to admit to them that I probably don’t think of this nearly as often as I should. But it’s such a good thing to consider. Because the truth is, I think it’s often harder than we realize for patients and caregivers to keep up with the plan for the many problems on an older adult’s list. (It can also be tricky for a clinician to not lose track of everything going on — a topic for future posts.)

In geriatrics, of course, we usually have a lot of problems to address: six or more in a visit isn’t uncommon in my practice. That’s because frail older patients have many ongoing chronic conditions, and often raise additional complaints at each visit.

But even younger Medicare patients often present with multiple problems.


Here’s a common scenario: If you have diabetes, high blood pressure, arthritis, glaucoma, are on eleven medications, and in the visit we uncover uncontrolled blood sugar, too high blood pressure, falls, urinary frequency, anxiety, trouble managing medications, and social isolation, then we are going to have a lot of shared decisions to make. Which will lead to a long list of recommendations.

Furthermore, I consider difficulty managing meds to be a sign of possible
cognitive impairment or possible financial difficulty; if either or both
are present, then plans for every other medical problem will need modifying.

(Also note that this isn’t a very medically complex patient in geriatrics; many present with this stock set of problems plus congestive heart failure, COPD, kidney disease, and complaining of pain and shortness of breath too. Oh and, rash and toe fungus. )

So here we are now with our mutually-agreed upon problem list and care plan. Now what?

The challenge for patient and caregivers: so much to do

My own experience has been that most patients and families have trouble keeping up with more than 1-2 recommendations. The trouble is, for adults with multiple medical problems, a single visit can generate multiple recommendations. And of course, the more action a recommendation requires, the less likely it will happen.

The simplest recommendations ask patients to do something simple, just once. Like “Stop medication X.”

But most recommendations are more complicated: “Increase your metformin to 500mg three times daily” requires a small ongoing change in what a person does every day.

Then there’s “Talk to your daughter about helping you figure out a way to not forget to take your medications.” (This is the kind of amorphous directive that the Heath brothers warn about in Switch, one of my fav books on change management.)

Or, “Check your blood sugar every morning before eating. If your blood sugar is over 150 for three days in a row, increase your Lantus by 2 units.”

Or “Start bladder training. You can review the attached handout for instructions.”

Let’s reconsider the example of the patient above, with her out of control blood sugar and blood pressure, plus falls, anxiety, urinary frequency, difficulty managing medications, and social isolation. Here are the problems we routinely face in helping such patients:

  • Do we list recommendations for all the problems we uncovered in the visit, or just for a few?
  • For every problem we make recommendations for, how to help patients and caregivers follow through?
  • If we focus one just one or two problems, how do we ensure we don’t lose
    track of the other issues? (Patients seem to hate coming back every
    week for another visit, but that’s often what we suggest, assuming we
    have appointment slots available.)
  • How do we clinicians update the plan for a problem, based on feedback we get from patient and family? (Many problems require a trial of an intervention before we can decide how to proceed long-term, or may require diagnostic results before we move on.)

What kind of technology can help us?

 
Technology is already helping, in that EHR systems are now creating clinical summaries for patients (it’s a criteria for Stage 1 Meaningful use).

This is a step in the right direction, but it’s not enough.

What patients and caregivers (and the clinicians helping them) really need is something more on the order of a sophisticated task management system. Or possibly even project management tools.

Specifically, we need something that:

  • Can keep track of multiple problems and recommendations
  • Helps patient and clinicians identify which recommendations will be the focus now, versus later
  • Allows us to update each other on the status of problems, and the plan for each problem
  • Allows us to break down the plan for a given problem into manageable and actionable chunks
  • Allows us to share information as needed with others involved in addressing a problem, i.e. other clinicians (such as nurses for problem-specific coaching), family caregivers, etc.

A bonus in my view would be technology that allows the clinician to enter several recommendations all at once (when the clinician is thinking comprehensively about the patient), but allows patient and caregiver to work through them over time.

So for instance, let’s imagine that for the patient above I have recommendations for the following problems:

  • diabetes management
  • blood pressure management
  • urinary urgency
  • falls
  • anxiety
  • medication management
  • socializing

Let’s also assume that the recommendations for these problems are NOT interdependent (often they are, but we’ll go for a simpler scenario).

I’ve actually discussed and provided management recommendations to patients and families on this many problems within a single 30 minute visit (it’s a bit of a hustle, but possible).  But asking the patient to take action for each problem would probably be overwhelming.

However, imagine a platform in which I propose recommendations for all problems and prioritize them. On the patient’s side of the technology, he or she gets to work through a problem for a period of time, and then later is given recommendations for the next problem. (These could be staggered based on time, such as weekly, or based on completion of the previous problem’s plan.)

Such technology could allow us as clinicians to be more comprehensive, with less risk of overwhelming patients and families. This would enable clinicians to make best use of their time, and help patients be more successful in taking the many steps needed to improve their health.

So is this technology out there? I’m not sure. Several companies are working on consumer products meant to help caregivers manage multiple tasks, but it’s not yet clear to me how easy it will be to integrate clinical recommendations into the programs.

On the provider side, patient portals are becoming de rigueur, but as far as I know, they have not yet evolved to support this kind of sophisticated care plan management for patients.

But hopefully that will change. In the meantime, if anyone has come across technology that helps clinicians help patients manage multiple problems, I’d love to hear about it.

In a nutshell

It’s very common for older adults to present to a primary care clinician with multiple problems, which can generate multiple recommendations for patients and caregivers to implement at home. But patients often have difficulty managing more than 1-2 recommendations, so a comprehensive approach is often too overwhelming.

We need technology to help patients follow through when there is a lot to do. Specifically, we need help making multiple recommendations more manageable for patients and families. Something along the lines of sophisticated task management (or perhaps project management?) would help.

The ideal technology would facilitate and reinforce effective collaboration between clinicians, patients, and caregivers, and would allow all to work through a longer problem list together over time.

If you can suggest any such technologies that might work for older adults with multiple problems, definitely let me know.

The Managing Meds Video Challenge: Where are the seniors? And can we get usability please?

If I had to pick one area in which I thought tech solutions could offer the maximum bang for the buck in improving healthcare for seniors, it would be medication management. (If you want to know why, see further below.)

So I was thrilled to notice a few weeks ago that the Office of the National Coordinator for Health IT was sponsoring a Managing Meds Video Challenge. In this challenge, people were invited to submit videos demonstrating “how one can use technology to manage meds effectively and improve health and safety.”

Yeah! I was sure this would help me find technologies to improve med management among elders. (I have a list of my technology priorities for med management at the bottom of this post.)

Well, I just viewed the six winning videos. I have bad news, and good news.

The bad news for GeriTech:

  • Not a single older person (aka Medicare beneficiary) in the winning videos!
  • Nobody taking more than 3-4 meds! One young person seems to be taking two meds, and then has to increase to four because of her wisdom teeth. Sigh. Where are the people taking 6-12 chronic meds (aka high cost Medicare beneficiaries)??
  •  Smartphone apps require laborious typing in of the medication name and dose. Crummy usability, in my mind, especially when one has more than 2-3 medications.
  • In other words, nothing that I’d think of prescribing to my patients.

 

The good news for GeriTech:

I was on the point of thinking that NOTHING here is going to help me and my patients with med management, when suddenly, I saw one of the things I’ve been looking for:

The patient uses smartphone to take a picture of the bar code on prescription bottle.

Ding! Ding! Ding! Ding! We may have a usability winner! There it is, folks, the technology I said I wanted for outpatient med reconciliation: something where you can scan the bottles and get the info on the prescription, instead of laboriously entering it yourself.

There’s a catch though, and it’s a big one: This technology is used by Walgreens and CVS as part of their prescription refill app. As far as I can tell, it doesn’t help you enter the medication into your reminder system, or into a list that can be shared with other providers and pharmacies. It just helps you buy more medications from these big pharmacy chains.

Bummer. 

Still, if Walgreens can use that technology, so can some other app developer. Maybe someone is even working on this now?

In a nutshell:

The solutions proposed by the winning Managing Meds Videos don’t look very usable for patients with significant med management needs (i.e. the ones who stand the most to gain from tech helping them with med management).

Perhaps ONC should consider a video challenge specifically addressing the needs of seniors and caregivers…they are also known as the Medicare population and I hear their needs are of grave concern to the federal goverment these days.

I do love the concept of using smartphones to scan prescription bottles. This would be a better way to enter prescription info into apps that are meant to track and organize medications.

More on why medication management is so important to improving geriatric care:

Because:

  • Meds are a prime source of adverse events in elders. In elders, falls and confusion are especially common, as are dangerous interactions due to polypharmacy.
  • Almost every clinical problem we address relates in some ways to the medications a person is (or isn’t) taking. High blood pressure? Make sure you know everything that has been prescribed, AND what the person is taking. Ideally you’d know what had been prescribed and discontinued in the past too.
  • Clinicians often do not access an accurate list of what has been prescribed, and what the elder is taking. This is especially true in the case of those many elders who see multiple prescribers.
  • Meds cost a lot of money, both to the system and to the individual elders.
  • Many medications, upon careful review, should be discontinued or reduced (or occasionally even increased). For patients and caregivers to request a good medication review, you need to start with a good accurate list. Ideally this would include when the medication was started and for what purpose.
  • Taking multiple medications is burdensome! It’s a huge logistic effort for the many elders who must take meds at three or even four times of the day, and turns into a major effort for caregivers.
  • Medications taken PRN must be properly tracked, for elder and clinician to make effective progress in managing the symptom at hand. In practice though, I’ve found this hard. (“Tell me again: how often did you use this medication? You don’t remember? Do you remember how you felt afterwards?” )
  • Medication reconciliation after hospital stays currently is difficult. It’s confusing to elders (and their primary care doctors) when medications aren’t properly reconciled after a hospitalization or other major event. 

I could go on, but I won’t right now. Suffice to say that I think we sorely need technology that does the following:

  • Allows elders and caregivers to easily maintain an up-to-date list of medications, regardless of prescriber, pharmacy, or hospital used.
  • Allows all providers to easily access the above list.
  • Helps elders take all their medication.
  • Spots medications that aren’t taken as prescribed, so that clinician and patient can discuss and work out a solution. (Facilitate engagement!)
  • Makes it easy for primary care providers to reconcile what the patient is taking with what has been prescribed (see my prev post for why it’s currently so darn time-consuming)

If you know of any tech or tools that work well for the needs above, please comment or send me an email (drlesliekernisan AT gmail).

Tech developers (if any of you happen to be reading): can you integrate zapgun entry (i.e. smartphones taking pics of prescription bottle codes) for your med management apps?

3 key points learned in a month of GeriTech

It’s now been a month since I started documenting my search for technology to improve geriatric care on GeriTech. During these past several weeks, I’ve watched some keynotes from recent big health tech conferences, started following clinicians and health techies on Twitter, met some like-minded clinicians in person and online, connected with some entrepreneurs in the health tech space, and reviewed some of the relevant peer-reviewed literature.

Here’s are three key things I’ve learned so far:

1. Healthcare tech is a hoppin’ space!

Lots of energy, lots of people, and a fair amount of money and entrepreneurial energy seem to be in healthcare tech. Recent big conferences included Health 2.0, the New York eHealth Digital Health Conference, the Wired Health Conference, the Strata Rx conference (that one is data-focused), and the Wireless Health Conference. They all seem to be combining technology, business, and a hefty dose of consumer-driver healthcare, with a variable amount of policy. Insurance companies are often partners, and sometimes their CEOs are featured as keynotes, which makes sense I suppose since big payers are big players in this arena. Some foundation support is present, especially RWJF.

On another front, the Digital Health group on LinkedIn has 13,348 members (now including yours truly), with multiple ongoing discussions and polls. A little over 1,100 appear to be physicians, although it’s hard to tell how many of them are practicing docs or academics, as opposed to physicians in industry and business.

2. There is interest in the aging space, but it’s probably not the focus of most healthcare tech innovation.

Boomers are a “large market”, and I’ve seen AARP involved in several events (including their own health tech innovation event, which I commented on here). I’ve also come across countless companies and products for aging-in-place, and connected with Aging 2.0, a group dedicated to fostering innovation for the 50+ market.

That being said, my impression so far is that most of the innovative energy is directed towards products for a younger, medically less complex population, and here’s why:

  • Private insurers are interested in saving money, and possibly also in looking hip. Boomers will be increasingly covered by Medicare, which is much less nimble when it comes to adopting new tech, decidedly less interested in seeming hip, and perennially bedeviled when it comes to saving money.
  • Healthcare tech innovators are understandably thinking of the business case when they design products. In general, seems a business case is easier to make when targeting a younger population who presumably will pay out-of-pocket, or use HSA money, or have their employers pay, or perhaps have their hip insurance companies pay.
  • For obvious reasons, it is WAY easier to design a product for younger less medically complex people. My own patients not only are medically complex, but also ideally would be offered products that accomodate vision problems, less flexible fingers, less flexible minds, the involvement of caregivers, etc. All this means that healthcare tech innovations for the elderly are a much tougher design proposition.

3. There seems to be an information and culture gap between academic experts in geriatrics, and the world of healthcare tech innovation.

Last May when I went to the American Geriatrics Society meeting, there was a talk on new innovations in technology. It was given by a non-clinician industry insider. Nothing wrong with this per se, but I do think this illustrates our relative uninvolvement in this big booming world of healthcare tech. Most likely this is because academics live on the grants-and-publication schedule, which every year is falling further behind the pace of healthcare change in the real world.

Meanwhile, here are a few telling statements I’ve heard since starting GeriTech:

“I don’t know what [integrated patient portals] are. Are they portals that give patients access to the EHR as in Open Notes?” — Academic physician & Ivy league professor, currently involved in a project of improving health care for seniors

” I am a bit of a professional techno skeptic but I am sure that
eventually it will become really and truely helpful.” — A program
director at a prominent foundation dedicated to improving the health of
older Americans.

“More care, less technology.” — Goal #3 of the Hasting Center’s Over 65 project.

Onwards and thank yous

I have a fair streak of techno-skepticism myself, but as I continue to believe that the right use of technology is critical to effectively and sustainably meeting the healthcare needs of America’s elders, I’ll be continuing to explore this space for the foreseeable future.

Clinicians, you’ve generally been pretty quiet so far, but I hope eventually to persuade some of you to contribute. Please consider:

  • explaining a clinical problem that might benefit from a tech solution
  • sharing a useful tech solution that you’ve found
  • commenting on anything tech and geriatrics that you come across
  • having me interview you (then you don’t have to write anything yourself)

Last but not least, a shout-out to some of the people who’ve helped me get going this past month:

Wen Dombrowski, MD and a geriatrician, social media maven, and healthcare tech connector who has been key to introducing me to the healthcare tech community.

Eric Widera and Alex Smith, MDs and founders of Geripal.org, who encouraged me to take these next steps into blogging and Twitter.

Christopher Langston of the John A. Hartford Foundation, who posted the very first comment on GeriTech.org, and encouraged me to keep going.

Julie Menack, geriatric care manager and aging-in-place tech maven, for giving me ideas on what to learn more about.

Mark Phillips, product manager at GE Healthcare IT, who noticed this blog early on and appreciates the perspective of working clinicians.

Jim Sabin, MD and an organizer of the Over 65 project, for his interest in this project and in learning from each other.

There are of course more, but I do have to get back to my day job now. If you’re still reading, thanks for your interest in Geritech.org, and I hope to hear from you soon!