AdvaMed, an advocacy group of medical device manufacturers, diagnostic product firms, and healthcare information technology providers, recently released a report developed by the Center for Telehealth at the Medical College of Georgia. Key report findings follow.
The report, which is based on a review of published studies on telehomecare and remote monitoring, as well as several current case studies, focused primarily on how these technologies have impacted the care of patients with diabetes, congestive heart failure and chronic obstructive pulmonary disease. Among the findings in the report:
● A study of 281 congestive heart failure patients who received telehomecare found that they experienced a 60 percent reduction in hospital admissions, a 66 percent decline in emergency room visits and a 59 percent reduction in pharmacy utilization. In contrast, the control group experienced increases in all of these areas.
● When patients with severe respiratory illness requiring long-term oxygen therapy were remotely-monitored, hospital admissions decreased by 50 percent, acute clinical problems decreased 55 percent and hospitalization costs went down by 17 percent.
● A study of 400 diabetes patients found that those monitored by in-home glucose meters and video conferencing showed significantly greater improvement in reducing average blood sugar levels than those who did not receive such monitoring.
These are impressive results, to be sure. Additional studies of the use of telehealth with such at risk patients are clearly warranted, if the reimbursement case is to be made.
Monday, November 19, 2007
Free Microchips to Alzheimer's Patients
The October 23-November 5 issue of the Florida Medical Business News featured a story about a joint venture between VeriChip and the Alzheimer's Community Care of West Palm Beach. VeriChip is offering free VeriMed radiofrequency implantable microchips to 200 patients with the disease. There are two goals for the undertaking. The first is to demonstrate that the product and the data base can raise care standards and improve the efficiency of care delivery. The second goal is to help persuade health insurance companies and CMS to provide reimbursement for the service. If one of the 200 patients is found wandering, law enforcement officials can take the patient to one of 12 hospitals with chip readers located in Palm Beach, Martin or St Lucie Counties. The chip contains a 16 digit number which enables medical personnel to access information stored by VeriChip. The patient database includes identification, next of kin contact information, allergies, medications, advance directives, and other pertinent material.
Friday, November 16, 2007
The Art Of Medicine
In the 25th Anniversary issue of Health Affairs, we find a compelling article by Dr Jerald Winakur. He reminds us that the ability to listen is a fundamental aspect of the "art" of medicine, and in so doing, warns against against the sole use of technology to assess patient status.
"One of the great lessons I have learned as I worked at my profession over the years is that the "art" of medicine is the honed ability to listen. The practice of medicine—at least the day-to-day, year-in, year-out primary doctoring that I do—involves, in large measure, interpreting stories. Words, not data; nuance, not numbers are the commodities exchanged between my patients and me. I ask a few questions over and over. The answers come in an infinite variety.
By listening to our patients’ stories, doctors glean and process most of the information we need not only to treat ailing bodies, but also to care for our fellow humans as unique beings. It is my job to evaluate and formulate from a constellation of symptoms and concerns and worries, from a blizzard of outside data of often questionable validity. Add to this a mix of freighted family and past medical history, a tendency toward superstition and phobia and fears, and a conglomeration of tidbits and details picked up in the mass media or from well-meaning friends.
I have also learned that it is not necessarily what patients tell me but what they don’t tell me—what I observe from years of being alert to nonverbal cues—that is often even more important. Those aspiring diagnosticians who are unwilling or incapable of reading this invisible text, who study only a check-marked questionnaire scrawled by the patient while she sat in another room, or who stare remotely into a computer monitor at a robotic encounter, never understand—never begin to hear—the complete story."
"One of the great lessons I have learned as I worked at my profession over the years is that the "art" of medicine is the honed ability to listen. The practice of medicine—at least the day-to-day, year-in, year-out primary doctoring that I do—involves, in large measure, interpreting stories. Words, not data; nuance, not numbers are the commodities exchanged between my patients and me. I ask a few questions over and over. The answers come in an infinite variety.
By listening to our patients’ stories, doctors glean and process most of the information we need not only to treat ailing bodies, but also to care for our fellow humans as unique beings. It is my job to evaluate and formulate from a constellation of symptoms and concerns and worries, from a blizzard of outside data of often questionable validity. Add to this a mix of freighted family and past medical history, a tendency toward superstition and phobia and fears, and a conglomeration of tidbits and details picked up in the mass media or from well-meaning friends.
I have also learned that it is not necessarily what patients tell me but what they don’t tell me—what I observe from years of being alert to nonverbal cues—that is often even more important. Those aspiring diagnosticians who are unwilling or incapable of reading this invisible text, who study only a check-marked questionnaire scrawled by the patient while she sat in another room, or who stare remotely into a computer monitor at a robotic encounter, never understand—never begin to hear—the complete story."
Sensei for Weight Loss
Check out this item from the 11/14/07 issue of Business First of Louisville. I hope the service is eventually made available from all cell phone carriers.
Sensei Inc., a joint venture between Humana Inc. and Card Guard AG, has introduced a new health and weight management program that uses cell phones as personal coaches. The program, called "Sensei for Weight Loss," currently is available to Sprint and AT&T customers.
Users go online to enter personal information such as desired weight, food preferences, meal times and exercise routines, and the program generates a customized nutrition and fitness plan. Throughout the day, the program delivers messages to the user's cell phone, such as weekly shopping lists, meal recommendations and motivational tips.
The program also records the user's eating choices and fitness activities and tracks progress toward goals. "Sensei for Weight Loss" is designed to help consumers make healthy choices throughout the day. For example, if someone plans a homemade lunch but then decides to eat out, the program can recommend an alternative meal that fits within the user's nutrition plan.
Boca Raton, Fla.-based Sensei was formed in 2005 by Louisville-based Humana, one of the nation's largest health benefits companies, and Card Guard AG, a Swiss health care technologies firm.
All contents of this site © American City Business Journals Inc. All rights reserved.
Sensei Inc., a joint venture between Humana Inc. and Card Guard AG, has introduced a new health and weight management program that uses cell phones as personal coaches. The program, called "Sensei for Weight Loss," currently is available to Sprint and AT&T customers.
Users go online to enter personal information such as desired weight, food preferences, meal times and exercise routines, and the program generates a customized nutrition and fitness plan. Throughout the day, the program delivers messages to the user's cell phone, such as weekly shopping lists, meal recommendations and motivational tips.
The program also records the user's eating choices and fitness activities and tracks progress toward goals. "Sensei for Weight Loss" is designed to help consumers make healthy choices throughout the day. For example, if someone plans a homemade lunch but then decides to eat out, the program can recommend an alternative meal that fits within the user's nutrition plan.
Boca Raton, Fla.-based Sensei was formed in 2005 by Louisville-based Humana, one of the nation's largest health benefits companies, and Card Guard AG, a Swiss health care technologies firm.
All contents of this site © American City Business Journals Inc. All rights reserved.
Wednesday, October 31, 2007
Projected Growth in the Telehealth Market
Datamonitor, an independent market research firm based in London, recently issued a report entitled "Telehealth's Increasing Role in Healthcare." They predict that the home telehealth market will grow at a five-year compound annual growth rate of 56 percent, compared to a 10 percent growth in the clinical market. The firm expects the overall global telehealth market will exceed $8 billion by 2012, driven by the needs of an aging population, a shortage of providers, and by extending the technology to a broader array of medical conditions. Growth inhibitors noted were, the lack of reimbursement, and the mismatch between available technologies and the day to day realities and preferences of end users.
Sunday, September 30, 2007
Fewer Nursing Home Patients
The USA Today recently reported that 7.4% of Americans aged 75 and older lived in nursing homes in 2006, compared with 8.1% in 2000 and 10.2% in 1990. The article further noted that the percentage of the oldest age group of seniors living in nursing homes has also been dropping. Less than 16% of the 85-plus population was in such facilities in 2006, according to the Census. In 1985, more than 21% in that age group lived in nursing homes. Few would deny that keeping seniors out of an institutional setting, for as long as possible, is good social policy. I'm taken by these observations, especially since they indicate a reduction in nursing home use, before the wide spread adoption of aging services technology.
Wii for Old and Young Alike
A recent article in The State.com caught my eye. It depicted South Carolina nursing home residents in a virtual bowling match using the Wii video game. One respondent noted that the Wii is being used across the country in senior facilities, and continuing care retirement communities, as a way of keeping seniors active. The article notes that the Wii games require the user to stand and mimic the movements of swinging a golf club, serving a tennis ball, rolling a bowling ball, or swinging a baseball bat using a hand-held remote controller. So, there is both a physical and mental component to the game's use. Amazing! And to think that my Grandson wants a Wii for Christmas. Maybe I should think of getting a Wii for one of my senior colleagues as well.
Wednesday, September 19, 2007
Continua Version One Guidelines
The Continua Health Alliance recently announced the unveiling of it's first guidelines, which will be promulgated early in 2008. The press release indicated that membership in Continua had grown six-fold, from 22 to 133 corporate members. According to the release,
"The comprehensive set of guidelines will help improve the quality of care by empowering consumers and their healthcare providers to more simply share information through common communication channels such as telephones, cell phones, PCs, TV set top boxes, as well as other dedicated health devices."
Continua's vision of readily connected health and medical devices to assist in chronic disease management is compelling.
"These interoperable devices include blood glucose tests, blood pressure monitors, pulse
oximeters and other basic vital sign monitors. Devices such as motion sensors, medication reminders and emergency response services ease the burden on family and professionals who provide care for the aging. These technologies proactively aid the secure, healthy independence of the aging in their own homes. Diet and fitness conscious individuals will also be able to seamlessly share their weight and exercise data with fitness consultants by using devices such as heart rate monitors, connected fitness equipment and activity monitors. Additionally, Continua-certified data transport hardware and software will further enhance broad based interoperability of these devices."
I was particularly taken by the announcement that Continua had decided to retain the services of Abt Associates Inc. to study telehealth reimbursement policy.
"Abt Associates will assist in cataloging, synthesizing and assessing all telehealth studies and
the peer-reviewed cost-effectiveness literature. This work will help Continua determine strategies for initiating increasing telehealth cost effectiveness, initiating quality improvement studies and for securing reimbursement for telehealth products and service."
"The comprehensive set of guidelines will help improve the quality of care by empowering consumers and their healthcare providers to more simply share information through common communication channels such as telephones, cell phones, PCs, TV set top boxes, as well as other dedicated health devices."
Continua's vision of readily connected health and medical devices to assist in chronic disease management is compelling.
"These interoperable devices include blood glucose tests, blood pressure monitors, pulse
oximeters and other basic vital sign monitors. Devices such as motion sensors, medication reminders and emergency response services ease the burden on family and professionals who provide care for the aging. These technologies proactively aid the secure, healthy independence of the aging in their own homes. Diet and fitness conscious individuals will also be able to seamlessly share their weight and exercise data with fitness consultants by using devices such as heart rate monitors, connected fitness equipment and activity monitors. Additionally, Continua-certified data transport hardware and software will further enhance broad based interoperability of these devices."
I was particularly taken by the announcement that Continua had decided to retain the services of Abt Associates Inc. to study telehealth reimbursement policy.
"Abt Associates will assist in cataloging, synthesizing and assessing all telehealth studies and
the peer-reviewed cost-effectiveness literature. This work will help Continua determine strategies for initiating increasing telehealth cost effectiveness, initiating quality improvement studies and for securing reimbursement for telehealth products and service."
Monday, September 10, 2007
VeriChips Linkage to Cancer?
Today's Healthcare IT Strategist carried this summary of an Associated Press story, which was presented, in more complete form, in yesterday's New York Times, MSNBC News, and The Lakeland Ledger.
"FDA-approved microchips linked to cancer: study
When the U.S. Food and Drug Administration approved implanting microchips in humans, the manufacturer said it would save lives, letting doctors scan the tiny transponders to access patients' medical records almost instantly. The FDA found "reasonable assurance" the device was safe, and a subagency even called it one of 2005's top "innovative technologies."
But neither the company nor the regulators publicly mentioned this: A series of veterinary and toxicology studies, dating to the mid-1990s, stated that chip implants had "induced" malignant tumors in some laboratory mice and rats. "The transponders were the cause of the tumors," said Keith Johnson, a retired toxicologic pathologist, explaining the findings of a 1996 study he led.
Leading cancer specialists reviewed the research for the Associated Press and, while cautioning that animal test results do not necessarily apply to humans, said the findings troubled them. Some said they would not allow family members to receive implants, and all urged further research before the glass-encased transponders are widely implanted in people."
The Lakeland Ledger conducted a post article survey (n=109 respondents) which responded to the question "Would you allow yourself or a relative to be implanted with a microchip that gives medics access to a patient's medical records?" 64% of the respondents said no, and 36% said yes. People who answered negatively did so for religious reasons, for privacy concerns, or because they had medical reservations about the implant. Positive voices saw value in the implant in an emergency situation, and for use in identifying patients with a chronic disease.
The MSNBC News survey (n=3963 respondents) asked "Will you get microchipped now that it has been revealed that studies are linking tumors in lab animals to the implants?" 7% said yes, 83% said no, and 10% were uncertain.
I'm buying the MSNBC results because of the larger numbers, and because the results seem more aligned with my sense of the US population's "unease" with microchip implants for humans. (Note: Tens of thousands of pets have microchip implants, without adverse medical impact, at least to date.) Privacy, religious concerns, and medical reservations are pretty powerful barriers to customer acceptance. There doesn't appear to be much evidence that these chips will be much more than a niche product, on a going forward basis. Today, VeriChip's (CHIP) stock fell by 11% , and its' lead investor, Applied Digital Solutions (ADSX) stock, fell by 10%.
Friday, August 31, 2007
High Tech Hearing Aids
On August 28th, the Wall Street Journal featured an article entitled "The Sleek, Chic, High-Tech....Hearing Aid." The featured device is Phonek's Audéo. The Phonak Group, headquartered in Stäfa, Switzerland, specializes in the design, development, production and global distribution of technologically advanced wireless and hearing systems. I suggest you check out the Audéo website not only to learn about the device, but to see how this vendor decided to market aging technology to an audience of upscale baby boomers. One of the "Audéo people" is featured to your right. He is described as an "Archeologist, Beach Volleyball Player, and Hopeless Romantic." The tag line for the site is "Your life, amplified." The site includes a sound demo, a self test, FAQ's, and a color guide featuring 15 color combinations with such labels as Green with Envy, Pinot Noir, and Flower Power. The devices cost $2500 to $3000 per ear. To me, the site is well done, but also borders a bit on parody. I should look so good!
Two other innovative hearing devices were mentioned in the Journal article. The first was Great Nordic Pulse and the second was Siemens' CIELO2 Active. Both devices are rechargeable, which is an improvement over the need to change batteries.
The article made several points which are worth noting.
a. By age 65, nearly a third of Americans have hearing loss, and 40-50% will develop such loss by 75.
b. Resistance to the use of hearing aids is high. Only one in 5 people who could benefit from the device wear it.
c. The cost of hearing aids is generally not covered by insurance.
d. The newer, smaller devices have driven overall sales of behind-the-ear devices from 44% last year to 50.2% of hearing-aid sales this year--exceeding sales of in-ear molds for the first time since 1982.
e. Digital hearing aids, in which incoming sound is processed with a computer chip before being fed into your ear, enables almost limitless massaging of the sound. For example, the Audéo automatically switches among four programs, one for music, one for quiet, one for speech alone, and one for speech and noise together.
Monday, August 27, 2007
The 2007 National Positive Aging Conference
I'd like to draw your attention to this Conference, which will be held on December 6-8, 2007 at Eckerd College in St Petersburg, FL. The Conference site will tell you all you need to know about the event. According to the site, benefits for Conference attendees include:
Learn about current and future trends in services and programs for mature adults.
Take home new ideas to integrate into your programs.
Network with program implementers and thought leaders from around the world.
Hear and learn from program participants.
Have hands on opportunities with new and emerging technology and program tools.
Develop contacts and relationships for future program information and development activities.
Explore programming and partnering opportunities beyond your traditional boundaries-step outside the box!
Increase your commitment to a philosophy of “Positive Aging” through association with national and international thought leaders and program developers.
Early registration is recommended.
Learn about current and future trends in services and programs for mature adults.
Take home new ideas to integrate into your programs.
Network with program implementers and thought leaders from around the world.
Hear and learn from program participants.
Have hands on opportunities with new and emerging technology and program tools.
Develop contacts and relationships for future program information and development activities.
Explore programming and partnering opportunities beyond your traditional boundaries-step outside the box!
Increase your commitment to a philosophy of “Positive Aging” through association with national and international thought leaders and program developers.
Early registration is recommended.
Thursday, August 23, 2007
VeriChip Implants and Privacy Concerns
Two articles dealing with human-implantable RFID chips in the St Pete Times and the Healthcare IT News are worth considering. The company producing the implantable RFID chips is VeriChip. The company is based in Delray Beach, Florida, and is publicly traded on NASDAQ (CHIP). The implantable chip was cleared for medical use by the FDA in October, 2004. The company's present focus is tagging "high risk" patients such as those with diabetes, heart conditions or Alzheimers Disease.
Some quick facts to consider:
a. The chips are inserted in the upper right arm with a a hypodermic-type needle. The cost of the procedure: $200.
b. VeriChip uses a patented process, called bio-bind, to secure the chip to muscle tissue and prevent migration.
c. Medical personnel wave a scanner within 12 inches of the chip. A 16-digit identification appears to identify the person.
d. VeriChip maintains the patient's records in its database. Customers pay an annual fee, from $20 to $80, to keep a medical file.
The American Medical Association Council on Ethical and Judicial Affairs recommended that radio frequency identification (RFID) devices can be used to help identify patients, improve patient care and secure access to patient clinical information. But the AMA cautioned that the "efficacy and security" of the devices has not been established. As precautions, the AMA said, physicians implanting such devices should:
a. Disclose the medical uncertainties of RFIDs to patients as part of the informed consent process.
b. Strive to protect patients' privacy by storing confidential information only on RFID devices with informational security similar to that required of medical records.
c. Support research into safe, effective and potential non-medical uses of RFID devices in people.
John Halamka, the Chief Information Officer of the Care Group Health System, wrote an article entitled "Straight From the Shoulder" in the July 28, 2005 issue of the New England Journal of Medicine. He has a VeriChip implanted in his body, and has claimed that there have been no harmful side effects. In a sense, he is serving as a poster child for the procedure.
Privacy advocates have yet to sign on, as far as I can tell. And, people who harbor religious concerns about such chips being a precursor to the "mark of the beast" will not be placated by the either the AMA or the FDA.
I sense that the use of implantable chips in humans will grow, albeit slowly. High risk patients would appear to be the major beneficiaries of the technology. Overcoming the public's unease, either on religious grounds or for privacy qualms, is a major constraint.
Some quick facts to consider:
a. The chips are inserted in the upper right arm with a a hypodermic-type needle. The cost of the procedure: $200.
b. VeriChip uses a patented process, called bio-bind, to secure the chip to muscle tissue and prevent migration.
c. Medical personnel wave a scanner within 12 inches of the chip. A 16-digit identification appears to identify the person.
d. VeriChip maintains the patient's records in its database. Customers pay an annual fee, from $20 to $80, to keep a medical file.
The American Medical Association Council on Ethical and Judicial Affairs recommended that radio frequency identification (RFID) devices can be used to help identify patients, improve patient care and secure access to patient clinical information. But the AMA cautioned that the "efficacy and security" of the devices has not been established. As precautions, the AMA said, physicians implanting such devices should:
a. Disclose the medical uncertainties of RFIDs to patients as part of the informed consent process.
b. Strive to protect patients' privacy by storing confidential information only on RFID devices with informational security similar to that required of medical records.
c. Support research into safe, effective and potential non-medical uses of RFID devices in people.
John Halamka, the Chief Information Officer of the Care Group Health System, wrote an article entitled "Straight From the Shoulder" in the July 28, 2005 issue of the New England Journal of Medicine. He has a VeriChip implanted in his body, and has claimed that there have been no harmful side effects. In a sense, he is serving as a poster child for the procedure.
Privacy advocates have yet to sign on, as far as I can tell. And, people who harbor religious concerns about such chips being a precursor to the "mark of the beast" will not be placated by the either the AMA or the FDA.
I sense that the use of implantable chips in humans will grow, albeit slowly. High risk patients would appear to be the major beneficiaries of the technology. Overcoming the public's unease, either on religious grounds or for privacy qualms, is a major constraint.
Wednesday, August 22, 2007
William Blair Health Care IT Index (WBHCIT)
I'd like to draw your attention to this Index which was developed by William Blair and Company. The Index (WBHCIT) is an equal-weighted index of 31 health care IT stocks, originally constituted with a base value of 1,000 on December 31, 2000. The index objective is to capture the aggregate stock performance of the majority of companies that focus on providing software, systems, online content, or technology-oriented services to the health care sector. It is designed to serve as a useful tool for benchmarking both historical and future Health Care Information Technology (HCIT) stock performance. Some of the stocks in the current mix include Cerner, Allscripts Healthcare Solutions, and QuadraMed.
Index members must meet the following criteria:
Business Requirement: 50% of revenue must come from HCIT activities
Company Structure: Must be an operating company, not an investment trust
Market Capitalization Requirement: $50 million or higher
Exchange Requirement- Must be traded on the NASDAQ, NYSE, or AMEX
A student of mine calculated that if you had invested in the Blair Index as of January 1, 2001, you would have enjoyed a 47.7% annual return.
To the best of my knowledge, there are no aging services technology firms in the Index, as of today. Most of these firms are either privately held, have a market cap of less than $50 million, or are like ADT Security Services, a division of Tyco. Perhaps we'll see the inclusion of such a company in the future, or it may make sense to consider a separate Index for aging technology companies.
Index members must meet the following criteria:
Business Requirement: 50% of revenue must come from HCIT activities
Company Structure: Must be an operating company, not an investment trust
Market Capitalization Requirement: $50 million or higher
Exchange Requirement- Must be traded on the NASDAQ, NYSE, or AMEX
A student of mine calculated that if you had invested in the Blair Index as of January 1, 2001, you would have enjoyed a 47.7% annual return.
To the best of my knowledge, there are no aging services technology firms in the Index, as of today. Most of these firms are either privately held, have a market cap of less than $50 million, or are like ADT Security Services, a division of Tyco. Perhaps we'll see the inclusion of such a company in the future, or it may make sense to consider a separate Index for aging technology companies.
Thursday, August 16, 2007
Med-eMonitor
The September 2007 issue of Prevention Magazine featured a brief article entitled "Peace-of-Mind Pillbox." The article featured Med-eMonitor, an electronic device that hooks up to a standard phone jack. Medication times are announced with a musical tone, coupled with warnings about potential drug or food interactions. If you don't take your drug in 3 minutes, a family member is notified. The initial price of $119.90 includes the Med-eMonitor unit, a one-time set-up fee of $59.95 which includes telephone assistance and training, and the first month's lease charge of $59.95. Annual fees at the current monthly rate amount to $720. I was unable to determine whether the device is covered by current health insurance plans.
The device website offers information for professionals and investors, for consumers, and an on line store. The professional section ably describes the product, refers to product studies demonstrating medication compliance rates of better than 90%, and features a Demo which gives a general overview of the device in operation.
Med-eMonitor is sold by a Maryland based medical device company called InforMedix. Bruce Kehr, M.D. is Chair of the Board of Directors and CEO of the company, which is traded on the OTC BB market (Symbol IFMX). The stock is currently trading at .125 a share. Some key business partners include ADT Security Services, a unit of Tyco Fire & Security, and XLHealth, one of the nation's fastest growing disease management companies. The company is partnering with drug store chains as part of the consumer launch of Med-eMonitor. The most recent partner is Rodman's Discount Drug Stores in Washington, D.C.
The device website offers information for professionals and investors, for consumers, and an on line store. The professional section ably describes the product, refers to product studies demonstrating medication compliance rates of better than 90%, and features a Demo which gives a general overview of the device in operation.
Med-eMonitor is sold by a Maryland based medical device company called InforMedix. Bruce Kehr, M.D. is Chair of the Board of Directors and CEO of the company, which is traded on the OTC BB market (Symbol IFMX). The stock is currently trading at .125 a share. Some key business partners include ADT Security Services, a unit of Tyco Fire & Security, and XLHealth, one of the nation's fastest growing disease management companies. The company is partnering with drug store chains as part of the consumer launch of Med-eMonitor. The most recent partner is Rodman's Discount Drug Stores in Washington, D.C.
Monday, August 13, 2007
Telehealth Ethical Issues
The 2006 Archives for the International Conference on Aging, Disability and Independence includes an excellent paper by Janice M. Blanchard of the Society of Certified Senior Advisors. Ms. Blanchard argues that as telehealth products move from the research phase into the broader marketplace, economic and technological considerations take center stage, while ethical issues merit less attention. A moral and ethical framework for home-based telemedicine is warranted, in her view. Her framework would consider the following issues.
(1) Privacy of information. Who has access to data and how it will be used? Can it be bought and sold? How will privacy, confidentiality, and security of user information be assured?
(2) Privacy of person/place. Can user control monitoring system (e.g., turn it off and on, or establish a monitor-free zone)? How is the privacy of others in the home maintained?
(3) Informed consent. What constitutes informed consent, particularly with a technologically naïve or cognitively impaired person?
(4) Equity of access. How do we develop equal access when technology use presupposes some technological sophistication, skills, and basic comfort level? Who will pay for services? Will it develop into a two-tier system of medical service delivery?
(5) Autonomy versus dependence. Does home monitoring foster autonomy or dependence? What will be the consequences of perceived non-compliance?
(6) Paternalism. Does the desire to “keep a better watch" over aging parents actually reveal or underscore a paternalistic attitude on the part of service providers, adult children, and/or the medical establishment towards elders?
(7) Patient and provider relationship. What is the overall effect on quality of care? How are empathy, compassion and trust maintained via telecommunication?
(8) Medicalization of home. Will long term monitoring change the character of home? How do we maintain the separation of public and private sphere?
The answers to these important questions will come from research and from the experiences of telemedicine users and their family members. Blanchard's framework is a valuable contribution to any careful examination of aging technology products and services.
(1) Privacy of information. Who has access to data and how it will be used? Can it be bought and sold? How will privacy, confidentiality, and security of user information be assured?
(2) Privacy of person/place. Can user control monitoring system (e.g., turn it off and on, or establish a monitor-free zone)? How is the privacy of others in the home maintained?
(3) Informed consent. What constitutes informed consent, particularly with a technologically naïve or cognitively impaired person?
(4) Equity of access. How do we develop equal access when technology use presupposes some technological sophistication, skills, and basic comfort level? Who will pay for services? Will it develop into a two-tier system of medical service delivery?
(5) Autonomy versus dependence. Does home monitoring foster autonomy or dependence? What will be the consequences of perceived non-compliance?
(6) Paternalism. Does the desire to “keep a better watch" over aging parents actually reveal or underscore a paternalistic attitude on the part of service providers, adult children, and/or the medical establishment towards elders?
(7) Patient and provider relationship. What is the overall effect on quality of care? How are empathy, compassion and trust maintained via telecommunication?
(8) Medicalization of home. Will long term monitoring change the character of home? How do we maintain the separation of public and private sphere?
The answers to these important questions will come from research and from the experiences of telemedicine users and their family members. Blanchard's framework is a valuable contribution to any careful examination of aging technology products and services.
Friday, August 10, 2007
QuietCare Overview
The Living Independently Group, a New York City based, privately held company was co-founded by John Lakian and George Boyajian, Ph.D. The CFO is Walter Bembenista and the COO is Robin McVey. It is a strong executive group with substantial expertise in investment banking, biotechnology, and home health security. Venture capital investors include Valence Capital, Loeb Partners and current investors. A 2006 financing of $10 million, led by Valence, will be used to enhance the product line, increase USA market penetration, and build market presence in the UK. In October of 2006, it was announced that Telemetry Systems, Inc. (TSI), a leading systems integrator and provider of home and business security solutions, would serve as a National Master Distributor for QuietCare.
QuietCare® is a 24/7 early detection and warning system that enables caregivers to monitor a senior or patient remotely, recognize potential health problems and intervene so as to avoid emergencies or more serious medical problems. There is no video or audio intrusion. The service was launched in 2002, and was the first commercially available solution of its kind. It was designed to meet the needs of approximately 35 million seniors who live alone in the US.
The QuietCare website is very user-friendly. Service benefits are clearly explained, there is a useful family assessment guide, and it's a simple matter to make contact with the company for further assistance. The home page notes that the service has received broad media exposure, including the New York Times, Wall Street Journal, and NBC Weekend Today.
A recent article on QuietCare in the Sarasota Herald Tribune merits our close attention. Key points from the article follow.
a. The service costs $400 for installation and activation, and $149.95 a month. The service also includes a two-way radio emergency alert system.
b. Typically, infrared motion sensors are installed in the refrigerator (Detect meal preparation), in the kitchen, inside and outside the bathroom, in the bedroom, and other activity areas. Most homes have six sensors, but some have as many as a dozen.
c. After installation, the off site computer measures daily living routines for 10 days, to establish a baseline activity pattern.
d. It works with people who live alone, so that any motion can be traced to a single occupant.
e. Privacy issues are minimized, since there are no camera's or microphones.
f. The family member, whether a mile or 500 miles away, can visit a password protected web site to get a quick status report. Deviations from normal behavior are flagged and communicated to the family member by cell phone and email alerts.
g. Four states have approved QuietCare for Medicaid reimbursement (Florida's Medicaid is not one of them).
h. It hasn't been proven that QuietCare, or other such technologies, actually delay institutionalization, one of the primary reasons for their development. However, such studies are likely, as more new products hit the market.
In sum, this product, and others like it, hold great promise for keeping loved ones at home for as long as possible. If the service can demonstrate real cost savings to the system, we'll see widespread insurance coverage , and significant product growth.
QuietCare® is a 24/7 early detection and warning system that enables caregivers to monitor a senior or patient remotely, recognize potential health problems and intervene so as to avoid emergencies or more serious medical problems. There is no video or audio intrusion. The service was launched in 2002, and was the first commercially available solution of its kind. It was designed to meet the needs of approximately 35 million seniors who live alone in the US.
The QuietCare website is very user-friendly. Service benefits are clearly explained, there is a useful family assessment guide, and it's a simple matter to make contact with the company for further assistance. The home page notes that the service has received broad media exposure, including the New York Times, Wall Street Journal, and NBC Weekend Today.
A recent article on QuietCare in the Sarasota Herald Tribune merits our close attention. Key points from the article follow.
a. The service costs $400 for installation and activation, and $149.95 a month. The service also includes a two-way radio emergency alert system.
b. Typically, infrared motion sensors are installed in the refrigerator (Detect meal preparation), in the kitchen, inside and outside the bathroom, in the bedroom, and other activity areas. Most homes have six sensors, but some have as many as a dozen.
c. After installation, the off site computer measures daily living routines for 10 days, to establish a baseline activity pattern.
d. It works with people who live alone, so that any motion can be traced to a single occupant.
e. Privacy issues are minimized, since there are no camera's or microphones.
f. The family member, whether a mile or 500 miles away, can visit a password protected web site to get a quick status report. Deviations from normal behavior are flagged and communicated to the family member by cell phone and email alerts.
g. Four states have approved QuietCare for Medicaid reimbursement (Florida's Medicaid is not one of them).
h. It hasn't been proven that QuietCare, or other such technologies, actually delay institutionalization, one of the primary reasons for their development. However, such studies are likely, as more new products hit the market.
In sum, this product, and others like it, hold great promise for keeping loved ones at home for as long as possible. If the service can demonstrate real cost savings to the system, we'll see widespread insurance coverage , and significant product growth.
Sunday, August 5, 2007
High Tech Tools for Older Folks
Today, we look to Parade magazine to learn about some high tech offerings for the elderly. The eminently readable article follows. In the same edition, one finds the ubiquitous ad for the easy to use Jitterbug cell phone. It is encouraging to see aging technology references in "mainstream" publications.
"Many baby boomers find themselves worrying about aging parents or other relatives who are determined to remain in their own homes. The good news, says Marion Somers, a gerontology expert, is that elder care is going high-tech: “Technology is letting older people improve their quality of life and preserve their independence for longer than ever before while still getting the support and care they need.” A few of Somers’ suggestions:
• Cell phones with big buttons, bright screens and extra-loud sound. Easy to use in emergencies, with service as low as $10 a month. (Be sure 911 is on speed-dial.)
• Light sensors, to automatically illuminate the basement and paths around the house.
• Electronic envelope openers, for people with arthritis.
• A QuietCare system, to help seniors stay safe by monitoring their daily activity—including eating and taking medication—via wireless sensors positioned throughout the home. It even checks if their residence is too warm or cold. Caregivers can access reports through a secure personal Web site. For less than $3 a day, the system identifies emergencies such as falls and alerts caregivers or emergency services.
• Safe Return bracelets to help track Alzheimer’s patients if they wander off (available from the Alzheimer’s Association ).
• GPS navigation devices you implant in their shoes to track Alzheimer’s patients."
"Many baby boomers find themselves worrying about aging parents or other relatives who are determined to remain in their own homes. The good news, says Marion Somers, a gerontology expert, is that elder care is going high-tech: “Technology is letting older people improve their quality of life and preserve their independence for longer than ever before while still getting the support and care they need.” A few of Somers’ suggestions:
• Cell phones with big buttons, bright screens and extra-loud sound. Easy to use in emergencies, with service as low as $10 a month. (Be sure 911 is on speed-dial.)
• Light sensors, to automatically illuminate the basement and paths around the house.
• Electronic envelope openers, for people with arthritis.
• A QuietCare system, to help seniors stay safe by monitoring their daily activity—including eating and taking medication—via wireless sensors positioned throughout the home. It even checks if their residence is too warm or cold. Caregivers can access reports through a secure personal Web site. For less than $3 a day, the system identifies emergencies such as falls and alerts caregivers or emergency services.
• Safe Return bracelets to help track Alzheimer’s patients if they wander off (available from the Alzheimer’s Association ).
• GPS navigation devices you implant in their shoes to track Alzheimer’s patients."
Monday, July 30, 2007
New York Times Article on "The Real Transformers"
The New York Times Magazine featured an article on robots and robotics which I found compelling. Several highlights of the article are featured below, followed by my commentary.
"Bill Gates has said that personal robotics today is at the stage that personal computers were in the mid-1970s. Thirty years ago, few people guessed that the bulky, slow computers being used by a handful of businesses would by 2007 insinuate themselves into our lives via applications like Google, e-mail, YouTube, Skype and MySpace. In much the same way, the robots being built today, still unwieldy and temperamental even in the most capable hands, probably offer only hints of the way we might be using robots in another 30 years."
Comment: I cannot imagine work or personal life without my pc, and recall all too well my first Radio Shack word processor, and how primitive it was relative to todays' offerings. Today's robots are primitive in that sense, but will evolve until they become so embedded in our lives that they become "pc-like."
"Sociable robots come equipped with the very abilities that humans have evolved to ease our interactions with one another: eye contact, gaze direction, turn-taking, shared attention. They are programmed to learn the way humans learn, by starting with a core of basic drives and abilities and adding to them as their physical and social experiences accrue. People respond to the robots’ social cues almost without thinking, and as a result the robots give the impression of being somehow, improbably, alive."
Comment: I believe I'd respond to a robot's social cues without thinking. Pretty eerie, but we're "programmed" to respond to such cues. I am also taken by the observation that you can program robots to learn.
"To qualify as that kind of (sociable) robot, they say, a machine must have at least two characteristics. It must be situated, and it must be embodied. Being situated means being able to sense its environment and be responsive to it; being embodied means having a physical body through which to experience the world. A G.P.S. robot is situated but not embodied, while an assembly-line robot that repeats the same action over and over again is embodied but not situated. Sociable robots must be both, as well as exhibiting an understanding of social beings."
Comment: The definition of a sociable robot-being both situated and embodied- is very helpful. I need to move beyond the term "robot" to "sociable robot," in order to better evaluate the role of robotics in health care.
"Scientists believe that the more a robot looks like a person, the more favorably we tend to view it, but only up to a point. After that, our response slips into what the Japanese roboticist Masahiro Mori has called the “uncanny valley.” We start expecting too much of the robots because they so closely resemble real people, and when they fail to deliver, we recoil in something like disgust."
Comment: There are pretty significant implications for robotic design, flowing from this condition. I wonder how important "person likeness" would be to an acutely ill, short stay patient or to a chronically ill, long term stay patient. Would there be a difference, based on patient condition and stay? And, would we be less demanding of "person likeness" when we are in a passive, patient role?
"The robot (weight-loss) coach, a child-size head and torso holding a small touch screen, is called Autom. It is able, using basic artificial-voice software, to speak approximately 1,000 phrases, things like “It’s great that you’re doing well with your exercise” or “You should congratulate yourself on meeting your calorie goals today.” It is programmed to get a little more informal as time goes on: “Hello, I hope that we can work together” will eventually shift to “Hi, it’s good to see you again.” It is also programmed to refer to things that happened on other days, with statements like “It looks like you’ve had a little more to eat than usual recently.”
Comment: Autom may be useful for my weight loss regimen, but I think I'd shut it down, if it nagged me too much. It does seem to reinforce the assertion that weight loss is aided by peer pressure, even if the "peer" happens to be a robot. However, they are certainly more cost-effective ways to lose weight.
"A few of these uBots are now being developed for use in assisted-living centers in research designed to see how the robots interact with the frail elderly. Each uBot-5 is about three feet tall, with a big head, very long arms (long enough to touch the ground, should the arms be needed for balance) and two oversize wheels. It has big eyes, rubber balls at the ends of its arms and a video screen for a face."
Comment: I wonder how I'd feel if I visited my Mom in a nursing home, and found her being tended by a uBot-5. I wonder how she'd feel. The attitudes of the patient and the family would be critical. Variability in the number and competency of nursing home staff, is an issue, at least in my experience. Would the use of robots diminish such variability?
"At their core, robots are not so very different from living things. “It’s all mechanistic,” Brooks said. “Humans are made up of biomolecules that interact according to the laws of physics and chemistry. We like to think we’re in control, but we’re not.” We are all, human and humanoid alike, whether made of flesh or of metal, basically just sociable machines."
Comment: Perhaps it is true that we are all "sociable machines" and that the distinction between human and humanoid is less evident than we think. Intellectually, I can get my arms around this observation. Emotionally, I'm not there yet.
"Bill Gates has said that personal robotics today is at the stage that personal computers were in the mid-1970s. Thirty years ago, few people guessed that the bulky, slow computers being used by a handful of businesses would by 2007 insinuate themselves into our lives via applications like Google, e-mail, YouTube, Skype and MySpace. In much the same way, the robots being built today, still unwieldy and temperamental even in the most capable hands, probably offer only hints of the way we might be using robots in another 30 years."
Comment: I cannot imagine work or personal life without my pc, and recall all too well my first Radio Shack word processor, and how primitive it was relative to todays' offerings. Today's robots are primitive in that sense, but will evolve until they become so embedded in our lives that they become "pc-like."
"Sociable robots come equipped with the very abilities that humans have evolved to ease our interactions with one another: eye contact, gaze direction, turn-taking, shared attention. They are programmed to learn the way humans learn, by starting with a core of basic drives and abilities and adding to them as their physical and social experiences accrue. People respond to the robots’ social cues almost without thinking, and as a result the robots give the impression of being somehow, improbably, alive."
Comment: I believe I'd respond to a robot's social cues without thinking. Pretty eerie, but we're "programmed" to respond to such cues. I am also taken by the observation that you can program robots to learn.
"To qualify as that kind of (sociable) robot, they say, a machine must have at least two characteristics. It must be situated, and it must be embodied. Being situated means being able to sense its environment and be responsive to it; being embodied means having a physical body through which to experience the world. A G.P.S. robot is situated but not embodied, while an assembly-line robot that repeats the same action over and over again is embodied but not situated. Sociable robots must be both, as well as exhibiting an understanding of social beings."
Comment: The definition of a sociable robot-being both situated and embodied- is very helpful. I need to move beyond the term "robot" to "sociable robot," in order to better evaluate the role of robotics in health care.
"Scientists believe that the more a robot looks like a person, the more favorably we tend to view it, but only up to a point. After that, our response slips into what the Japanese roboticist Masahiro Mori has called the “uncanny valley.” We start expecting too much of the robots because they so closely resemble real people, and when they fail to deliver, we recoil in something like disgust."
Comment: There are pretty significant implications for robotic design, flowing from this condition. I wonder how important "person likeness" would be to an acutely ill, short stay patient or to a chronically ill, long term stay patient. Would there be a difference, based on patient condition and stay? And, would we be less demanding of "person likeness" when we are in a passive, patient role?
"The robot (weight-loss) coach, a child-size head and torso holding a small touch screen, is called Autom. It is able, using basic artificial-voice software, to speak approximately 1,000 phrases, things like “It’s great that you’re doing well with your exercise” or “You should congratulate yourself on meeting your calorie goals today.” It is programmed to get a little more informal as time goes on: “Hello, I hope that we can work together” will eventually shift to “Hi, it’s good to see you again.” It is also programmed to refer to things that happened on other days, with statements like “It looks like you’ve had a little more to eat than usual recently.”
Comment: Autom may be useful for my weight loss regimen, but I think I'd shut it down, if it nagged me too much. It does seem to reinforce the assertion that weight loss is aided by peer pressure, even if the "peer" happens to be a robot. However, they are certainly more cost-effective ways to lose weight.
"A few of these uBots are now being developed for use in assisted-living centers in research designed to see how the robots interact with the frail elderly. Each uBot-5 is about three feet tall, with a big head, very long arms (long enough to touch the ground, should the arms be needed for balance) and two oversize wheels. It has big eyes, rubber balls at the ends of its arms and a video screen for a face."
Comment: I wonder how I'd feel if I visited my Mom in a nursing home, and found her being tended by a uBot-5. I wonder how she'd feel. The attitudes of the patient and the family would be critical. Variability in the number and competency of nursing home staff, is an issue, at least in my experience. Would the use of robots diminish such variability?
"At their core, robots are not so very different from living things. “It’s all mechanistic,” Brooks said. “Humans are made up of biomolecules that interact according to the laws of physics and chemistry. We like to think we’re in control, but we’re not.” We are all, human and humanoid alike, whether made of flesh or of metal, basically just sociable machines."
Comment: Perhaps it is true that we are all "sociable machines" and that the distinction between human and humanoid is less evident than we think. Intellectually, I can get my arms around this observation. Emotionally, I'm not there yet.
Wednesday, July 25, 2007
IBM and the University of Florida
Excerpts from a recent article in PC World merit your attention, I believe. The key players are IBM, the University of Florida's Department of Computer and Information Science and Engineering, a spin off company called Pervasa and the Eclipse Foundation, an open source development tool sponsor. Dr Sumi Helal leads the initiative at the University. During the past several years, Dr Helal and his colleagues developed smart devices for the elderly in a model home known as the Gator Tech Smart House in Gainesville.
I recently had a brief chat with Bob Sutor, Vice President for Standards and Open Source at IBM. He noted that the collection of patient information from smart devices could help build an electronic medical record, a perspective I can now appreciate. Security issues seemed of import, and in his view, IBM was involved in this venture for both commercial and social purposes.
Be sure and view the multi-purpose video referenced below. It is well done!
IBM Corp. and the University of Florida believe they've come up with middleware that will allow doctors to remotely monitor the health of their patients. The technology makes it possible for standard wired or wireless devices like blood-pressure and glucose monitors to be reconfigured so that when used by patients at home the devices can automatically send the collected readings to health-care professionals.
IBM and the university have been working on the smart device project for the past 12 to 15 months and have produced a short video to illustrate its possible use. In the video, an elderly man called Charley requires twice weekly visits to his doctor to check his blood pressure. He's able to cut down on the number of those visits by taking his readings at home using a monitor that's been reconfigured with the middleware.
The value of the technology is what could be achieved with it by any device manufacturer, said Sumi Helal, professor of computer and information science and engineering at the University of Florida, who headed up the project. The technology is a combination of middleware software and sensor hardware called Atlas from University of Florida spin-off Pervasa Inc. Should the technology be adopted, Helal would expect to see smart devices on the market within the next one to two years. It would then be possible to buy a device off the shelf and by dialing a 1-800 phone number establish a connection between the device and one's doctor. "The device itself becomes a service," he said.
Much of the work on developing Web services around a SOA (service-oriented architecture) has been looking at how to exchange information between people when neither party is familiar with how the other's IT system was built. There's been plenty of SOA work to Web-enable legacy mainframe systems. "What's the ultimate legacy system for us? The human body," said Bob Sutor, vice president of standards and open source at IBM.
The security governing the devices would be the same as that used in online banking, Helal said. It's possible to make that security very finely grained, Sutor added, to encrypt particularly sensitive fields. It will be up to device manufacturers to ensure that their products are tamper-proof to avoid the possibility of false readings, Helal said.
As a way to start building momentum behind the technology, IBM has contributed components of the project to the Open Healthcare Framework of the open-source development tools Eclipse Foundation community.
"You could look at this as something very nice for IBM," Sutor said, in terms of the vendor being a provider of all the necessary back-end technologies including middleware, databases, servers and storage. "But because it's standards-based, anyone can play," he added. "There's nothing we're doing here that gives us a product advantage."
I recently had a brief chat with Bob Sutor, Vice President for Standards and Open Source at IBM. He noted that the collection of patient information from smart devices could help build an electronic medical record, a perspective I can now appreciate. Security issues seemed of import, and in his view, IBM was involved in this venture for both commercial and social purposes.
Be sure and view the multi-purpose video referenced below. It is well done!
IBM Corp. and the University of Florida believe they've come up with middleware that will allow doctors to remotely monitor the health of their patients. The technology makes it possible for standard wired or wireless devices like blood-pressure and glucose monitors to be reconfigured so that when used by patients at home the devices can automatically send the collected readings to health-care professionals.
IBM and the university have been working on the smart device project for the past 12 to 15 months and have produced a short video to illustrate its possible use. In the video, an elderly man called Charley requires twice weekly visits to his doctor to check his blood pressure. He's able to cut down on the number of those visits by taking his readings at home using a monitor that's been reconfigured with the middleware.
The value of the technology is what could be achieved with it by any device manufacturer, said Sumi Helal, professor of computer and information science and engineering at the University of Florida, who headed up the project. The technology is a combination of middleware software and sensor hardware called Atlas from University of Florida spin-off Pervasa Inc. Should the technology be adopted, Helal would expect to see smart devices on the market within the next one to two years. It would then be possible to buy a device off the shelf and by dialing a 1-800 phone number establish a connection between the device and one's doctor. "The device itself becomes a service," he said.
Much of the work on developing Web services around a SOA (service-oriented architecture) has been looking at how to exchange information between people when neither party is familiar with how the other's IT system was built. There's been plenty of SOA work to Web-enable legacy mainframe systems. "What's the ultimate legacy system for us? The human body," said Bob Sutor, vice president of standards and open source at IBM.
The security governing the devices would be the same as that used in online banking, Helal said. It's possible to make that security very finely grained, Sutor added, to encrypt particularly sensitive fields. It will be up to device manufacturers to ensure that their products are tamper-proof to avoid the possibility of false readings, Helal said.
As a way to start building momentum behind the technology, IBM has contributed components of the project to the Open Healthcare Framework of the open-source development tools Eclipse Foundation community.
"You could look at this as something very nice for IBM," Sutor said, in terms of the vendor being a provider of all the necessary back-end technologies including middleware, databases, servers and storage. "But because it's standards-based, anyone can play," he added. "There's nothing we're doing here that gives us a product advantage."
Thursday, July 19, 2007
International Conference on Aging, Disability, and Independence (ICADI)
I want to draw your attention to the 4th annual ICADI conference which will be held in St Petersburg, FL on February 20-23, 2008. Early registration ends by November 30th, and details can be found at the ICADI website. A conference summary follows.
"The International Conference on Aging, Disability and Independence (ICADI) will focus on approaches to support people as they age in maintaining independence in daily living at home, at work and in the community.
As people age, independence can be maintained by use of assistive technology, by modifying homes, workplaces and environments and by selecting products that follow universal design principles. As people remain in the workforce into advanced years or return to work, knowledge and technologies are developing to adapt workplaces to meet their needs. Aging in the workplace is a new and significant area of focus for ICADI this year. Livable communities is another new focus, representing a broadening of the concepts of home modification and universal design to address design of communities so they are livable for all people. Mobility is another important component of independence as it relates to walking and wheeling, to driving and to using other methods of transportation. Prevention of injuries is essential to maintaining independence in advanced years. Current and future development in robotics will help and support individuals in everyday tasks; and, advances in telehealth approaches hold promise in monitoring and serving health and independence-related needs.
Each of these is important to aging well and will be addressed in eight ICADI tracks by an international cadre of presenters representing research and development, policy, practice and services, business, and consumer perspectives."
"The International Conference on Aging, Disability and Independence (ICADI) will focus on approaches to support people as they age in maintaining independence in daily living at home, at work and in the community.
As people age, independence can be maintained by use of assistive technology, by modifying homes, workplaces and environments and by selecting products that follow universal design principles. As people remain in the workforce into advanced years or return to work, knowledge and technologies are developing to adapt workplaces to meet their needs. Aging in the workplace is a new and significant area of focus for ICADI this year. Livable communities is another new focus, representing a broadening of the concepts of home modification and universal design to address design of communities so they are livable for all people. Mobility is another important component of independence as it relates to walking and wheeling, to driving and to using other methods of transportation. Prevention of injuries is essential to maintaining independence in advanced years. Current and future development in robotics will help and support individuals in everyday tasks; and, advances in telehealth approaches hold promise in monitoring and serving health and independence-related needs.
Each of these is important to aging well and will be addressed in eight ICADI tracks by an international cadre of presenters representing research and development, policy, practice and services, business, and consumer perspectives."
Monday, July 16, 2007
Remote Presence Robotic System
Today, we look to Yahoo News for an interesting story on robot use for hospital patients recovering from bariatric or weight loss surgery.
"Has it come to this? Robots standing in for doctors at the hospital patients' bedside?
Not exactly, but some doctors have found a way to use a videoconferencing robot to check on patients while they're miles from the hospital. One is at Baltimore's Sinai Hospital. Outfitted with cameras, a screen and microphone, the joystick-controlled robot is guided into the rooms of Dr. Alex Gandsas' patients where he speaks to them as if he were right there. "The system allows you to be anywhere in the hospital from anywhere in the world," said the surgeon, who specializes in weight-loss surgery.
Besides his normal morning and afternoon in-person rounds, Gandsas uses the $150,000 robot to visit patients at night or when problems arise. The robot can circle the bed and adjust the position of its two cameras, giving "the perception from the patient's standpoint that the doctor is there," the surgeon said. "They love it. They'd rather see me through the robot," he said of his patients' reaction to the machine.
Gandsas presented the idea to hospital administrators as a method to more closely monitor patients following weight-loss surgery. Gandsas, an unpaid member of an advisory board for the robot's manufacturer who has stock options in the company, added that since its introduction, the length of stay has been shorter for the patients visited by the robot. A chart-review study of 376 of the doctor's patients found that the 92 patients who had additional robotic visits had shorter hospital stays. Gandsas' study appears in the July issue of the Journal of the American College of Surgeons.
Nicknamed Bari for the bariatric surgery Gandsas practices, the RP-7 Remote Presence Robotic System by InTouch Technologies is one of a number of robotic devices finding their way into the medical world. Across town at Johns Hopkins, for example, a similar robot is used to teleconference with a translator for doctors who don't speak their patient's language. Robotic devices have also been used to guide stroke patients through therapy and help them play video games."
Let's try to get behind the information presented in the article. Our aim is to better understand such issues as patient privacy, consumer acceptance of "virtual services", and cost versus benefit assessments.
1. According to a January 2007 report published by the Agency for Healthcare Research and Quality, the total number of bariatric surgeries in the US increased nine-fold from 1998 to 2004. Across all age groups, the fastest growth in bariatric surgery occurred among adults aged 55-64. And, in 2004, 78% of these surgeries were covered by private insurance, with Medicare and Medicaid covering roughly 7% and 5% respectively.
2. The robot stands 5 1/2 feet tall and has a computer screen where a person's head would be. The screen broadcasts the face of a physician, who controls the device remotely. In addition to a screen, the device includes cameras and a microphone. According to the article, the device cost $150,000. About 120 of the robots are being used in hospitals worldwide.
3. The device was purchased by the Sinai Hospital in Baltimore. Patients using the device were discharged sooner than patients who didn't, yielding the hospital more than $200,000 in new admissions and saving some $14,000 in room and board costs, according to an article in the July 16, 2007 edition of Modern Healthcare.
4. The patients were hospital based, and not home based, and bore no added cost for the service. Apparently, they had positive reactions to the device, and there was no indication that privacy infringement was an issue. I'd like to see further studies of in-patient reactions, and also, am curious whether nursing home or home bound patients would have the same positive reactions.
5. The attending physician made normal morning and afternoon rounds, and used the device at night, or when problems arose and he was not immediately available. Thus, there was a mix of high touch and high tech.
6. The attending physician indicated that he was an unpaid advisory board member of the manufacturer and had stock options in the company.
7. A study by the attending physician in a peer reviewed journal cited a decrease in patient stay for patients who experienced robotic visits. If the results are replicated elsewhere, significant system cost savings could be achieved.
8. The robot was being used at Johns Hopkins Hospital to overcome language barriers with patients and for guiding stroke patients through therapy. It's hard to imagine there couldn't be a more cost effective way to deal with the former use, and the latter use would suggest a broader application to other patients with chronic conditions.
9. For the time being, the device would appear to be available for hospital inpatients only, less available to nursing home residents, and not a financially feasible alternative for the home bound.
"Has it come to this? Robots standing in for doctors at the hospital patients' bedside?
Not exactly, but some doctors have found a way to use a videoconferencing robot to check on patients while they're miles from the hospital. One is at Baltimore's Sinai Hospital. Outfitted with cameras, a screen and microphone, the joystick-controlled robot is guided into the rooms of Dr. Alex Gandsas' patients where he speaks to them as if he were right there. "The system allows you to be anywhere in the hospital from anywhere in the world," said the surgeon, who specializes in weight-loss surgery.
Besides his normal morning and afternoon in-person rounds, Gandsas uses the $150,000 robot to visit patients at night or when problems arise. The robot can circle the bed and adjust the position of its two cameras, giving "the perception from the patient's standpoint that the doctor is there," the surgeon said. "They love it. They'd rather see me through the robot," he said of his patients' reaction to the machine.
Gandsas presented the idea to hospital administrators as a method to more closely monitor patients following weight-loss surgery. Gandsas, an unpaid member of an advisory board for the robot's manufacturer who has stock options in the company, added that since its introduction, the length of stay has been shorter for the patients visited by the robot. A chart-review study of 376 of the doctor's patients found that the 92 patients who had additional robotic visits had shorter hospital stays. Gandsas' study appears in the July issue of the Journal of the American College of Surgeons.
Nicknamed Bari for the bariatric surgery Gandsas practices, the RP-7 Remote Presence Robotic System by InTouch Technologies is one of a number of robotic devices finding their way into the medical world. Across town at Johns Hopkins, for example, a similar robot is used to teleconference with a translator for doctors who don't speak their patient's language. Robotic devices have also been used to guide stroke patients through therapy and help them play video games."
Let's try to get behind the information presented in the article. Our aim is to better understand such issues as patient privacy, consumer acceptance of "virtual services", and cost versus benefit assessments.
1. According to a January 2007 report published by the Agency for Healthcare Research and Quality, the total number of bariatric surgeries in the US increased nine-fold from 1998 to 2004. Across all age groups, the fastest growth in bariatric surgery occurred among adults aged 55-64. And, in 2004, 78% of these surgeries were covered by private insurance, with Medicare and Medicaid covering roughly 7% and 5% respectively.
2. The robot stands 5 1/2 feet tall and has a computer screen where a person's head would be. The screen broadcasts the face of a physician, who controls the device remotely. In addition to a screen, the device includes cameras and a microphone. According to the article, the device cost $150,000. About 120 of the robots are being used in hospitals worldwide.
3. The device was purchased by the Sinai Hospital in Baltimore. Patients using the device were discharged sooner than patients who didn't, yielding the hospital more than $200,000 in new admissions and saving some $14,000 in room and board costs, according to an article in the July 16, 2007 edition of Modern Healthcare.
4. The patients were hospital based, and not home based, and bore no added cost for the service. Apparently, they had positive reactions to the device, and there was no indication that privacy infringement was an issue. I'd like to see further studies of in-patient reactions, and also, am curious whether nursing home or home bound patients would have the same positive reactions.
5. The attending physician made normal morning and afternoon rounds, and used the device at night, or when problems arose and he was not immediately available. Thus, there was a mix of high touch and high tech.
6. The attending physician indicated that he was an unpaid advisory board member of the manufacturer and had stock options in the company.
7. A study by the attending physician in a peer reviewed journal cited a decrease in patient stay for patients who experienced robotic visits. If the results are replicated elsewhere, significant system cost savings could be achieved.
8. The robot was being used at Johns Hopkins Hospital to overcome language barriers with patients and for guiding stroke patients through therapy. It's hard to imagine there couldn't be a more cost effective way to deal with the former use, and the latter use would suggest a broader application to other patients with chronic conditions.
9. For the time being, the device would appear to be available for hospital inpatients only, less available to nursing home residents, and not a financially feasible alternative for the home bound.
Friday, June 29, 2007
Talking Pill Bottles
In 2004, I ran across an news article which described the concept of a talking pill bottle, and it's utility for the visually impaired, handicapped, illiterate, and people with cataracts. Several firms were mentioned, and I thought I'd visit each firms website for a product overview. Each firm used a small electronic chip attached to the pill container, or a receptacle around it. But they had drawbacks, such as requiring a pharmacist or caregiver to read information into a recording device, needing patients to buy a $325 "reader" device, or using $10 disposable pill bottles. I did check with my local Walgreen's pharmacist, and he claimed they had no experience with such devices, though he agreed they'd be useful.
First, we have En-Vision America's Script Talk. The system acts in this fashion. When a patient using a ScripTalk reader submits a prescription, the pharmacy software prints and programs an auxiliary smart label using a dedicated, small-footprint printer. The smart label, which stores prescription information is placed onto the prescription container by the pharmacist. In the home, the patient uses a hand-held ScripTalk Reader that speaks out the label information using speech synthesis technology. By simply moving the prescription within an inch of the ScripTalk reader, pertinent information such as, the name of the patient; the name of the drug; the dosage; general instructions; warnings; prescription (Rx) Number; along with the doctor’s name and phone number are converted into speech.
The second vendor is MedivoxRx Technologies' Rex-The talking Prescription Bottle. Rex is fully automated through text-to-speech technology, allowing pharmacists to electronically record the label information to the pill bottle in a natural sounding computer generated voice using the pharmacy’s current software and data. As the pharmacist sends the label information to the printer, the label information is recorded into the base of the bottle. Features and benefits include ease of use (one push button), no special reader required, no usage training required, disposability, and low cost for patients.
The third vendor cited was Talking Rx. Talking Rx® is a simple, yet effective solution that provides audible guidance in taking medications. The device attaches to common-sized prescription bottles and contains a memo recorder that allows a physician, pharmacist, caregiver, family member or patient to record necessary information about the medication. Samples of the information that can be recorded include: name of the medication and the name of the person for whom it is prescribed, instructions for proper use, any special instructions or possible side effects, name and telephone numbers of physician and pharmacy, and expiration date and refill information, including the prescription reorder number.
First, we have En-Vision America's Script Talk. The system acts in this fashion. When a patient using a ScripTalk reader submits a prescription, the pharmacy software prints and programs an auxiliary smart label using a dedicated, small-footprint printer. The smart label, which stores prescription information is placed onto the prescription container by the pharmacist. In the home, the patient uses a hand-held ScripTalk Reader that speaks out the label information using speech synthesis technology. By simply moving the prescription within an inch of the ScripTalk reader, pertinent information such as, the name of the patient; the name of the drug; the dosage; general instructions; warnings; prescription (Rx) Number; along with the doctor’s name and phone number are converted into speech.
The second vendor is MedivoxRx Technologies' Rex-The talking Prescription Bottle. Rex is fully automated through text-to-speech technology, allowing pharmacists to electronically record the label information to the pill bottle in a natural sounding computer generated voice using the pharmacy’s current software and data. As the pharmacist sends the label information to the printer, the label information is recorded into the base of the bottle. Features and benefits include ease of use (one push button), no special reader required, no usage training required, disposability, and low cost for patients.
The third vendor cited was Talking Rx. Talking Rx® is a simple, yet effective solution that provides audible guidance in taking medications. The device attaches to common-sized prescription bottles and contains a memo recorder that allows a physician, pharmacist, caregiver, family member or patient to record necessary information about the medication. Samples of the information that can be recorded include: name of the medication and the name of the person for whom it is prescribed, instructions for proper use, any special instructions or possible side effects, name and telephone numbers of physician and pharmacy, and expiration date and refill information, including the prescription reorder number.
Thursday, June 28, 2007
Google's Health Council
I see both Google and Quicken as emerging players in the digital health arena (Please refer to my January 7, 2007 posting.). Today, Google announced the formation of it's Health Advisory Council. According to an article in the Health IT Strategist, the mission of the Council is to enable Google to better understand the problems consumers and providers face every day and offer feedback on product ideas and development. The Council is comprised of IT "movers and shakers" in the USA, including AARP's John Rother. It shall be interesting to follow their deliberations.
According to the news release, the panel will be chaired by Dean Ornish, the founder and president of the Preventive Medicine Research Institute and a clinical professor of medicine at the University of California at San Francisco. Other members of the panel are: RAND Health research scientist Douglas Bell; Cleveland Clinic Chief Executive Officer Toby Cosgrove; Health Technology Center CEO Molly Coye; Former Congressional Budget Office Director Dan Crippen; Wal-Mart Executive Vice President of Risk Management, Benefits and Sustainability Linda Dillman; Beth Israel Deaconess Medical Center and Harvard Medical School Chief Information Officer and Healthcare Information Technology Standards Panel Chairman John Halamka; U.S. News & World Report Health Editor and Columnist and a former head of the National Institutes of Health Bernadine Healy; American Medical Association Chief Operating Officer Bernie Hengesbaugh; AAFP Executive Vice President Douglas Henley; University of California at San Francisco Vice Chancellor of Medical Affairs and School of Medicine Dean and former Food and Drug Administration Commissioner David Kessler; Robert Wood Johnson Foundation Senior Vice President and Director of Health Care Group John Lumpkin; AARP Group Executive Officer of Policy and Strategy John Rother; Kaiser Permanente Vice President of Online Services Anna-Lisa Silvestre; FasterCures President Greg Simon; California HealthCare Foundation President and CEO Mark Smith; Palo Alto Medical Foundation Vice President and Chief Medical Information Officer and American Medical Informatics Association Board of Directors Chairman Paul Tang; Genetic Alliance President and CEO Sharon Terry; American College of Physicians Executive Vice President and CEO John Tooker; Lance Armstrong Foundation President Doug Ulman; UCSF Department of Medicine Associate Chairman and UCSF Medical Center Chief of Medical Service Robert Wachter; and I'm Too Young for This! Cancer Foundation for Young Adults Founder and Executive Director Matthew Zachary.
According to the news release, the panel will be chaired by Dean Ornish, the founder and president of the Preventive Medicine Research Institute and a clinical professor of medicine at the University of California at San Francisco. Other members of the panel are: RAND Health research scientist Douglas Bell; Cleveland Clinic Chief Executive Officer Toby Cosgrove; Health Technology Center CEO Molly Coye; Former Congressional Budget Office Director Dan Crippen; Wal-Mart Executive Vice President of Risk Management, Benefits and Sustainability Linda Dillman; Beth Israel Deaconess Medical Center and Harvard Medical School Chief Information Officer and Healthcare Information Technology Standards Panel Chairman John Halamka; U.S. News & World Report Health Editor and Columnist and a former head of the National Institutes of Health Bernadine Healy; American Medical Association Chief Operating Officer Bernie Hengesbaugh; AAFP Executive Vice President Douglas Henley; University of California at San Francisco Vice Chancellor of Medical Affairs and School of Medicine Dean and former Food and Drug Administration Commissioner David Kessler; Robert Wood Johnson Foundation Senior Vice President and Director of Health Care Group John Lumpkin; AARP Group Executive Officer of Policy and Strategy John Rother; Kaiser Permanente Vice President of Online Services Anna-Lisa Silvestre; FasterCures President Greg Simon; California HealthCare Foundation President and CEO Mark Smith; Palo Alto Medical Foundation Vice President and Chief Medical Information Officer and American Medical Informatics Association Board of Directors Chairman Paul Tang; Genetic Alliance President and CEO Sharon Terry; American College of Physicians Executive Vice President and CEO John Tooker; Lance Armstrong Foundation President Doug Ulman; UCSF Department of Medicine Associate Chairman and UCSF Medical Center Chief of Medical Service Robert Wachter; and I'm Too Young for This! Cancer Foundation for Young Adults Founder and Executive Director Matthew Zachary.
Wednesday, June 20, 2007
Andy Grove's Open Letter
Check out the June 11th issue of Fortune, where Andy Grove makes a pitch for using technology to keep parents at home as part of his "modest" proposal to fix the health care system. His comments follow.
"The cost of caring for the elderly is huge and will only grow as our population ages. Of the $440,000 the average American spends on health care in his lifetime, $280,000 will be spent after age 65.
Probably 50% of that post-65 outlay goes to assisted-living facilities and nursing homes. So it stands to reason that if there were a way to keep elderly patients in their own homes longer - without degrading quality of care - we'd have a cheaper and better system.
And we can do just that using technology. I'm talking everyday, low-cost technology - the sensors, microchips, small radios you'd find in today's PCs, in cellphones, and in Bluetooth earpieces. It's not too difficult to use this stuff as monitoring tools. Not to spy, but to detect trouble. For example, did the patient go outside to get the newspaper or did she wander away? Has the patient taken his meds? The same technology that brings us HBO can watch over the patient and trigger human intervention when needed.
A critical step to make this happen is to have it blessed - and reimbursed - by the dominant health-care supplier to the aged, Medicare. Candidates, I hope to see a phrase in your inauguration speech that starts like this: "I will have Medicare define specifications for electronic equipment that allows the average aging citizen to stay home two years longer than today."
As for affordability, Grove claims "As for the elder-care plan, the savings achieved by keeping just 10% of the aging population in their homes can amount to $30 billion a year."
"The cost of caring for the elderly is huge and will only grow as our population ages. Of the $440,000 the average American spends on health care in his lifetime, $280,000 will be spent after age 65.
Probably 50% of that post-65 outlay goes to assisted-living facilities and nursing homes. So it stands to reason that if there were a way to keep elderly patients in their own homes longer - without degrading quality of care - we'd have a cheaper and better system.
And we can do just that using technology. I'm talking everyday, low-cost technology - the sensors, microchips, small radios you'd find in today's PCs, in cellphones, and in Bluetooth earpieces. It's not too difficult to use this stuff as monitoring tools. Not to spy, but to detect trouble. For example, did the patient go outside to get the newspaper or did she wander away? Has the patient taken his meds? The same technology that brings us HBO can watch over the patient and trigger human intervention when needed.
A critical step to make this happen is to have it blessed - and reimbursed - by the dominant health-care supplier to the aged, Medicare. Candidates, I hope to see a phrase in your inauguration speech that starts like this: "I will have Medicare define specifications for electronic equipment that allows the average aging citizen to stay home two years longer than today."
As for affordability, Grove claims "As for the elder-care plan, the savings achieved by keeping just 10% of the aging population in their homes can amount to $30 billion a year."
Thursday, June 14, 2007
Consumers' Guide to Aging Services Technologies
Enhanced use of information technology in health is believed to lower costs, enhance
quality, and improve access to care for all Americans. Information technology
designed for the aging has similar promise, and we are only in the formative stages
in the design and installation of such products. Emerging technologies for the aging
include smart homes, monitoring robots, talking pill bottles, virtual communities, and on line medicine cabinets. Will consumers embrace these products? Will they be cost effective? Will they ensure personal privacy? Ultimately, will they lower costs and improve care quality? For answers to these and other issues, come join us and learn how to be a wise consumer of aging technologies.
quality, and improve access to care for all Americans. Information technology
designed for the aging has similar promise, and we are only in the formative stages
in the design and installation of such products. Emerging technologies for the aging
include smart homes, monitoring robots, talking pill bottles, virtual communities, and on line medicine cabinets. Will consumers embrace these products? Will they be cost effective? Will they ensure personal privacy? Ultimately, will they lower costs and improve care quality? For answers to these and other issues, come join us and learn how to be a wise consumer of aging technologies.
Tuesday, February 27, 2007
Uncommon Common Sense
Recently, I ran across a podcast sponsored by Deloitte called "Sharing the Health: The Promise of Health Information Exchanges." John Halamka and John Glaser (HIT household names, to be sure) were the featured panelists. I commend this podcast to you without reservation, because their views are devoid of hype, and grounded in the hard realities of HIT transformation in this country. Here is my take-away list.
a. HIT may be able to reduce the 15% redundancy rate in medical practice, but the 15% cost savings for payers equates to 15% income loss for practioners, who won't suffer that kind of income reduction lightly.
b. Two winning business propositions for HIE's are e-prescribing and sending discharge summaries to referring MD's.
c. The information exchanges are a social good, and therefore, governments need to play a major role in their funding--certainly well beyond the current support levels.
d. President Bush's goal of most Americans having access to EHR's by 2014 is unrealistic (I've often referred to it as a "mirage," not a vision). This vision will take decades to be realized. We'd better set in for the long haul.
e. Leadership will come from the States, and not the Federal government. The States can serve as funders, convenors, standard setters, and trust builders.
f. Payer sponsored personal health records are intended to capture market share. The payers are powerful, well funded, uncoordinated, and present real problems for the RHIO's community coordinating function.
g. BEWARE of the grant funding model, unless the grant covers 100% of the work to be done.
h. A shakeout in the RHIO world is forthcoming, akin to the dot com bust of the past. We're in an era of "irrational expectations." They anticipate that about a dozen HIE's will achieve financial sustainability (Out of 160 HIE's currently in existence).
i. There are much more pressing system needs than HIT (i.e., the uninsured). Sobering, but true, I believe.
j. RHIO's may have a better chance to thrive in regions with few payers, local ownership, and non profit structures.
a. HIT may be able to reduce the 15% redundancy rate in medical practice, but the 15% cost savings for payers equates to 15% income loss for practioners, who won't suffer that kind of income reduction lightly.
b. Two winning business propositions for HIE's are e-prescribing and sending discharge summaries to referring MD's.
c. The information exchanges are a social good, and therefore, governments need to play a major role in their funding--certainly well beyond the current support levels.
d. President Bush's goal of most Americans having access to EHR's by 2014 is unrealistic (I've often referred to it as a "mirage," not a vision). This vision will take decades to be realized. We'd better set in for the long haul.
e. Leadership will come from the States, and not the Federal government. The States can serve as funders, convenors, standard setters, and trust builders.
f. Payer sponsored personal health records are intended to capture market share. The payers are powerful, well funded, uncoordinated, and present real problems for the RHIO's community coordinating function.
g. BEWARE of the grant funding model, unless the grant covers 100% of the work to be done.
h. A shakeout in the RHIO world is forthcoming, akin to the dot com bust of the past. We're in an era of "irrational expectations." They anticipate that about a dozen HIE's will achieve financial sustainability (Out of 160 HIE's currently in existence).
i. There are much more pressing system needs than HIT (i.e., the uninsured). Sobering, but true, I believe.
j. RHIO's may have a better chance to thrive in regions with few payers, local ownership, and non profit structures.
Tuesday, February 6, 2007
2nd Annual HIMSS Blogger Meetup
Be sure to check out the 2nd Annual HIMSS Blogger Meetup in New Orleans, outlined at the Healthcare IT Guy. It should be an interesting session!
Thursday, February 1, 2007
Early Adopters
For some time, I have been interested in the characteristics of the early adopters in HIT. The annual 100 "Most Wired Hospitals" list for 2006 seemed like a good place to start an examination. There were 13 new members in the 2006 listing, and if memory serves me correctly, the annual turnover on the list is about 15%. So, who are the institutions who have maintained the rating for all 8 years of the survey? Turns out there are 7 - Avera Health from Sioux Falls, MeritCare from Fargo, Partners from Boston, Sharp from San Diego, Hackensack University Hospital, the University of Pittsburgh Medical Center, and Valley Health System in Winchester, VA. On the surface, we can find no symmetry relative to geography, hospital type, or size. The answers lie within, apparently.
Turning to Wikipedia, we find the following:
Diffusion of innovations theory was formalized by Everett Rogers in a 1962 book called Diffusion of Innovations. Rogers stated that adopters of any new innovation or idea could be categorized as innovators (2.5%), early adopters (13.5%), early majority (34%), late majority (34%) and laggards (16%), based on a bell curve. Each adopter's willingness and ability to adopt an innovation would depend on their awareness, interest, evaluation, trial, and adoption. Some of the characteristics of each category of adopter include:
Innovators - venturesome, educated, multiple info sources, greater propensity to take risk
Early adopters - social leaders, popular, educated
Early majority - deliberate, many informal social contacts
Late majority - skeptical, traditional, lower socio-economic status
Laggards - neighbours and friends are main info sources, fear of debt
The 8 institutions are "Innovators,"to be sure, and have sustained their edge, when the diffusion rate of HIT was growing rapidly.
From my vantage point, I would think the internal reasons why the 8 have maintained their rating are: continuity of leadership, a culture which values innovation, sustained financial success, and thoughtful implementation of HIT initiatives.
Turning to Wikipedia, we find the following:
Diffusion of innovations theory was formalized by Everett Rogers in a 1962 book called Diffusion of Innovations. Rogers stated that adopters of any new innovation or idea could be categorized as innovators (2.5%), early adopters (13.5%), early majority (34%), late majority (34%) and laggards (16%), based on a bell curve. Each adopter's willingness and ability to adopt an innovation would depend on their awareness, interest, evaluation, trial, and adoption. Some of the characteristics of each category of adopter include:
Innovators - venturesome, educated, multiple info sources, greater propensity to take risk
Early adopters - social leaders, popular, educated
Early majority - deliberate, many informal social contacts
Late majority - skeptical, traditional, lower socio-economic status
Laggards - neighbours and friends are main info sources, fear of debt
The 8 institutions are "Innovators,"to be sure, and have sustained their edge, when the diffusion rate of HIT was growing rapidly.
From my vantage point, I would think the internal reasons why the 8 have maintained their rating are: continuity of leadership, a culture which values innovation, sustained financial success, and thoughtful implementation of HIT initiatives.
Friday, January 26, 2007
Comment on HIMSS January 2007 Standards Insight
The HIMSS January 2007 Standards Insight posits a shift from a positive HIT outlook to a negative outlook over the past year and a half. My take is as follows. The "high" to "low" arc referenced spanned 18 months-too short a period to assess either success or failure. I, for one, feel the earlier assessment was much too optimistic, and the latter assessment, too pessimistic. We need to reduce the variation in our HIT expectations, in much the same way we need to reduce variation in clinical outcomes. HIT products and services continue to be oversold and over hyped. There is a huge gap between promise and performance. In truth, all we are doing is chipping away at a major dilemma--how to accelerate the transition from a paper culture to a digital culture in health. Technology is but one part of the answer. The larger issue is changing behaviors, power relationships, and institutional cultures, no easy task.
I was struck by the observation from the Premier study that "top performers were no more likely than others to have effective HIT." I don't think it means hospitals are ineffective in using HIT or that HIT is ineffective in enabling process improvement. Rather, I believe hospitals are ineffective in HIT use and HIT is ineffective in helping process improvement. The combination of these two factors is what is causing us dyspepsia.
It is inconceivable that HIT will not play a major role in the health system of the future. It just won't drive system overhaul. Such an overhaul will come from a combination of factors including rising costs, variation in quality, and increasing numbers of uninsured. Once the status quo becomes intolerable, and it hasn't yet, change will come, and HIT will be part of the solution. For now, we all need to keep our expectations in check regarding HIT.
I was struck by the observation from the Premier study that "top performers were no more likely than others to have effective HIT." I don't think it means hospitals are ineffective in using HIT or that HIT is ineffective in enabling process improvement. Rather, I believe hospitals are ineffective in HIT use and HIT is ineffective in helping process improvement. The combination of these two factors is what is causing us dyspepsia.
It is inconceivable that HIT will not play a major role in the health system of the future. It just won't drive system overhaul. Such an overhaul will come from a combination of factors including rising costs, variation in quality, and increasing numbers of uninsured. Once the status quo becomes intolerable, and it hasn't yet, change will come, and HIT will be part of the solution. For now, we all need to keep our expectations in check regarding HIT.
Tuesday, January 16, 2007
Suggested Reading Lists
The HIT field is awash in studies, reports, newsletters, and press clippings. It takes a major effort to stay current, and there is a need for a rating system, or some other discriminating device to lesson the reading load for busy IT stakeholders. In my judgment, these three sites are an essential starting point for any HIT tracking system: the AHRQ National Resource Center for HIT, the Markle Foundation, and the eHealth Initiative. The following articles are my first attempt at a "top ten" reading list. The articles on this list are accessible, insightful, and provocative.
1. Gary Baldwin. (November 1, 2005). Bringing order to CPOE: 10 Make or Break Steps (and 5 myths). HealthLeader
2. Gerard F. Anderson, Bianca K. Frogner, Roger A. Johns, and Uwe E. Reinhardt. (2006, June). Health Care Spending And Use Of Information Technology In OECD Countries. Health Affairs, 25(3), 819-831.
3. Jonathan Oberlander. (2003, August). The Politics of Health Reform: Why Do Bad Things Happen to Good Plans? Health Affairs Web Exclusive, W3 391-W3 404.
4. Nicholas G. Carr. (2003, May). IT Doesn't Matter. Harvard Business Review, 41-49.
5. Rainu Kaushal, David Blumenthal, & Eric G. Poon. (2005). The Costs of a National Health Information Network. Annals of Internal Medicine, 165-173.
6. Sheera Rosenfeld, Shannah Koss, Karen Caruth, & Gregory Fuller. (2006, January). Evolution of State Health Information Exchange/A Study of Vision, Strategy, and Progress (AHRQ Publication No. 06-0057).
7. (September 2006) Massachusetts Technology Collaborative, CPOE Lessons Learned in Community Hospitals
8. (25 September 06) eHealth Initiative, Improving the Quality of Healthcare Through Health Information Exchange; Third Annual Survey Report
9. (October 2006) National Committee for Quality Health Care, CEO Survival Guide: Electronic Health Record Systems
10. (September/October 2005) Hillestad R. et al, Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs
1. Gary Baldwin. (November 1, 2005). Bringing order to CPOE: 10 Make or Break Steps (and 5 myths). HealthLeader
2. Gerard F. Anderson, Bianca K. Frogner, Roger A. Johns, and Uwe E. Reinhardt. (2006, June). Health Care Spending And Use Of Information Technology In OECD Countries. Health Affairs, 25(3), 819-831.
3. Jonathan Oberlander. (2003, August). The Politics of Health Reform: Why Do Bad Things Happen to Good Plans? Health Affairs Web Exclusive, W3 391-W3 404.
4. Nicholas G. Carr. (2003, May). IT Doesn't Matter. Harvard Business Review, 41-49.
5. Rainu Kaushal, David Blumenthal, & Eric G. Poon. (2005). The Costs of a National Health Information Network. Annals of Internal Medicine, 165-173.
6. Sheera Rosenfeld, Shannah Koss, Karen Caruth, & Gregory Fuller. (2006, January). Evolution of State Health Information Exchange/A Study of Vision, Strategy, and Progress (AHRQ Publication No. 06-0057).
7. (September 2006) Massachusetts Technology Collaborative, CPOE Lessons Learned in Community Hospitals
8. (25 September 06) eHealth Initiative, Improving the Quality of Healthcare Through Health Information Exchange; Third Annual Survey Report
9. (October 2006) National Committee for Quality Health Care, CEO Survival Guide: Electronic Health Record Systems
10. (September/October 2005) Hillestad R. et al, Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs
Tuesday, January 9, 2007
Newt Gingrich's Remarks
Today, I listened to Mr. Gingrich present his vision of a "21st Century Intelligent Health System" to the Delaware Valley Chapter of HIMSS. Prior to the webinar, my bias was that he was playing the health care card to enhance his national image and position himself to run again for higher office. Time will tell. On the other hand, he did impress me with his grasp of the issues, and his ability to get his message across. He is clearly a force to be reckoned with, and I believe he'll help break the current logjam in the health IT debate. Many of the things he said resonated with me. Here are some examples.
a. Health is essentially a moral issue.
b. Focus first on saving lives, and cost savings will follow.
c. A simple argument for EHR's--"paper kills."
d. The inevitability of a digital health system--the issue is when, not if.
e. An EHR makes sense from a public safety standpoint, especially when disaster strikes.
f. See past the system noise and political theater about HIT. There is bipartisan interest in moving forward in this arena.
Check out the Center for Health Transformation for additional information on Mr Gingrich's vision and initiatives.
a. Health is essentially a moral issue.
b. Focus first on saving lives, and cost savings will follow.
c. A simple argument for EHR's--"paper kills."
d. The inevitability of a digital health system--the issue is when, not if.
e. An EHR makes sense from a public safety standpoint, especially when disaster strikes.
f. See past the system noise and political theater about HIT. There is bipartisan interest in moving forward in this arena.
Check out the Center for Health Transformation for additional information on Mr Gingrich's vision and initiatives.
Monday, January 8, 2007
What I'd like to See in 2007
In no special order, in 2007, I'd like to see the following.
a. A state making a commitment to ehealth connectiveness, in the same fashion that Massachusetts set itself on a path to universal coverage, and became a trend setter.
b. EHR vendor consolidation. There are too many vendors chasing chasing the early adopters in the industry.
c. President Bush's signature on a Federal HIT bill, which among other things, gives permanence to the ONCHIT.
d. A successful start to the Dossia experiment, and double the number of large industry sponsors.
e. Expansion of open source EHR offerings. My dream is to witness the health care equivalent of Firefox, Wikipedia, or Linus.
f. More success stories for RHIO's, in every region in the country.
g. Google Health and Quicken Health making their mark on the industry.
h. The private health care sector moving past resource constraints, competitive matters, and other assorted excuses, to forge true region-wide information exchanges.
i. Measureable success toward the joint AHIP and BCBSA pledge to provide a functional PHR by 2008.
j. Agreement and implementation, by all accrediting bodies, of a single set of quality and patient safety measures.
a. A state making a commitment to ehealth connectiveness, in the same fashion that Massachusetts set itself on a path to universal coverage, and became a trend setter.
b. EHR vendor consolidation. There are too many vendors chasing chasing the early adopters in the industry.
c. President Bush's signature on a Federal HIT bill, which among other things, gives permanence to the ONCHIT.
d. A successful start to the Dossia experiment, and double the number of large industry sponsors.
e. Expansion of open source EHR offerings. My dream is to witness the health care equivalent of Firefox, Wikipedia, or Linus.
f. More success stories for RHIO's, in every region in the country.
g. Google Health and Quicken Health making their mark on the industry.
h. The private health care sector moving past resource constraints, competitive matters, and other assorted excuses, to forge true region-wide information exchanges.
i. Measureable success toward the joint AHIP and BCBSA pledge to provide a functional PHR by 2008.
j. Agreement and implementation, by all accrediting bodies, of a single set of quality and patient safety measures.
Tuesday, January 2, 2007
Dossia Musings
Briefing:
On December 6th, 5 US Companies (Walmart, Intel, BP America, Applied Materials, and Pitney Bowes) announced a plan to provide digital health records to their employees, dependents, and retirees. Omnimedix, a non profit firm based in Oregon, will build and run the new system. The sponsoring employers will chip in $1.5 million apiece to construct a data warehouse to store and update the e-records. The stated goal is to cut costs by having consumers coordinate their own health care among doctors and hospitals. Independent studies suggest that employers with an established Dossia System could save about 7% in healthcare costs.
Intel and Walmart had been having separate discussions with the CDC, and the agency suggested that they combine their efforts to press for digital health records. Craig Barrett, Intel's Chair, and Linda Dillman, the leader of Walmart's health care initiative, would appear to be the major spokespersons for the initiative.
At this reading, neither the AHA nor the AMA have specifically endorsed the initiative. Support has come from the Federal government, The American Academy of Family Physicians, and the National Association of Manufacturers.
Musings:
a. This initiative, together with Googles' and Intuit's announced intentions to enter the e Health market, suggest that the private sector is ready to play a major role in the digital transformation of health care.
b. The sponsoring companies could benefit on the revenue side as well. For example, Intel sells chips that power PC's and giant file servers.
c. Apparently, key employers believe the health industry isn't moving quickly enough to digitize health records. Intel's Barrett claimed the industry is incapable of modifying itself.
d. I doubt this initiative will have the same impact as Walmart's RFID requirement for it's vendors. The only comparable force facing the health care industry is the US government, and the political will to spur system change is lacking.
e. The jury is out as to whether employers and insurers will use the information to deny employment or insurance coverage.
f. Will the patient/consumer turn out to be the best integrator of health information? Perhaps over the long term, but in the short term?
On December 6th, 5 US Companies (Walmart, Intel, BP America, Applied Materials, and Pitney Bowes) announced a plan to provide digital health records to their employees, dependents, and retirees. Omnimedix, a non profit firm based in Oregon, will build and run the new system. The sponsoring employers will chip in $1.5 million apiece to construct a data warehouse to store and update the e-records. The stated goal is to cut costs by having consumers coordinate their own health care among doctors and hospitals. Independent studies suggest that employers with an established Dossia System could save about 7% in healthcare costs.
Intel and Walmart had been having separate discussions with the CDC, and the agency suggested that they combine their efforts to press for digital health records. Craig Barrett, Intel's Chair, and Linda Dillman, the leader of Walmart's health care initiative, would appear to be the major spokespersons for the initiative.
At this reading, neither the AHA nor the AMA have specifically endorsed the initiative. Support has come from the Federal government, The American Academy of Family Physicians, and the National Association of Manufacturers.
Musings:
a. This initiative, together with Googles' and Intuit's announced intentions to enter the e Health market, suggest that the private sector is ready to play a major role in the digital transformation of health care.
b. The sponsoring companies could benefit on the revenue side as well. For example, Intel sells chips that power PC's and giant file servers.
c. Apparently, key employers believe the health industry isn't moving quickly enough to digitize health records. Intel's Barrett claimed the industry is incapable of modifying itself.
d. I doubt this initiative will have the same impact as Walmart's RFID requirement for it's vendors. The only comparable force facing the health care industry is the US government, and the political will to spur system change is lacking.
e. The jury is out as to whether employers and insurers will use the information to deny employment or insurance coverage.
f. Will the patient/consumer turn out to be the best integrator of health information? Perhaps over the long term, but in the short term?
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