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.

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.

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.

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.

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.

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.

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.

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."