Digital Health Technologies Teaching Toolkit

I first began to teach a class called "Emerging Technologies Transforming Home Healthcare" in the Fall semester of 2017. It was offered to registrants at the Osher Lifelong Learning Institiute (OLLI) at Eckerd College and at the University of South Florida.

I decided, from the outset, to include aging tech devices as an integral part of the lecture for illustrative purposes, and also to give attendees a chance to directly engage with the devices. My impression, based on immediate feedback and subsequent course evaluations, is that the attendees valued access to the devices and associated apps.

I'd like to share my inventory of devices and apps which proved to be successful supplements to the teaching material.

For Voice-Activated Devices: Amazon Echo Show, Lenovo Smart Display with Google Assistant, and Google Home are featured. "Competitions" between the Amazon Show and Google Smart Display were especially effective. Start by asking each device to introduce themselves.

For Robot Pets: Hasbro's Joy for All pet dog (Golden Pup) and pet cat (Orange Tabby) are consistent hits with the attendees. We distribute the robots at the start of class, and let the participants play with them during and after class.

For Robot Companions: Anki's Vector is always entertaining-whether it's playing blackjack or giving a fist bump. Vector now features Alexa access as well, so you can make any Alexa query you wish. I had access to Catalia Health's MABU care manager for a year, and attendees enjoyed using either voice or touch to respond to the robot's prompts (How are you feeling today? Did you take your medications?)

For Virtual Reality:  The Zeiss VR One Plus viewer using a smartphone together with an Orbulus VR app is a great place to begin the VR experience. The Oculus Go by Facebook is also offered for a more comprehensive and engaging VR experience.

For the Internet of Things: The Roomba 675 vacuuming robot is fun to use, directed either by a smartphone app or by voice commands in conjunction with Alexa.

For the Internet of Health Things: Use the Apple Smart Watch (Series 4) together with an iPhone for it's Health, and it's Watch app. You can demonstrate how the EKG feature of the watch works. I share my bike accident and the subsequent trigger of the Watch's fall alert. The Kardia portable EKG device and associated app are interesting alternatives to the Apple watch. Eargo hearing aids are also presented as a novel approach to dealing with hearing loss.

For the Visually Impaired: Demos using Microsoft's Seeing AI (Free for iPhones only) and the KNFB reader (costing $100 and compatible with iPhone and Android) feature reading handwriting, scanning bar codes, and identifying money.

For Augmented Reality: Amazon's AR View within the Amazon app and the IKEA Place app
showcase an AR overlay of furniture in your home setting. The WANNAKICKS app is an great way to use AR in deciding which sneaker to buy.

For Virtual Care: I encourage attendees to download Ada Health's free symptom checking software, try it out, and share their impressions in class. Also, I inquire whether anyone has used the BayCare Anywhere app or Tampa General's Virtual Care app and to share their impressions.

Please let me know if you have any questions or comments.

The Ethical Considerations of Virtual Reality

"Never has a medium been so potent for beauty and so vulnerable to creepiness.  

Virtual reality will test us. It will amplify our character more than other media ever have."

VR pioneer Jaron Lanier

Source: https://www.theatlantic.com/magazine/archive/2018/05/realitys-end/556877/

                   Four Ethical Concerns About Virtual Reality                                         

First, VR poses potential mental health risks, including Depersonalization/Derealization Disorder*

Depersonalization-derealization disorder occurs when you persistently or repeatedly have the feeling that you're observing yourself from outside your body or you have a sense that things around you aren't real, or both. Feelings of depersonalization and derealization can be very disturbing and may feel like you're living in a dream.

Second, VR technology raises serious concerns related to personal neglect of users’ own actual bodies and real physical environments 

Third, VR technologies may be used to record personal data which could be deployed in ways that threaten personal privacy and present a danger related to manipulation of users’ beliefs, emotions, and behaviors 

Fourth, there are other moral and social risks associated with the way VR blurs the distinction between the real and illusory

Source: https://link.springer.com/article/10.1007/s11948-017-9979-y

 

 

Six Ways Telehealth Made Progress in 2018

1. Collaboration between bedside and virtual care teams paved the way for seamless care. 
2. Legislation supported the expansion of telehealth services. In June 2018, The Centers for Medicare & Medicaid Services (CMS) publicly encouraged states to utilize telemedicine and telepsychiatry to facilitate coordinated care.
3. Large scale research studies showed significant reduced telehealth cost, paired with positive satisfaction and quality.
4. Retail players broke into the telehealth market, possibly spurring additional innovation. Retail giant Walmart partnered with consumer health and hygiene company RB to launch a telehealth initiative with Doctor on Demand, a virtual care provider.
5. Growth of virtual care for behaviorial health enhanced the mind-body connection.
6. The line between physical and virtual care began to blur. Use cases appeared covering the full spectrum of care from acute to post-acute and urgent to managing healthy lifestyles.

Sources: https://www.healthleadersmedia.com/innovation/6-ways-telehealth-made-progress-2018 

Source: https://www.healthexec.com/topics/care-delivery/walmart-telehealth-campaign-doctor-demand 

Care Robot Classification Scheme and Examples

Disclaimer: I own Pillo, Anki Vector and two Hasbro Joy For All pet robots (Orange Tabby cat and Golden Pup), and have had a year-long access to MABU and owned Jibo for a short time. Before year-end, I expect to own ElliQ and Temi, the telepresence robot.

In the course of my study of care robots, I developed the following classification system which is composed of three categories: Humanoid Design, Care Companions/Care Managers, and Pet Robots. Let's go through each category and identify robots which "fit" within that category. To enable further study, hyperlinks have been provided for each robot.

Humanoid Design


Robear

Moxi by Diligent Robotics

Kompai-2

Pepper by Softbank Robotics

MERA (Multi-Purpose ElderCare Assistant)

Zora by Zorarobotics

Omnilabs Telepresence Robot

Temi Telepresence Robot

Care Companions/Care Managers

MABU by Catalia Health

Misty II Personal Robot

ElliQ by Intuition Robotics

Buddy by Blue Frog Robotics

Pillo by PilloHealth

iPal Robot by AvatarMind

Vector by Anki

Pet-Like Devices

Personal Assistive Robot (PARO)

Hasbor's Joy For All

Aibo by SONY

I

Launched in 2017 and Closed in 2018 (Companion Robots)

Jibo

Kuri

In summation, Here is a listing of Robots supporting Aging In Place

Remote Patient Monotoring (RPM):  ElliQ, Temi Telepresence Robot

Care Companions: Anki Vector, Pepper

Chronic Care Managers: MABU, Pillo

Digital Nursing Assistants: Moxi, Robear

Safety Monitoring and Care Alerts: iPal, Buddy

Reflections on Digital Health Technologies supporting Aging In Place

Enduring Conclusions

• Keeping the aging in their homes for as long as possible enhances the quality of life and preserves scarce resources
• Consumers for these technologies need a framework of analysis, a sense of the evolving market, and a discerning eye for compatibility and value
• Don't turn your back on low tech assistive devices such as a magnifying glass or an amplified telephone
• Biggest concern of seniors at home? Falls! Need to fall-proof your home or apartment

Near Term Projections

 2019>>>>>>>>2021

•Immature sector >>Sector maintstreaming                                   

•Unbundled services>>Bundled services (Amazon model)

•Voice emerging>>Voice becoming pervasive

•Diffuse market leadership>>Big 5 owns the aging tech space

•Care Robots pilots>>Care robots in home and post acute care

•Privacy & security concerns>>Ongoing, but Blockchain helps   

•HIPAA concerns>>Amazon & Google drive compliance by others

•Technologies not well supported/intuitive>>Frictionless technologies

•Predictive analytics gaining favor>>Predictive analytics commonplace

•VR & AR pilots>>VR & AR clinical applications used widely

•Accreditation/Certification?>>Telehealth, robots and IoHT certified

Few smart homes and senior living units>>Smart living options abound

Digital tech is out of pocket>>Provided free by health systems/plans*

* Freely provided by systems/plans to prevent re-admissions and to manage chronic care

Comparing Amazon Echo Show and Lenovo Smart Display with Google Assistant

Have owned both voice activated screen devices for several months, and use them on a daily basis. Although the percentage of current screen owners is small, I prefer the option for several reasons. Screens nicely compliment voice experiences by reinforcing the main message of the dialog, presenting options, and providing videos and images as well.

Advantage Google Assistant?

• More touch screen options
• Access to YouTube
• Visual prompts for follow-up questions
• True search engine*
• Baked in skills-no need to use smart phone to enable skills
• More users world-wide and more language options
• The ability to do some chores for you—things like screen your calls on an Android phone, or (in a feature called Duplex, which rolled out this fall) hold telephone conversations with an actual human to book a table at a restaurant or an appointment at the salon 

Advantage Amazon Echo Show?

• Access to Amazon Marketplace for order, reorder, and shipping updates
• More skills than Google, and the gap shows no sign of narrowing
• Dominant market share in the United States
• The Amazon Alexa is found in Anki Vector, LifePod, and behind the Facebook Portal
• Acquisition of Ring and Eero indicates a major bundling initiative-one stop shopping for connected internet of things
• More than 10 thousand employees working on Amazon voice
• Better member support. Both send weekly e-mails touting new uses, but Amazon's is more comprehensive and more helpful

*Query: Ask both devices this question: Who is the Chief Executive Officer of Leading Age Florida? Google's answer is accurate while Alexa will tell you about the Chief Executive of Florida. The Amazon features what has been described as an action engine, telling the person what it thinks they want to hear.

Screen size, options for other voice devices, sound quality, and pricing are comparable. Both devices are constantly updated in the cloud and both have improved services over time.

My vote? Slight edge to Amazon Show.

Takeaways from the 2019 Alexa Conference, Chattanooga, TN January 15-17

Most older adults need help and support in setting up Alexa and managing skills-an observation borne out in my aging tech classes here in Tampa Bay.

Alexa may have 20,000 skills, but we have yet to see a "killer app." And, most people abandon their skills after a very short time.

Voice biomarkers will likely be used to detect dementia or stroke -  probing information buried in human voice.  Check out Sonde Health's focus on biomarkers.

HIPAA Discussions: Law passed in 1996 and no updates since then. Amazon's Alexa was launched in 2014 and Google Assistant in 2016. No adoption to emerging technologies. Few, if any players are willing to defy HIPAA. Projections that Amazon and Google will be HIPAA compliant by the end of 2019.

Voice wars among the Big 5 (Apple, Microsoft, Google, Facebook and Amazon). Prediction that no start-up will come to dominate the market.

Front Porch has made major research contributions to the post acute care community. They have done studies of voice, telehealth, hearing loss and video games.

How about a voice activated smart car that would monitor your vital signs and direct you to the nearest hospital in the event of a significantly abnormal finding?

Orbita, the Boston based voice platform, likens itself to a "word press" for healthcare - software used to create website, blog, or app/skill.

Vision offered by Teri Fisher? Sick bay in the home. No MD intervention. Voice first serving as a triage nurse. Daily reminders for aging in place. Ordering scripts via Alexa, and delivery to the home by drone.

Melissa Campbell talk on "Why Parents Should be Wary of Echo Dot Kids" was a remarkable counterpoint to general upbeat nature of the conference. Here  are some of her comments. Anyway you slice it it, Alexa is a market device. Great for data collection and revenues, but not for kids. Not made for kids, but made to appeal to kids. It's all for Amazon. (See New York Times' article on Co-Parenting with Alexa)

Keynote address by Kesha Willaims, Software Engineering Manager, Chick-fil-A Corporate, was awesome-one of the best speeches I have ever heard!

With voice, the user controls the technology. Before, had to access technology by typing, touch, or coding. First time tech is adjusting to us!! (Brad Metrock, Conference Organizer)

Health Care entities will be the biggest users of Voice. 

Will take 5 years for Voice to mainstream, then Voice will be everywhere/pervasive

Geico and Progressive (Flo) should have synthetic voices specific to their brand-they don’t now

All in all, a remarkable experience! I am already booked for Alexa 2020!

Digital Health Technology Series

After two years of testing this material with attendees at local Osher Lifelong Learning Institutes, I have prepared this 6 part series on Digital Health Technologies supporting Aging In Place. Your reviews and comments will be welcomed. Thank you.

Digital Health Technologies Supporting Aging In Place

1. An Overview of Digital Health Technologies

Digital health technologies have the potential to transform health and wellness for aging clients, and to provide assurances for their family members. Broadly speaking, consumers of these emerging technologies need context, a framework of analysis, and a sense of the dynamic marketplace for such services. Learn what the promoters and the critics of these technologies have to offer. Key ethical issues will be discussed, and you will discover a device certification program, and its distinctive logo. The overall goal of the presentation is to help you make informed decisions on the cost, utility and quality of digital health technologies

2. Care Robots: Managing Care and Providing Companionship 

Care robots have the potential to increase the productivity of caregivers, provide emotional support and companionship, and to serve as effective accountability partners in such matters as medication adherence and physical exercise. Experiments with robotic pets in senior settings such as memory care units are increasing. In this class, you will learn to identify the types of robots currently available and to understand what the promoters and the critics have to say about these devices. You will have hands-on experience with robot pets and a robot companion called Vector. The overall objective is to ensure that you have the tools and insights to be an informed consumer of care robots.

3. Virtual and Augmented Reality's Potential for Health and Wellness 

The immersive experience of virtual reality (VR) is being used both for diversion therapy as well as a growing number of clinical applications, like pain management. Augmented Reality (AR) allows users to view digital information and images as an overlay to the real world. Increasingly, AR is being used to provide surgeons with an array of clinical information while operating, and it is playing an important role in medical education. We will examine use cases for both VR and AR and identify leading VR and AR vendors and their respective products. Attendees will experiment with VR viewers, including the Oculus Go by Facebook

4. Voice-activated Devices: Improving Care Coordination and Patient Engagement

Voice assistants have achieved popular adoption with over 50 million consumers in the U.S and an estimated 100 million users worldwide by the end of 2018. The devices are expected to play a major role in care coordination and patient education. Like any new device, they have strengths and limitations, which we'll explore. While Amazon and Google are current market leaders, we'll identify other tech companies coming into the market, especially with smart display devices. Use cases for voice in clinical trials and in senior settings will be identified. The Amazon Echo Show and the Lenovo Smart Display (With Google Assistant) will be available for student inspection and interaction.

5. Smart Homes and the Internet of Health Things

Smart homes, featuring wireless security, safety and utility devices, are entering the mainstream, after years of experimentation at leading academic institutions. For example, Lennar, a major home builder, is now marketing a Wi-Fi Certified™ Smart Home featuring Amazon Alexa. Internet of Health Things are devices/wearables which track vitals, monitor medication use, and issue fall warnings. Apple’s Smart Watch (Series 4) is a prominent example of such devices. Discover the strengths and weaknesses of both technologies, the interplay between each, and future projections. 

6. Telehealth/Virtual Care

Telehealth has potential to make care available to underserved areas, extend the reach of specialty medical and psychiatric care, and to reduce care and transportation costs. Nearly all US health systems are planning to offer telehealth options to their constituents. We will discuss factors which will promote telehealth growth as well as factors impeding such expansion. Special attention will be paid to virtual physician visits, which are becoming more available to healthcare consumers. Case studies of telehealth market leaders like the Veterans Administration and Avera Health E-Care will be considered. We’ll examine what the skeptics of telemedicine have to say as well. Lastly, we will showcase the new ClearHealth Quality Institute Telemedicine Accreditation Program sponsored by the American Telemedicine Association.

February 2019