Friday, March 8, 2019

Essential Building Blocks for Digital Health Technology Adoption

I choose to believe that all types of post acute care facilities should take steps to incorporate digital health technologies into their settings. It will be a competitve advantage, to be sure. And, it won't be particularly easy. However, the technologies have the potential to keep seniors living independently for extended periods, to support caregivers and families, and to improve the quality of care for patients and residents.

If you accept this premise, then I would suggest that you consider applying the following suggestions which-in combination-are most likely to lead to a successful digital health technology initiative.

1. Commitment from the Board of Trustees and top management to support the initiative at the outset, and throughout the period of implementation.
2. Incorporate digital health technology experimentation and adoption in the entity's strategic plan.
3. Encourage a culture of innovation ("Failing your way to success!"). I worry that a process or top down culture may scuttle a successful technology effort.
4. Install enterprise-wide Wi-Fi, and try to identify and eliminate eliminate dead zones as much as possible. Having WiFi in common areas only just won't cut it.
5. Identify product champions in management, nursing and information technology, and give them the resources and recognition necessary to get the job done.
6. Conduct extensive research on alternative technologies, and select the one which is most likely to be accepted in your particular facility. The first technology chosen might be voice, telehealth or care robots. Don't try to pilot more than one technology at a time. Do one well, before considering another technology. Consider that over time, you'll be adopting a number of new or improved technologies in support of your mission.
7. Once you decide to pilot a technology, be sure to fund it adequately and establish metrics which include customer satisfaction and improved clinical oucomes.
8. Be sure to include a guided orientation to the new technology, and consider a "Help Desk" to support everyday users. Often, seniors are unsure of how to enable or disable an Alexa skill, or how to pair Alexa with wireless lighting, air conditioning, or security devices.
9. Encourage residents to chart their own way with the technologies and to share their stories of success or failure. Tech-savvy seniors may be more numerous than you might imagine.
10. Seek out academic partners to provide guidance and support for your initiatives. It is in everybody's best interest to insure that the healthcare leaders of tomorrow are well versed in advanced technologies!

I hope that these suggestions are useful. I welcome your critical commentary.



Thursday, March 7, 2019

Brookings Institution 2018 Survey on Robots

The survey was undertaken by researchers at the Brookings Institution through an online U.S. national poll of 2,021 adult internet users between June 4 and 6, 2018. Here are some of the key survey findings, followed by my observations.

1. The survey asked how likely robots are to take over most human activities within the next 30 years? 19% feel this was very likely, 33% believes this is somewhat likely, 23% feel it is not very likely, and 25% were not sure. 

The headline for the Brooking's posting claims "52% believe robots will perform most human activities in 30 years." Combining the very likely (19%) and somewhat likely (33%) into a broad affirmation of the 30 year scenario seems to me to be a bit overstated. I honestly don't think people I encounter have fixed ideas about robots. Rather, what I witness is ambiguity and a bit of anxiety and awkwardness when confronting a care robot.


2. Thirty-two percent believe the U.S. government should set up a Federal Robotics Commission to regulate robot development and usage, compared to 29 percent opposed and 39 percent who were unsure. 

I am not seeing a significant mandate for Federal governmental action in these findings.
3. Sixty-one percent said they were uncomfortable with robots, while only 16 percent felt comfortable with robots and 23 percent were unsure. When asked how worried they were about robots, 61 percent said they were unworried, while 29 percent were worried and 22 percent were not sure.

How are we supposed to reconcile the finding that 61% of respondents are uncomfortable with robots, with the finding that 61% are unworried about robots? It doesn't make sense to me.

4. Thirty-eight percent felt robots would make their lives easier in the next five years, while 17 percent felt their lives would become harder and 45 percent did not know.

I believe the 45% of the respondents who claimed they didn't know is the more useful finding. If one has never had interactions with a care robot for example, how are they supposed to make a judgment about making their lives easier? Today, most Americans have had little or no personal interaction with care robots, or robots of any kind. 
5. When asked how common they thought robots would become over the next five years, 13 percent said very common, 32 percent said somewhat common, 26 percent felt they would not be very common, and 29 percent did not know.

I believe that care robots won't be commercially viable for 3 years or more, putting me in the "not very common" group. For now, pet robots are being used in a number of post acute care settings, and the Front Porch system has published a definitive study on the positive clinical impact of a robot pet called PARO. Kaiser Permanente is making a care robot named MABU available to some of it's members to help manage their chronic diseases. A nurse assistant robot called MOXI by Diligent Robotics is being piloted in Dallas and Austin hospitals. Interesting developments, to be sure, but far from widespread acceptance.

6. We asked about the kinds of robots that would interest them. Twenty percent were interested in robots that would help them clean house, 17 percent wanted robots that would provide home security, and only 9 percent were interested in a robot that helps to care for a child or aging relative.

To me, the key finding is the 9% who were interested in a robot that cares for a child or an aging relative. It doesn't suggest much market demand for robots to serve children or aging clients. Looking at a more nuanced breakdown, we observe the following.


6 a.How interested are you in having a robot that helps care for a child or aging relative?


  • 71% very disinterested
  • 13% somewhat disinterested
  • 4% somewhat interested
  • 5% very interested
  • 7% don’t know no answer

To me the finding of 71% very disinterested is a stark reminder that while we may be willing to have robots wash dishes and clean the house, we draw a line involving robots in direct care. This distinction was made clear to me during a recent lecture when an RN in the audience was adamant that no robot could ever deliver compassionate care to an aging client!

7. The survey inquired how much people would pay for a robot that handles routine chores.  Forty-two percent said they would pay $250 or less, 10 percent said they would pay between $251 and $500, 3 percent said they would pay from $501 and $750, 3 percent indicated they would pay between $751 and $1,000, and 3 percent were willing to pay more than $1,000. Thirty-nine percent did not provide a figure. 

The price points of care robots that I cover range from $100 for a Hasbro Joy for All pet to $18,000 for a robot nursing assistant, with the average purchase price between $500 and $1000, before adding monthly subscription fees. Two robots-JIBO and KURI- went out of business in 2018, because their price points were high ($700 to $900) and the units offered questionable value. There clearly is a sizeable gap between what the respondents wish to pay for a care robot and what the vendors are now asking. And, you can buy an Amazon or Google voice activated smart display for $250 and no subscription fees. These devices present significant competition for care robots. Finally, there isn't a care robot in this country with a commanding market position, enjoying a first mover advantage.


Source: https://www.brookings.edu/blog/techtank/2018/06/21/brookings-survey-finds-52-percent-believe-robots-will-perform-most-human-activities-in-30-years/

Sunday, March 3, 2019

Digital Health Technology Lecture Evaluation

My lectures are designed for active and curious adults who want to better understand and possibly apply digital health technologies to help them age in place. Their feedback, either from questions offered during the lecture, following the talk, or incorporated in program evaluations, is vital to the ongoing enrichment of the material. 

Immediately following a lecture, I seek out a quiet spot and prepare program notes. This process continues for the next few days until I have captured all of the relevant feedback that I can recall. I then review the notes, highlighting key points and insights. Refernce is made to these notes before I give another lecture on the same topic.


Here are ten things I look for as I examine my post meeting notes:

1. Identify the slides which clearly connected with the audience and those which did not. I'll continue to use the former, and remove or edit the latter. For example, a big hit with the audience is attributing a Myers-Briggs rating to Alexa. The latest gadgets from the annual Consumer Electronic Show (CES) don't seem to have much traction, however.
2. Did the device demos works as intended? The demos which are the most effective involved voice activated devices, virtual reality viewers, and robot pets like the Hasbro Joy for All cat and dog. I have encountered less success with augmented reality and wearables (e.g., Apple Smart Watch) demos.
3. The differences between Digital Health Technologies are often muted and I try to take note of technology spillovers. For example, many care robots use voice activation, and telemedicine may well be broadcast using Amazon or Google visual display devices.
4. I try to take note of repeated audience concerns with regard to using Digital Health Technologies. In my experience, the top three concerns are privacy/security, fall prevention, and overcoming loneliness.
5. Often members in the audience are looking for guidance using the devices. I try to offer suggestions when appropriate. For example, I suggest that the introduction of voice activated devices in a post-acute setting begin with an orientation, a "help desk" to assist with such concerns as enabling/disabling Alexa skills, and the formation of a Voice club or an Alexa club.
6. I encourage audience members to tell their stories about their experience with the technologies. One person recently noted that she gave Amazon Echo Dots to her  7 grandchildren, and they really enjoyed them. A more common response is that attendees use their grandchildren to help them understand and manage the devices.
7. Attendees have a way of asking questions that you don't anticipate: How do you trigger fall alerts when you are unconscious? What happens when there is a power outage? How can robots give compassionate care to frail elderly?
8.Have I given equal weight to the promoters and the critics of these devices? Being overly positive or overly negative upsets the balanced view needed by prospective consumers of the devices.
9. Did we look ahead three years or more, and project how the devices might be used by the audience members? After all, we are in the very early stages of device adoption.
10, Did I allow enough time at the close of the talk to provide for direct audience feedback and discussion?




Digital Health Technologies Lecture Preparation

John Wooden, the legendary UCLA Basketball coach, once said "If you don't prepare, prepare to fail." Therefore, I prepare. I have been following a pre-lecture routine for almost 20 years. Briefly, let me outine the steps I take prior to giving the lecture.
1. Over three separate days prior to the talk, I review the slides in presentation mode, and also carefully review my lecture notes. This gives me a chance to make any last minute edits to the material-which I often do!
2. I check with the lecture sponsor to learn the headcount for the lecture, and print my own handouts accordingly.
3. Ideally, I'd like to know the layout of the room, wireless availability and password access, seating arrangements, location of podium and microphones, and access to plugs for my demos. I try to make a site visit prior to the talk to check these things out.
3. I always bring a back up computer, projector, microphone, and power strip. Many times, one finds the technology components in the lecture space are inadaquate. Thus, you need  to have a failsafe support system. And, as a last resort, I am always prepared to give the lecture without using slides.
4. I arrive at least an hour before my lecture is scheduled to begin. Problems can then be identified and corrected well before the students arrive.
5. For students who arrive early, I usually provide an "early bird special" showcasing the technologies that will be discussed that day. For example, I conduct a face-off between the Amazon Echo Show and the Lenovo Smart Display with Google Assistant, or encourage attendees to utilize several virtual reality viewers.
6. I prefer to handle my own introduction, and to keep it brief. 
7. Attendees are encouraged to ask questions at any time. It keeps the audience engaged, and makes them part of the presentation.
8. Lastly, I remind myself to repeat questions from the audience, and to be sure to check on the following: Can you hear me? Is the pace of delivery OK? Can you see and read the slides easily?

These steps have served me well over the years, and I commend them to you.