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Beneficial Technologies to
Promote Independence of
Older and Disabled People:
Adoption and Diffusion
David Lindeman, PhD
Director, Center for Technology and Aging
Co-Director, Center for Innovation and
Technology in Public Health
Aging in America March 17, 2010
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© 2010 Center for Technology and Aging
Rapid Advancement of Technology
 US putting $19 Billion into Health Information Tech (HIT)
 57% of Americans age 65 and older have a cell phone
 $7 Billion ARRA 2009 into Broadband Expansion and
Distance Learning and Telemedicine Expansion
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© 2010 Center for Technology and Aging
Diffusion of Beneficial Technologies
Many technologies wither on the vine . . .
• Social-cultural factors — readiness vs. resistance
• Economic factors — who pays, how?
• Political/legal factors — laws, regulations, and policies
that favor or impede
• Technology factors — ready for broad use or tech
enthusiasts only?
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© 2010 Center for Technology and Aging
Medication Optimization
 Medication information, dispensing, adherence, and
monitoring.
 Medication use is ubiquitous among older adults, with 90% of
older adults using one or more prescription medications/week.
 New England Healthcare Institute:
$290 billion in healthcare savings
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© 2010 Center for Technology and Aging
Technologies to Optimize Medication Use
Medication Adherence
Medication Reconciliation
Prescribe
Assess
Dispense
Administer
Monitor
Goals
Goals
Goals
Goals
•Patient history
includes a
complete and
accurate
medication list
•Patient needs
are accurately
conveyed and
understood
• Medication
orders are
documented
and shared
with patients
• Medication is
• Individual dose
made available
dispensed
• Medication picked • Individual dose
up by patient
taken by patient (on
• Patient and
time, in the right
caregivers
does, and for the
understand
right length of time)
medication
instructions
Example
Technologies
Example
Technologies
•Medication List
Software
•Personal Health
Records (PHR)
•Medication List
Software
•Personal Health
Records (PHR)
Example
Technologies
Example
Technologies
Example
Technologies
•Teleconsultations
•Online Patient
Education
•Cognitive
Assessment Tools
•Pharmacy Kiosks
•Medication
Adherence Devices
(integrated and
standalone, simple
and advanced
function)
•Personal Biometric
Testing Devices
•Wireless
Communication
Devices
•Personal Health
Records (PHR)
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© 2010 Center for Technology and Aging
Goals
Medication Monitoring
• Routine dosing and
tracking of medication
• Reports and trending
information from
medication log
generated
• Clinician adjusts
medication as needed
• Prescriptions refilled
Improve Medication Reconciliation
One-time entry Medication
List – electronic or paper
• User adds medication
information for print out
Name
My
Medication
Log
Universal
Medication
Form
Health and
Safety
Passport
Med List
My
Medicine
List
Pill Card
My
Medicine
Record
Organization
Cardiovascular
and Public
Health Detailing
Programs
McLeod Health
in Florence, SC
California
Pacific Medical
Center, San
Francisco
A statewide,
collaborative
initiative in
Massachusetts
ASHP
AHRQ
FDA
Description
A medication log for use in the Cholesterol
Action Kit
ihttp://www.ihi.org/IHI/Topics/PatientSafety/M
edicationSystems/Tools/MyMedicationLog.ht
m
A form where patients can enter medications
used, allergies, and immunization records
Patients list their medications, health history,
and other relevant information
Medication list to keep track of patient
medications and supplements. Also offers
tips for using medications wisely.
A tool where patients can develop and
manage their own medication list. The tool
can be found on the ASHP Foundation
website
Information on how to develop an easy-touse "pill card" for patients, parents, or
anyone who has a hard time keeping track of
their medicines at
http://www.ahrq.gov/qual/pillcard/pillcard.htm
Continuous Electronic Continuous Electronic
Medication List
Medication List
Integrated with Personal
• Medication
Health Records
information stored
online.
• Info can be updated
manually or
automatically if
linked to pharmacy.
• Print out required to
share information
with providers
Patients list prescription medicines, over-thecounter medicines and dietary supplements.
http://www.fda.gov/cder/consumerinfo/my_m
edicine_record.htm
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© 2010 Center for Technology and Aging
• Medication information
stored online.
• Info can be updated
manually or automatically
if linked to pharmacy.
• Medication list accessible
to providers through PHR
Improve Medication Adherence
Single Function
Advanced Function
Integrated Function
• Performs one function • Performs one or more of • Technologies that
currently available
the currently available
integrate medication
within the medication
spectrum functions and
administration with other
adherence technology can also perform one of
health-related
the more advanced
management functions
spectrum
Rex Talking Pill Bottle
functions
MagneTrace
Source: www.rxtalks.com
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Health Buddy
Improve Medication Monitoring
•
Medications that place patients at risk for adverse reactions are
especially important to monitor
•
Point-of-care testing devices are available to monitor blood pressure,
peak flow (for asthma), blood glucose (for diabetes), warfarin dosing and
a host of other health conditions
Islet iPhone Application
Warfarin iPhone
Application
•
Source:www.princeton.edu/main/news/archive/S25/10/88K09/index.xml?section=featured
Devices to monitor medication are becoming more prevalent with
wireless capabilities and enhanced tracking and trending features.
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© 2010 Center for Technology and Aging
Center for Technology and Aging:
Medication Optimization Diffusion Grants Program
•
Improve efficiency of care delivery
•
Improve health and independence
•
Reduce the cost and burden of care
•
Improve chronic disease self-management
•
Improve rate of diffusion and adoption
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© 2010 Center for Technology and Aging
Veterans Administration of Central CA
 Home self-management and medication adherence
 Veterans that are home-based with chronic heart failure
 Remotely located internists and allied health professionals
 5 central California rural and medically underserved counties
 The Health Buddy® system plus weight scale, blood
pressure monitor, assessment algorithms and clinician alerts
 . . . VHA is a leader in telehealth coupled with care
coordination
Health Buddy
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© 2010 Center for Technology and Aging
Caring Choices - Chico, CA
 Improve medication monitoring and adherence
 Philips Medication Dispensing Service technology
 Four home health and senior living organizations in four rural
and urban areas of CA
 Partner, Home Health Care Management, has successfully
deployed medication dispensers for the past 10 years
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© 2010 Center for Technology and Aging
Connecticut Pharmacists Foundation Long Beach, CA
 Culturally and linguistically appropriate Medication Therapy
Management (MTM) services
 Community health workers and remotely located pharmacists
will use videoconferencing, Electronic Health Records, and
spoken format technology to deliver MTM services to
Cambodian-American older adults
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© 2010 Center for Technology and Aging
Visiting Nurse Service of New York
 A multi-faceted, IT-based intervention designed to better
support nurses, as well as cognitively impaired patients and
their caregivers, in the challenging process of managing
multiple medications in the context of multiple co-morbidities
 4 boroughs of New York City
 Technology: medication complexity algorithm, electronic
clinical alerts and decision support tool, and caregiver support
materials for CI elders with complex medications regimens
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© 2010 Center for Technology and Aging
American Society of Consultant
Pharmacists Foundation
 Pharmacists will use Monitor-Rx, a web-based patient
medication assessment tool, to optimize the medication
regimens of older adults
 Southern California organizations:
 OASIS Older Adult program
 University of CA, Irvine Senior Health Center
 Alzheimer’s Family Services Center
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© 2010 Center for Technology and Aging
Center for Technology and Aging: Remote Patient
Monitoring Diffusion Grants Program
 Remote collection of patient information using a
device: physiological, emotional, location
 RPM benefits:
 support patient self-management
 early diagnosis
 reduce ED and hospital services
 shift responsibilities to non-clinical providers
 improve care coordination
 built in patient education programs
 improve patient and provider satisfaction
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© 2010 Center for Technology and Aging
Center for Technology and Aging
www.techandaging.org
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© 2010 Center for Technology and Aging