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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 1 © 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 2 © 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? 3 © 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 4 © 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) 5 © 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 6 © 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 7 © 2010 Center for Technology and Aging 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. 8 © 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 9 © 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 10 © 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 11 © 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 12 © 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 13 © 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 14 © 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 15 © 2010 Center for Technology and Aging Center for Technology and Aging www.techandaging.org 16 © 2010 Center for Technology and Aging