Weekend wrapup & reading: Amazon Health on talent hunt, Practice Fusion fined $200K for violating $145M prosecution agreement, and must-read studies and articles on older adults tech

April 2, 2022 | by

Resumes and networking up! A writer at Becker’s Hospital Review tired of their usual diet of healthcare departures, ‘alarming’ rises of COVID rates by state, and cyber-attacks on hospitals to publish six top-level jobs opening up in Amazon’s healthcare areas. The lead is Head of worldwide health technology solutions to lead strategy in that area at the C-level. Two are in UX and software development at Alexa Health, a senior solutions architect, health artificial intelligence , a principal of behavioral health for digital health benefit programs, and a health information exchange specialist. So if your spring brings a yen for change….

Physician EHR Practice Fusion, now Veradigm owned by Allscripts, got another $200,000 spanking from the Feds. Back in January 2020, right before Pandemic Hell really broke loose on the world, the Department of Justice successfully resolved both criminal and civil charges against the EHR company. Practice Fusion was charged with “soliciting and receiving kickbacks in return for embedding electronic prompts in its electronic medical record (“EMR”) to influence the prescribing of opioid medications” as part of the platform’s clinical decision support (CDS) alerts. The kickback was $1 million from an unnamed ‘opioid company client’, The deferred prosecution agreement (DPA) was accompanied by 1) a $145 million fine and 2) maintenance of an Oversight Organization based on three specific requirements. DOJ in the District of Vermont found that Practice Fusion did not comply with the terms of the latter, charges that Practice Fusion denied. They settled with the DPA extended by 11 weeks with a fine of $200,000. Release, US Attorneys Office, District of Vermont 29 March, US DOJ release 27 January 2020

Weekend Reading. Laurie Orlov of Aging and Health Technology Watch has been hard at work, recently updating her Market Overview Technology for Aging and releasing The Future of Smart Homes and Older Adults. No time with spring cleaning to tackle long-form? Try three tart short takes on PERS smartwatches (not getting the ‘why’), did ‘voice first’ technologies meet their 2018 promises (not quite), and what she sees as the Seven Top Trends for tech to reach older adults–with the first being hospital to home (Optum and Humana have voted ‘yes’). 

Aging and Health Technology Watch’s latest: The Future of Wearables and Older Adults 2021

June 24, 2021 | by

Laurie Orlov’s latest report takes a look at the state of wearables in the older adult market. She posits that it’s comparable to where voice tech (Alexa et al) stood in 2018–at the early stage, with the present state of minimal adoption ramping up in about a three to five-year time frame. 

From the report, she identifies these tipping points:

  • Self-service hearables have made hearing improvements cool – and cheap. In the US, hearing assistance has become mass marketed and, as a result, has become less of a stigma. While not for all, it’s reduced prices overall.
  • Fitness wearables already appeal to the younger, better educated, and more affluent cohort of older adults. They will carry this trend forward as they age.
  • Designs are improving, from the Apple Watch to mobile PERS. The pendant is the past.
  • Pricing is improving
  • Technology means that one wearable can be multi functional–and research is pouring into new uses, creating new companies and tech
  • Investment is pouring into digital health, accentuating all the above
  • Doctors may be more accomodating of the ‘data overload’–but consumers may drive this with recording their own data

The future for wearables? Personalized, predictive, proactive, smart, integrated, affordable, privacy-protective–and prescribed.

The report is free and downloadable from AgeInPlaceTech.com.

Weekend Must Read: The Future of Remote Care Technology and Older Adults 2020

December 10, 2020 | by | 1 Comment

Laurie Orlov, founder of Aging and Health Technology Watch and well-known industry analyst/advocate in health and aging-related technologies, has released her latest report, The Future of Remote Care Technology and Older Adults 2020 (PDF, free download). Recently, Laurie and I had an opportunity to catch up and review her findings.

This Editor immediately went to the ‘bleed lead’ which was:

COVID-19 HARMED THE WELLBEING OF OLDER ADULTS
Gap in technology access widened into connection chasm

The University of Michigan study from June (cited above and elsewhere in the report) illustrates the change in social isolation for those aged 50 to 80, with numbers that were slightly high to begin with in 2018. Isolation rocketed to 56 percent, putting a Klieg light on mental health that we’ve seen continued in the recent ‘lockdown loneliness’ PLOS One and SECOM studies. The reasons why will be no surprise, as they’re true for nearly all: a screeching halt to in-person experiences, severing in-person connections with family and friends, closing the doors of senior living and nursing homes to visitors (still closed in many states!), breaking healthcare contacts with providers, and losing timely diagnosis of health conditions, new and ongoing.

Most of the report documents the consequences: how telehealth rose, then fell (Epic and Commonwealth Fund last reports), how the experience wasn’t entirely satisfactory and held multiple structural limitations (e.g. tech, vision, hearing, dexterity) for the 50-80 age group (nor providers in obtaining a physical sense of the patient)–a POV you won’t see in mainstream healthcare/tech media nor the funding markets–and how technologies scrambled to fill the gaps (with plenty of examples).

But moving on to the future, which is the aim of this report, there are many gaps which need to be closed that are bigger than Teladongo:

  • synchronous and asynchronous telehealth–the latter primarily remote patient monitoring (RPM)
  • adoption of voice tech
  • broadband and device access, including training and management
  • governmental policy at all levels from Federal to local, including payer reimbursement

The last section of the report (page 18 to end) takes a look at where innovations could take remote care, where expectations are now, and where the opportunities are in connecting older adults. On page 22, there is a checklist for care providers and what they must consider in managing remote care. The summary of the future on page 23 wraps it all nicely.

The Future of Remote Care Technology and Older Adults 2020 (PDF, free download)

 

Weekend reading: contact tracing in assisted living/LTC facilities via sensor-based ADL technology raises ethical issues

October 24, 2020 | by

Contact tracing for COVID-19 is still ‘not quite there’ in many countries, especially those countries like the UK which had created centralized models and were slow to move to the decentralized systems based on Apple and Google’s APIs, the (Gapple? AppGoo?) Exposure Notification system now in use in Ireland and Germany. For the most vulnerable in assisted living, who aren’t using smartphones that ping adjacency to other smartphones and are moving around most of the time within the residence, other approaches have been developed. Already in place in many communities are sensor-based trackers for activities of daily living (ADLs) for both safety and predictive health analytics, as well as provide conveniences such as apartment entry for residents.

As we noted in July, a number of ADL and location trackers have repurposed themselves into highly accurate contact tracers since they retain the history of resident and staff movement. Profiled are CarePredict (ADLs), ZulaFly (location tracking), and CenTrak (location tracking). Residents in many facilities with these systems are early adopters of contact tracing, even if they don’t know it.

While the article is detailed and fairly laudatory about how these systems can assist residents and staff in arresting the spread of COVID-19 which has ripped through nursing homes and senior living, it then diverges into other issues, some worth considering even if some of the verbiage is over the top:

  • These location monitoring systems haven’t been used for infectious disease outbreaks before, but the article admits that the pandemic has presented extraordinary circumstances
  • Use of these systems cannot substitute for effective infection control: staff and resident handwashing, mask wearing, and staff PPE. (Something like wearing a used mask and not washing your hands for the rest of us)
  • These systems are dependent on facility-wide internet/Wi-Fi. Many LTCPAC facilities do not have it, thus creating a digital divide in care even in residences proven to have high-quality care.
  • Resident rights and privacy. Residents apparently have only limited choices in using these technologies, even if they are restricted to their rooms. Not all see the need for monitoring technology for their safety and intrusive ‘alarms’ that bring in staff. There is a real issue around older adults’ autonomy and privacy rights which tends to be forgotten in the balance of privacy and safety, with prediction of illness based on behavior a step further.

Interviewed for this article, Laurie Orlov of Aging in Place Technology Watch, believes “It’s pretty darn useful if you’re in independent living, and you decide to go for a walk. If it’s night, and there’s ice, having a full detection capability that knows where you are is really useful. I think with fall detection, and anything that can help when you’re alone, the benefits exceed the cost of the privacy — assuming that you’re with it enough to opt in.”  Senior Sensors (The Verge)  (Disclosure: Editor Donna consulted for CarePredict in 2017-18)

A counterpoint to this article is also by Laurie Orlov and published on her website, reviewing the future of remote care technology and older adults in 2020. It’s a preview of a to-be-released later this year report.

News roundup: Kompaï debuts, Aging Tech 2020 study, Project Nightingale may sing to the Senate, Amwell, b.well, Lyft’s SDOH, more on telehealth for COVID-19

March 13, 2020 | by

Believe it or not, there IS news beyond a virus!

France’s Kompaï assistance robot is finally for sale to health organizations, primarily nursing homes and hospitals. Its objective, according to its announcement release, is to help health professionals in repetitive daily tasks, and to help patients. It’s interesting that the discussion of appearance was to achieve a ‘slightly humanoid’ look, but not too human. The development process took over 10 years. (Here at TTA, Steve’s first ‘in person’ with the developers was in May 2011!) Kompaï usage mentioned is in mobility assistance and facility ‘tours’ and public guidance. Here’s Kompai in action on what looks like a tour. Press release (French/English)

Not much on robotics here. Laurie Orlov has issued her 2020 Market Overview Technology for Aging Market Overview on her Aging and Health Technology Watch, and everyone in the industry should download. Key points:

  • In 2020, aging technologies finally nudged into the mainstream
  • The older adult tech market has been recognized as an opportunity by such companies as Best Buy, Samsung, and Amazon. Medicare Advantage payers now cover some tech.
  • Advances plus smart marketing in hearing tech–one of the top needs in even younger demographics–is disrupting a formerly staid (and expensive)
  • The White House report “Emerging Technologies to Support an Aging Population” [TTA 7 March] first was an acknowledgment of its importance and two, would also serve as a great source document for entrepreneurs and developers.

The study covers the demographics of the older adult market, where they are living, caregiving, the effect of data breaches, optimizing design for this market, the impacts of voice-driven assistants, wearables, and hearables.

Project Nightingale may be singing to some US Senators. The 10 million Ascension Health identified patient records that were transferred in a BAA deal to Google [TTA 14 Nov 19], intended to build a search engine for Ascension’s EHR, continue to be looked into. They went to Google without patient or physician consent or knowledge, with major questions around its security and who had access to the data. A bipartisan group of senators is (finally) looking at this ‘maybe breach’, according to Becker’s. (Also WSJ, paywalled)

Short takes:  b.well scored a $16 million Series A for its software that integrates digital health applications for payers, providers, and employers. The round was led by UnityPoint Health Ventures….Lyft is partnering with Unite Us to provide non-emergency patient transportation to referred health appointments. Unite Us is a social determinants of health (SDOH) company which connects health and community-based social care providers….What happens if you’re a quarantined physician due to exposure to the COVID-19 virus? Use telehealth to connect to patients in EDs or in direct clinic or practice care, freeing up other doctors for hands-on care. 11 March New England Journal of Medicine….American Well is finally no more, long live Amwell. Complete with a little heart-check logo, American Well completed its long journey to a new name, to absolutely no one’s surprise. It was set to be a big reveal at HIMSS, but we know what happened there. Amwell blog, accompanied with the usual long-winded ‘marketing’ rationale They are also reporting a 10 to 20 percent increase in telehealth consults by patients (Becker’s)….Hospitals and health systems such as Spectrum Health (MI), Indiana University Health, Mount Sinai NY, St. Lukes in Bethlehem PA, and MUSC Health, are experimenting with COVID-19 virtual screenings and developing COVID-19 databases in their EHRs. The oddest: Hartford (CT) Healthcare’s drive-through screening center and virtual visit program. Is there an opportunity to cross-market with Wendy’s or Mickey D’s? After all, a burger and fries would be nice for a hungry, maybe sick, patient before they self-quarantine.

Is ‘age-tech’ a stereotype that misses the larger mark–and market?

October 24, 2019 | by

Two thoughtful articles this week comment on the difference between the highly touted ‘age-tech’ and products and services that older people actually need and want. The first is by the Centre for Ageing Better’s Jemma Mouland, who quite ably points out that ‘age-tech’ as a category (apologies to Laurie Orlov) inherently screams ‘old’, ‘feeble’, and ‘ill’–while it searches desperately for the ‘silver unicorn’. Yes, older people (and the disabled) do need solutions that help with changes as we age, but even the things that we need tend to be couched in negatives, feel like they don’t fit in our lives, reinforce a feeling of decline, or stigmatize. (The real hot button issues are hearing, vision, and driving.)

Moreover, older consumers often feel left behind or neglected by (formerly) favorite brands or services. A recent UK retail study stated that this is the belief of over 80 percent of 55+ consumers–now edging into the older cohort of Gen X. (One observation this Editor will make is that a huge negative is current clothing appearance, fit and cut.) It’s disappointing to your Editor as a marketer–that means that this group, with 83 percent of household wealth in age 50+ hands, keeps their wallets shut.

MIT Technology Review this month is cited in Ms. Mouland’s article. Building on Joseph Coughlin’s work at the MIT AgeLab in its ‘Old Age Is Over!’ issue, he cites that old age and even retirement is an obsolete construct built on early 19th century beliefs around the depletion of ‘vital energy’ and 20th century social policy around that. The stereotype the latter built was one was either needy–needing social support, or greedy–living the easy retirement life off a pension and looking for early-bird specials.  That tends to frame how we look at older people in employment, in living at home, or in social policy as driving up the cost of care–just a problem to be solved, and certainly not productive or, in Ezekiel Emanuel’s end game, even worthy of anything other than palliative medical care or being part of the political polity.

Mr. Coughlin’s close may be a bit reductionist, but this Editor will take it. “By treating older adults not as an ancillary market but as a core constituency, the tech sector can do much of the work required to redefine old age. But tech workplaces also skew infamously young. Asking young designers to merely step into the shoes of older consumers (and we at the MIT AgeLab have literally developed a physiological aging simulation suit for that purpose) is a good start, but it is not enough to give them true insight into the desires of older consumers. Luckily there’s a simpler route: hire older workers.” And work on making your products and service meet the needs of a broad spectrum of people. Hat tip to Alistair Appleby of Optalis–whose team, in a bit of news, is moving over to Wokingham Borough Council at the end of the month.

A useful White House study released: ‘Emerging Technologies to Support an Aging Population’

March 7, 2019 | by

Just released is the 40 page Executive Branch report on technologies with the potential to better support aging in place. Emerging Technologies to Support an Aging Population was developed by the Task Force on Research and Development for Technology to Support Aging Adults organized by the National Science and Technology Council (NSTC) and the Office of Science and Technology Policy (OSTP).

The Trump Administration has made finding solutions for an aging population–now over 15 percent of the American population–a research and development (R&D) priority to enhance the functional independence and continued safety, well-being, and health of older Americans, while reducing overall economic costs and the stress on the Nation’s healthcare infrastructure. The report identifies six primary functional areas which are critical to aging adults and which should be addressed by technology:

  1. Key activities of independent living 
  2. Cognition
  3. Communication and social connectivity
  4. Personal mobility
  5. Transportation
  6. Access to healthcare

Added to this are cross-cutting themes across two or more of these functional areas.

Each of these areas are broken down into focus areas with key functional needs. From each need, the study identifies R&D topics for developing solutions. For instance, a key functional need under both independent living and healthcare is oral hygiene, and one solution is  developing systems to support personalized dental regimens.

What is attractive about this study is that it cuts to the chase in identifying the themes and the analysis leading to the R&D–and a great deal here that’s useful for developers and healthcare organizations. Hat tip to Laurie Orlov of Aging In Place Technologies, who this week also released her 2019 Technology Market Overview

 

The Apple Watch, ECG and fall detection–a trend too far?

October 4, 2018 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/10/apple-watch-series-4-elektrokardiogram.jpg” thumb_width=”125″ /]Mid-September’s Apple Fans kvelled about the Apple Watch Series 4 debut. Much was made in the health tech press of Apple’s rapid FDA clearance and the symbolism of their further moves into medical devices with the Series 4 addition of a built-in atrial fibrillation-detecting algorithm and an ECG, along with fall detection via the new accelerometer and gyroscope.

This latter feature is significant to our Readers, but judging from Apple’s marketing and the press, hardly an appealing Unique Selling Proposition to the Apple FanBoys’n’Girls who tend to be about 35 or wannabe. The website touts the ECG as a performance feature, a ‘guardian and guru’ topping all the activity, working out, and kickboxing you’re doing. It positions the fall detection and Emergency SOS in the context of safety during or after hard working out or an accident. It then calls 911 (cellular), notifies your emergency contacts, sends your current location, and displays your Medical ID badge on the screen for emergency personnel, which may not endear its users to fire and police departments. 

Laurie Orlov in her latest Age In Place Tech article points out the disconnect between the fall risk population of those aged 70+ and the disabled versus the actual propensity (and fisc) to buy an Apple Gizmo at $400+. PewInternet’s survey found that 46 percent of those over 65 actually own a smartphone, though this Editor believes that 1) much less than 50 percent are Apple and 2) most smartphone features beyond the basic remain a mystery to many. (Where store helpers, children, and grandchildren come in!)

Selling to older adults is obviously not the way that Apple is going, but there may be a subset of ‘young affluent old’ who want to sport an Apple Watch and also cover themselves for their cardiac or fall risk. (Or have children who buy it.) This is likely a sliver of a subset of the mobile PERS market, which is surprisingly small–only 20 percent of the total PERS market. But monitoring centers–doubtful, despite it being lucrative for GreatCall.

Best Buy update: ‘Assured Living’ assuredly up and running. And was this Editor’s in-store experience not typical?

September 14, 2018 | by

Reader and Opinionator Laurie Orlov wrote this Editor to advise her that Assured Living was most definitely alive and well in Best Buy-land. The Assured Living page presents a variety of services, starting with a personal monitoring service (video) for an older adult that starts with a fairly standard pendant PERS (two way) and also creates an in-home network of motion sensors for doors, windows, and furniture installed by Geek Squad. These sensors send activity to a control panel which tracks activity and wellness patterns (sic!–as we know it’s algorithms and rules in the software). Within about a month, the system will send real-time automated alerts if something is out of the ordinary. The video then promises the usual ‘deeper insights’ into wellness and potential issues with the older person.

What doesn’t sound like QuietCare circa 2006, down to the need for installation, are the Wi-Fi camera in the doorbell and the automated remote door locks, the tie ins with the Mayo Clinic and UnitedHealthcare. 

We both speculated on the motion sensor set as being Lively Home (from GreatCall) –Laurie added possibly Alarm.com’s BeClose, which has supplied Best Buy in the past.

Assured Living is available only in limited markets (not listed) but you can get 10 percent off with AARP! But product packages go up to nearly $189.97 for a one time fee plus $29.99/month, not inclusive of that nifty doorbell camera and remote door locks.

One wonders if the reluctance of older adults to admit they need monitoring and consent to the installation is less than in 2006, when QuietCare’s and ADT’s sales people had difficulty overcoming the reluctance of a person living home on their own to be monitored by their (usually) child. Sometimes a sale would be made, the installer would come, and the installer would be shooed out after second thoughts. The genius of GreatCall was in making technology palatable to this market by assigning it a positive use, such as communicating with friends and direct personal safety, not someone minding her. Right now, the template is 2006 with a tech twist.

Drop in and visit Laurie Orlov on her Website We Like, Aging in Place Technology Watch. (She’s alarmed about chipping people too and frames it as more of a security and a moral issue than this Editor did, who prefers her chips to be chocolate and her cars to be driven by her alone.)

As to this Editor’s ghostly experience buying a TV in store, perhaps I should have invited a Best Buy rep over! Reader, former Marine flyboy, eldercare expert, and full time grandfather John Boden did and got a simple solution to an annoying problem. Read about it in comments on our prior article here.

The REAL acute care: hurricanes, health tech, and what happens when electricity goes out

September 19, 2017 | by

This afternoon, as this New York-based Editor is observing the light touch of the far bands of Hurricane José’s pass through the area (wind, spotty rain, some coastal flooding and erosion), yet another Category 5 hurricane (Maria) is on track to attack the already-wrecked-from-Irma Puerto Rico and northern Caribbean, thoughts turn to where healthcare technology can help those who need it most–and where the response could be a lot better. (Add one more–the 7.1 magnitude earthquake south of Mexico City)

Laurie Orlov, a Florida resident, has a typically acerbic take on Florida’s evacuation for Irma and those left behind to deal with no electricity, no assistance. Florida has the highest percentage of over-65 residents. Those who could relocated, but this Editor from a poll of her friends there found that they didn’t quite know where to go safely if not out of state, for this storm was predicted first to devastate the east coast, then it changed course late and barreled up the west (Gulf) coast. Its storm surges unexpected produced record flooding in northeastern Florida, well outside the main track. Older people who stayed in shelters or stayed put in homes, senior apartments, 55+ communities, or long-term care were blacked out for days, in sweltering heat. If their facilities didn’t have backup generators and electrical systems that worked, they were unable to charge their phones, use the elevator, recharge electric wheelchairs, or power up oxygen units. Families couldn’t reach them either. Solutions: restore inexpensive phone landlines (which hardwired, mostly work), backup phone batteries, external power sources like old laptops, and backup generators in senior communities (which would not have prevented prevent bad fuses/wiring from frying the AC, as in the nursing home in Hollywood where eight died).  Aging In Place Tech 

It’s another reason why senior communities and housing are supposed to have disaster preparedness/evacuation plans in place. (If you are a family member, it should be included in your community selection checklist and local records should be checked. This Editor recently wrote an article on this subject (PDF) that mentions disaster and incident planning twice. (Disclaimer: the sponsoring company is a marketing client of this Editor.) In nursing homes, they are mandatory–and often not executable or enforced, as this article from Kaiser Health News points out. 

Another solution good for all: purchase 200-400 watt battery packs that recharge with solar panels, AC, and car batteries (AARP anyone?). Campers and tailgaters use these and they range below $500 with the panels. Concerned with high-power lithium-ion batteries and their tendency to go boom? You’ll have to wait, but the US Army Research Laboratory and University of Maryland have developed a flexible, aqueous lithium-ion battery that reaches the 4.0 volt mark desired for household electronics without the explosive risks associated with standard lithium-ion power–a future and safer alternative. Armed With Science

Telemedicine and telehealth are not being fully utilized to their potential in disaster response and recovery, but the efforts are starting. Medical teams are starting to use telehealth and telemedicine as adjunct care. It has already been deployed successfully in Texas during Harvey. Many evacuees were sent to drier Dallas and the Hutchinson arena, where Dallas-based Children’s Health used telemedicine for emergency off-hour coverage. Doctor on Demand and MDLive gave free direct support to those affected in Texas and Louisiana through 8 September, as well as Teladoc, American Well, and HealthTap for a longer period to members and non-members. Where there are large numbers of evacuees concentrated in an area, telemedicine is now deployed on a limited basis. Doctor on Demand release, STAT News, MedCityNews 

But what about using affordable mobile health for the thousands who long term will be in rented homes, far away from their local practitioners–and the doctors themselves who’ve been displaced? What will Doctor on Demand and their sister telemedicine companies have available for these displaced people? What about Puerto Rico, USVI, and the Caribbean islands, where first you have to rebuild the cellular network so medical units can be more effective, then for the longer term? (Can Microsoft’s ‘white space’ be part of the solution?)  

One telehealth company, DictumHealth, has a special interest and track record in both pediatric telehealth and global remote deployments where the weather is hot, the situation is acute, and medical help is limited. Dictum sent their ruggedized IDM100 tablet units and peripherals to Aster Volunteers who aid the permanently displaced in three Jordanian refugee camps in collaboration with the UNHCR and also for pediatric care at the San Josecito School in Costa Rica. In speaking with both Amber Bogard and Elizabeth Keate of Dictum, they are actively engaging with medical relief agencies in both the US and the Caribbean. More to come on this.

Health and tech news that’s a snooze–or infuriating

May 26, 2017 | by

The always acerbic Laurie Orlov has a great article on her Aging in Place Technology Watch that itemizes five news items which discuss the infuriating, the failing, or downright puzzling that affect health and older adults. In the last category, there’s the ongoing US Social Security Administration effort to eliminate paper statements and checks with online and direct deposit only–problematic for many of the oldest adults, disabled and those without reasonable, secure online access–or regular checking accounts. The infuriating is Gmail’s latest ‘upgrade’ to their mobile email that adds three short ‘smart reply’ boxes to the end of nearly every email. Other than sheer laziness and enabling emailing while driving, it’s not needed–and to turn it off, you have to go into your email settings. And for the failing, there’s IBM. There’s the stealth layoff–forcing their estimated 40 percent of remote employees to relocate to brick-and-mortar offices or leave, while they sell remote working software. There’s a falloff in revenue meaning that profits have to be squeezed from a rock. And finally there’s the extraordinarily expensive investment in Watson and Watson Health. This Editor back in February [TTA 3 and 14 Feb] noted the growing misgivings about it, observing that focused AI and simple machine learning are developing quickly and affordably for healthcare diagnostic applications. Watson Health and its massive, slow, and expensive data crunching for healthcare decision support are suitable only for complex diseases and equally massive healthcare organizations–and even they have been displeased, such as MD Anderson Cancer Center in Houston in February (Forbes). Older adults and technology – the latest news they cannot use

65+ smartphone ownership is up to 42 percent–but slumps with increased age

March 22, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/03/elderly-smartphone.jpg” thumb_width=”150″ /]A report of progress in smartphone ownership by those over 65 years of age is mixed indeed. There’s progress–ownership is up to 42 percent of the age group, and 64 percent of these smartphone owners are users of the Internet according to Pew Research‘s 2016 study. But mitigating factors to this good news is that ownership is very much a function of income and age. According to the US Census’ American Community Survey 2015, 66 percent of those aged 65+ households with income $70,000+ own smartphones, but that declines to 33 percent in the 75+ age range and 27 percent of those 80+. Perhaps Laurie Orlov exaggerates the cost of smartphones, especially Android–this Editor has never bought an LG phone over $200 and has a miserly data plan, using Wi-Fi most of the time; Verizon has plenty of new older models at lighter prices and other carriers like Consumer Cellular and GreatCall have excellent deals. But what is true is that interest wanes with age–and that phones, especially Apple, still present legibility and usability barriers to those with low vision or hand arthritis. Ms Orlov also notes Pew’s discovery that 65+ users are less likely to secure their phones with lock codes and regularly update their apps. Aging in Place Technology Watch

Technology for Aging in Place, 2017 edition preview

March 7, 2017 | by

Industry analyst Laurie Orlov previews her annual review of ‘Technology for Aging In Place’ on LinkedIn with six insights into the changes roiling health tech in the US. We’ll start with a favorite point–terminology–and summarize/review each (in bold), not necessarily in order.

“Health Tech” replaces “Digital Health,” begins acknowledging aging. This started well before Brian Dolan’s acknowledgment in Mobihealthnews, as what was ‘digital health’ anyway? This Editor doesn’t relate it to a shift in investment money, more to the 2016 realization by companies and investors that care continuity, meaningful clinician workflow, access to key information, and predictive analytics were a lot more important–and fundable–than trying to figure out how to handle Data Generated by Gadgets.

Niche hardware will fade away – long live software and training. Purpose-built ‘senior tablets’ will likely fade away. The exception will be specialized applications in remote patient monitoring (RPM) for vital signs and in many cases, video, that require adaptation and physical security of standard tablets. These have device connectivity, HIPAA, and FDA (Class I/II) concerns. Other than those, assistive and telehealth apps on tablets, phablets and smartphones with ever-larger screens are enough to manage most needs. An impediment: cost (when will Medicare start assisting with payments for these?), two-year life, dependence on vision, and their occasionally befuddling ways.

Voice-first interfaces will dominate apps and devices. “Instead we will be experimenting with personal assistants or AI-enabled voice first technologies (Siri, Google Home, Amazon Alexa, Cortana) which can act as mini service provider interfaces – find an appointment, a ride, song, a restaurant, a hotel, an airplane seat.” In this Editor’s estimation, a Bridge Too Far for this year, maybe 2018. Considerations are cost, intrusiveness, and accuracy in interpreting voice commands. A strong whiff of the Over-Hyped pervades.

Internet of Things (IoT) replaces sensor-based categories. Sensors are part of IoT, so there’s not much of a distinction here, and this falls into ‘home controls’ which may be out of the box or require custom installation. Adoption again runs into the roadblocks of cost and intrusiveness with older people who may be quite reluctant to take on both. And of course there is the security concern, as many of these devices are insecure, eminently hackable, and has been well documented as such.

Tech-enabled home care pressures traditional homecare providers – or does it? ‘What exactly is tech-enabled care? And what will it be in the future?’ Agreed that there will be a lot of thinking in home care about what $200 million in investment in this area actually means. Is this being driven by compliance, or by uncertainty around what Medicare and state Medicaid will pay for in future?

Robotics and virtual reality will continue — as experiments. Sadly, yes, as widespread adoption means investment, and it’s not there on the senior housing level where there are other issues bubbling, such as real estate and resident safety. There are also liability issues around assistance robotics that have not yet been worked out. Exoskeletons–an assistance method this Editor has wanted to see for several years for older adults and the disabled–seems to be stalled at the functionality/expense/weight level.

Study release TBD

Eric Dishman departs Intel for NIH’s Precision Medicine Initiative Program

April 13, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/04/20160411-eric-dishman-pmi-1.jpg” thumb_width=”150″ /]Late breaking news….Reported in Aging in Place Technology Watch from the Oregonian is that Eric Dishman, one of Oregon’s more famous sons (and certainly a star in health tech), is leaving Intel after 17 years. Currently an Intel Fellow and general manager of the Health and Life Sciences for the Data Center Group (profile), he is joining the National Institutes for Health (NIH) in their Precision Medicine Initiative (PMI) Cohort program as a director. According to the Oregonian, Mr Dishman “will lead an effort to study more than 1 million volunteers to study the impact of “precision medicine” – the practice of studying an individual’s specific genetic makeup and lifestyle to produce targeted treatments. It had been a key focus of Dishman’s work at Intel, and he had helped design the study he will now oversee.” Mr Dishman had his own extreme experience with precision medicine to treat his recurrent cancer in 2012, which made him eligible for a life-saving kidney transplant later that year [TTA 27 Feb 14 and 12 Apr 2013]. He had recently been a key part of the PMI Network working group in this ‘audacious’ study as NIH, in announcing his appointment, termed it. His last day at Intel will be 29 April, according to Intel’s data center chief. Replacing him (at least in the organization) on an interim basis will be Steve Agritelley. NIH release, USNews interview

Laurie Orlov (hat tip re this article–Ed.) commented to this Editor that Mr Dishman could be considered the ‘father of Care Innovations‘; certainly he was crucial to the development of the original Intel Health Guide out of Intel’s Digital Health Group, and was prominently in the leadership of the early Louis Burns days of the company. His work during Intel spanned over LeadingAge’s CAST, Ireland’s Technology Research for Independent Living (TRIL) Centre, Everyday Technologies for Alzheimer’s Care (ETAC) and the Oregon Center for Aging & Technology (ORCATECH). Mr Dishman’s work is marked by a singular focus on delivering health into the home, changing aging and hospitals as we know them. Now he will be more focused on genomic medicine and changing disease treatments as we know them.

Your Editors wish him good fortune and hope that his experiences with NIH and in Washington will be fruitful and all that he intends it to be.

Technology for Aging in Place 2016

March 2, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/03/elderly-smartphone.jpg” thumb_width=”150″ /]Laurie Orlov’s updated view of technologies that assist home caregiving/living, and her observations on trends for both boomers and those well over 65, is hot off the (virtual) presses and available here on her website. It is US-market oriented, but the trends explored here will be of interest internationally. The focus in this study is home-based systems for safety, alerts, activity/location tracking (telecare), home care/caregiving tools and what this Editor would call ‘health monitoring light’–med minders and logging apps versus medically-oriented telehealth (vital signs, save for AliveCor) and telemedicine (virtual visits/consults).

Highlights:

  • In communication, internet non-usage among 75+ has declined to 50 percent over the past 15 years.
  • The tablet form factor is losing ground as smartphones get bigger. Older adults and smartphones are beginning to ‘get along’ partly as they grow larger, but also that feature and simple phones are becoming less available.
  • Also losing ground is senior housing–residents are delaying entry to assisted living until they are mid 80s and frailer. Savings and debt in the boomer group is low and high, respectively.
  • Investors are caring more about home care, with large investments ($80 million) in three regional home care worker startups: Honor (San Francisco), Home Hero (Los Angeles), and Hometeam (New York/New Jersey), caregiving apps and chronic care management (CareSync, with an $18 million raise).
  • Dementia care support tools are (finally) developing into its own category.

Surprising conclusions: PERS alerting stays strong, but changes to be mobile-enabled and more cosmetic; a lot of convergence of categories and forms; and the term ‘health tech’ will replace ‘digital health’. Oh my!

Can technology help to bridge the Loneliness Factor?

February 4, 2016 | by

The Guardian’s impassioned article on how common and harmful loneliness is among older adults led to some reflection by this Editor on how difficult and ‘multi-part’ an approach to help can be, even if you call it ‘The Campaign to End Loneliness’. “Studies have found loneliness can be more harmful than smoking 15 cigarettes a day, increases the risk of premature death by 30% and the chances of developing dementia by 64%. More than one million people aged over 65 are thought to be lonely – around 10-13% of older people.”–statistics from the article and AgeUK’s press release on their recent study, ‘ Promising approaches to reducing loneliness and isolation in later life’.  GPs see a lot of them, and some more for an ‘event of the day’ than actual medical need. Loss of hearing, sight and mobility further isolate the older person, particularly those in rural areas where everyone and everything is at a distance requiring driving, creating dependency among those who can no longer. Even among the middle-aged, loss of hearing reduces engagement in social situations. (And the article does not include the disabled.) It closes with suggestions that councils need to budget for and organize programs to reach out to lonely adults, including carers, and that not one approach can fit all, but emphasizes more personal approaches such as groups and one-on-one support. Hat tip to Malcolm Fisk via Twitter

Is a way to fight the Loneliness Factor located in technology, even remote patient monitoring? That’s been the primary reason for some systems such as GrandCare, but even in RPM, whether hub-based or smartphone/tablet based, the reminders and active clinician monitoring part of chronic care management can and do engage. Older people are using smartphones and tablets–perhaps not as fully as a 40 year old, but they are using Skype, calendaring and social media (Facebook, LinkedIn and news/opinion sites). A big help here, according to Laurie Orlov, would be voice recognition and integration into safety/alarm technologies. This Editor also sees proactive alerting to changes in condition as a still-untapped area.  There’s $279 billion of potential in ‘silvertech’ as estimated by AARP and Parks Associates–it’s a matter of getting young techies/entrepreneurs excited about it, and the Sand Hill funder crowd realizing that yes, it’s sexy too. Long Term Living