While I'm Providing Aging Services, What Should the Technology Be Doing?

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Marianna Payne
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1 While I'm Providing Aging Services, What Should the Technology Be Doing? Bill G. Felkey Prof. Emeritus of Healthcare Informatics Auburn University s Harrison School of Pharmacy felkebg@auburn.edu grape : raisin :: plum : 1. peach 2. fig 3. apricot 4. prune 87% 1% 12% 0% peach fig apricot prune 1

2 My attitude toward technology is: 41% 1. Enthusiastically embracing 50% 5% 2% 2% 2. Somewhat positive 3. Neutral 4. Somewhat negative 5. Very skeptical I am currently spending 6 or more hours at home online per week Abstain 67% 33% 0% Abstain 2

I am currently spending more time online per week than watching broadcast television. 1. 2. 3.

3 I am currently spending more time online per week than watching broadcast television Abstain 60% 40% 0% Abstain The Connected Healthcare Community RHIO, CDR, HIE, CCD based IT systems are connected via a shared architecture Collaborative Care Model All providers have access to up to date patient information 3

4 Patients in Washington legally own the information in their medical records Abstain 62% 36% 2% Abstain We have installed or are currently in the active process of acquiring an EHR Abstain 61% 19% 20% Abstain 4

5 Healthcare must become more patient centric. 1. Strongly Agree 95% 2. Agree 3. Neutral 4. Disagree 5. Strongly Disagree 5% 0% 0% 0% Strongly Agree Agree Neutral Disagree Strongly Disagree 5

6 Thus one could question a funding scheme that places so much emphasis on medical care and not on prevention. McGinnis 2002 We as an industry can have a significant impact on patient outcomes and overall cost of care. 89% Abstain 8% 4% Abstain 6

7 We should be getting great situational awareness from our system investments Abstain 91% 1% 8% Abstain 7

8 Information Technology Basics Technology can either enhance the work that a human does or replace that work, especially when it is tedious and/or repetitive All information serves the primary purpose of reducing our uncertainty when we are making decisions The best technology and information interventions are closed looped and are workflow and/or lifestyle sensitive of any form, to anyone, anywhere, at any time, on any device. Where Are We? Essentially, we have the ability to communicate information: Carleton University - The Evolution of the Web 16 8

9 I would love to have a dashboard in our facilities (EPM) Abstain 86% 7% 7% Abstain 9

10 Feedback to Practitioners Interventions Errors ADRs 10 0 Brent Susan Bill Penny Gordon Motivating staff without sticks and carrots can take place by this method Abstain 78% 14% 7% Abstain 10

11 How Fragile is the Current Environment? 11

12 Redefining the Enterprise My 5 10 yr. vision includes a redefining of our scope of practice to include patients homes. 1. Strongly Agree 50% 2. Agree 3. Neutral 4. Disagree 21% 20% 5. Strongly Disagree 8% 2% Strongly Agree Agree Neutral Disagree Strongly Disagree 12

13 ThisCaringHome.org 13

14 This image cannot currently be displayed. June 2013 Prevention & Early Detection INTEGRATED HEALTH SYSTEM Health Plans End-of-life Care Family & Community Services Continuum of Care Long-term Care Home Care Primary & Specialty Care Pharmacies Emergency Care Hospital Care Rehabilitation Mental Health Care Medical Transport 03/02/

15 Our membership will continue to enjoy a dominance in long term care for seniors in WA. 1. Strongly Agree 2. Agree 31% 34% 3. Neutral 21% 4. Disagree 5. Strongly Disagree 10% 4% Strongly Agree Agree Neutral Disagree Strongly Disagree If we are not at the table we could be on the menu in a reformed system Abstain 92% 4% 3% Abstain 15

16 Connected Cardiac Care Program Telehealth and Readmission 16

17 VHA Care Coordination Results It appears that others may be successfully redefining their enterprise Abstain 84% 10% 6% Abstain 17

(Leape LL et al. Systems analysis of adverse drug events.

Improvements are Needed Safe patient s safety comes first Timely

science available Efficient avoids waste of time, money,

18 Where Do Errors Occur? Ordering Transcribing 39% Administering 12% Preparing 11% 38% (Leape LL et al. Systems analysis of adverse drug events. JAMA 1995;274:35 43.) S.T.E.E.E.P. Improvements are Needed Safe patient s safety comes first Timely care delivered in a timely manner Effective based on the best science available Efficient avoids waste of time, money, resources Equitable care provided to all in an equitable manner Patient centered patients participate fully in care decisions IOM Quality Dimensions Workshop 18

19 Reality Therapy Handwriting example Bates,

20 Those that fall behind early will usually have more time to catch up Abstain 90% 8% 2% Abstain What is ehealth? The use of communication and information technology to deliver health, healthcare services, and information over large and small distances." 20

21 How is mhealth Different? t necessarily a subset of ehealth Focuses more on behavior change than infrastructure Mobile is very personal Mobile is permanently carried Mobile is always on Mobile has a built-in payment channel Mobile is available at the point of creative impulse Mobile is most accurate at measuring its audience Only mobile can capture the social context of consumption Only mobile can offer augmented reality I have a smartphone within 3 feet of me 24/7. 1. Strongly Agree 55% 2. Agree 3. Neutral 4. Disagree 5. Strongly Disagree 14% 5% 17% 10% Strongly Agree Agree Neutral Disagree Strongly Disagree 21

22 Stats for Mobile Tech 93% own a cell phone >50% are Smart Phones More texting than the planet s population/day 40% of workforce could work from home More use social networks than to connect I am already more connected than I want to be. 1. Strongly Agree 38% 2. Agree 3. Neutral 4. Disagree 5. Strongly Disagree 21% 17% 13% 10% Strongly Agree Agree Neutral Disagree Strongly Disagree 22

23 What will the next wave of patients loyal to your service be like and expect? Pew Research,

24 We are getting significant pressure to be more connected with our constituencies Abstain 73% 21% 6% Abstain There s an App for That! 24

25 Will You Create an App? How about a multidisciplinary app? Gerijoy Introtech 25

26 26

27 Top 10 Patient Diabetes Apps 27

28 Medication Technologies 28

29 Multimedia in Multiple Languages ClearlyHealth.com 29

imetrikus MediCompass Connect imetrikus MediCompass: Biometric Device Interfaces Diabetes Management Blood Glucose Monitors: Accu-Chek Active

Pumps: D-TRON Plus Respiratory Management Digital Spirometry: AirWatch Cardiac Management Blood Pressure Cuffs: A&D LifeSource UA-767PC (Arm)

30 imetrikus MediCompass Connect imetrikus MediCompass: Biometric Device Interfaces Diabetes Management Blood Glucose Monitors: Accu-Chek Active Accu-Chek Advantage Accu-Chek Compact Accu-Chek Complete Ascensia Breeze Ascensia Contour Ascensia Elite XL Bayer Glucometer DEX Bayer Glucometer DEX2 Bayer Glucometer Elite XL BD Logic BD Paradigm Link In Duo One Touch Basic One Touch II One Touch Profile One Touch Ultra One Touch UltraSmart One Touch Sure Step Precision Q-I-D Precision XTRA Prestige Smart System TrueTrack Smart System TheraSense FreeStyle Insulin Pumps: D-TRON Plus Respiratory Management Digital Spirometry: AirWatch Cardiac Management Blood Pressure Cuffs: A&D LifeSource UA-767PC (Arm) OMRON HEM-637 (Wrist) OMRON HEM-705CP (Arm) Digital Scales: A&D LifeSource UC-321PL* Lipid Testing: CardioChek PA* (cholesterol, triglycerides, glucose, & ketones) 30

31 Intel and GE Care Innovations 31

32 Memory Phone Most commonly used social media tools 32

33 Social Media and Health Systems 65 Should you YouTube? Google video sites reach over 37% of all internet users! 33

34 HealthVault 34

35 Do you have a means to encrypt Protected Health Information (PHI)with patient and family s? I can encrypt an ? 17% 62% 21% I can encrypt an ? Last clicker question. What do you want to know from your peers? Abstain 94% 6% 1% Abstain 35

Collect Clickers Please Disease Management 860 million chronic disease patients world wide Pedometer Implant Chronic disease Post trauma Pre op Pulse Ox Weight

Medication reminders and compliance Utilize home network to locate devices in logical places: Scale in bathroom Pill minder in kitchen BP cuff in living room Trend

36 Collect Clickers Please Disease Management 860 million chronic disease patients world wide Pedometer Implant Chronic disease Post trauma Pre op Pulse Ox Weight Bloodpressure Cuff Fitness equipment Medication Tracking Cell Phone Personal Health System Internet PC Digital Home Disease Management Vital sign monitoring (RPM) Medication reminders and compliance Utilize home network to locate devices in logical places: Scale in bathroom Pill minder in kitchen BP cuff in living room Trend analysis and alerts , chat, video Appointment scheduling Family care givers Disease management service Healthcare provider Personal Health Record 36

Aging Independently 600 million elderly individuals world wide Pedometer Implant Independent living Chronic disease Home Automation & Control Family care givers Pulse Ox Bloodpressure Cuff Elderly

Aging Independently An adult child helping their elderly parents age gracefully in their own home.

37 Aging Independently 600 million elderly individuals world wide Pedometer Implant Independent living Chronic disease Home Automation & Control Family care givers Pulse Ox Bloodpressure Cuff Elderly monitoring service Weight Fitness equipment Medication Tracking Cell Phone Personal Health System Internet Diet & wellness services PC Digital Home Disease management service, healthcare provider Aging Independently An adult child helping their elderly parents age gracefully in their own home. Basic life monitoring as appropriate (ADL): Bed pressure (sleep) Bathroom sensor Gas / water sensor Emergency sensor Vital sign monitoring (RPM) Medication reminders and compliance Trend analysis and alerts , chat, video Appointment scheduling Health & Wellness One billion adults overweight world wide Healthy family Weight loss and fitness coaching Pedometer Weight Scale Fitness equipment Bloodpressure Cuff Medication Tracking Internet Glucose meter Healthcare Professionals Digital Home Personal Health Record Health & Wellness Weight loss Fitness Worried Well vital sign monitoring: Weight Blood pressure Glucose Cholesterol Activity level Personal Health Records In the future Extension of healthcare system into the home Initial triage of conditions Vital signs Images / chat / video Appointment scheduling 37

38 RTX Bluetooth PatientsLikeMe.com 38

Wireless Glucose Monitoring Kivalo Bluetooth Systems General Design of a Health System Portal Reference Lab, radiology etc Orders with Labels, Manifests Clinical Data Repository

Single Sign-on; Orders Patients PHR, Home Monitoring Other connections including: Health Plans Public Health RHIOS Personal Health monitoring devices.

39 Wireless Glucose Monitoring Kivalo Bluetooth Systems General Design of a Health System Portal Reference Lab, radiology etc Orders with Labels, Manifests Clinical Data Repository Prescriptions Community Pharmacies Results. Single Sign-on; Orders Patients PHR, Home Monitoring Other connections including: Health Plans Public Health RHIOS Personal Health monitoring devices.etc Ask Billing Questions; Ask a Nurse; Appointment Requests; Request Prescription Refills; E-visit/E-consultation, etc Referral Treatment Feedback Hospitals Consulting Physicians, Home Health Secure Messaging Rounding Information; ADT tification; Results; Reports; Images; Demographics/Insurance Updates; Critical Alerts; Transcription Signing Referral Requests Physicians & Staff 39

40 Ignorance is not an option! 40

41 Do You Need to Have a Sense of Urgency? 41

McDonald s has electronic order verification.

42 McDonald s has electronic order verification.decreases errors and improves service. Imagine if Customer: Cohen, Stu Age: Over 40 Alert: Big Mac Combo You ve ordered a Big Mac Combo with large fries. Your last cholesterol level was: too high. Downsizing to a medium fry is recommended. 1 medium fry 42

43 AND THERE ARE OPPONENTS Pizza Anyone? Excellence is the result of caring more than others think is wise, risking more than others think is safe, dreaming more than others think is practical, and expecting more than others think is possible. 43

44 Bill G. Felkey Professor Emeritus Pharmacy Care Systems Auburn University 44

Session Name: New Session 6 18 2013 11 05 AM Created: 6/18/2013 11:08 AM Turning Graphical Results by Question 1.

45 Session Name: New Session AM Created: 6/18/ :08 AM Turning Graphical Results by Question 1.) grape : raisin :: plum : (multiple choice) Responses peach 0 0% fig 0 0% apricot 0 0% prune 1 100% Totals 1 100% 0% 0% 100% peach fig apricot prune 2.) grape : raisin :: plum : (multiple choice) Responses 1% 12.4% 0% peach % fig % apricot 0 0% prune % Totals % 86.7% peach fig apricot prune 3.) My attitude toward technology is: (multiple choice) Responses Enthusiastically embracing % Somewhat positive % Neutral % Somewhat negative % Very skeptical % Totals % Page 1 of 8 4.5% 1.8% 1.8% 50.4% Enthusiastically embracing Neutral Very skeptical 41.4% Somewhat positive Somewhat negative

46 4.) I am currently spending 6 or more hours at home online per week. (multiple choice) Responses 32.7% 0% % % Abstain 0 0% Totals % 67.3% Abstain 5.) I am currently spending more time online per week than watching broadcast television. (multiple choice) Responses 40% 0% 66 60% 44 40% Abstain 0 0% Totals % 60% Abstain 6.) Patients in Washington legally own the information in their medical records. (multiple choice) Responses 35.8% 1.8% % % Abstain % Totals % 62.4% Abstain Page 2 of 8

7.) We have installed or are currently in the active process of acquiring an EHR. (multiple choice) Responses 65 61.32% 20 18.87% Abstain 21 19.81% Totals 106 100% 18.9% 19.8% 61.3% Abstain 8.

47 7.) We have installed or are currently in the active process of acquiring an EHR. (multiple choice) Responses % % Abstain % Totals % 18.9% 19.8% 61.3% Abstain 8.) Healthcare must become more patient centric. (multiple choice) Responses 4.6% 0% Strongly Agree % Agree % Neutral 0 0% Disagree 0 0% Strongly Disagree 0 0% Totals % 95.4% Strongly Agree Agree Neutral Disagree Strongly Disagree 9.) We as an industry can have a significant impact on patient outcomes and overall cost of care. (multiple choice) Responses 7.6% 3.8% % % Abstain % Totals % 88.7% Abstain Page 3 of 8

48 10.) We should be getting great situational awareness from our system investments. (multiple choice) Responses 1.1% 8% % % Abstain % Totals % 90.9% Abstain 11.) I would love to have a dashboard in our facilities (EPM). (multiple choice) Responses 6.8% 6.8% % % Abstain % Totals % 86.4% Abstain 12.) Motivating staff without sticks and carrots can take place by this method. (multiple choice) Responses 14.4% 7.2% % % Abstain % Totals % 78.4% Abstain Page 4 of 8

49 13.) My 5 10 yr. vision includes a redefining of our scope of practice to include patients homes. (multiple choice) Responses Strongly Agree % Agree % Neutral % Disagree % Strongly Disagree % Totals % 19.8% 7.9% 2% 20.8% Strongly Agree Agree Neutral Disagree Strongly Disagree 49.5% 14.) Our membership will continue to enjoy a dominance in long term care for seniors in WA. (multiple choice) Responses Strongly Agree 31 31% Agree 34 34% Neutral 21 21% Disagree 10 10% Strongly Disagree 4 4% Totals % 10% 4% 31% 21% 34% Strongly Agree Agree Neutral Disagree Strongly Disagree 15.) If we are not at the table we could be on the menu in a reformed system. (multiple choice) Responses 4.5%3.4% % % Abstain % Totals % 92.1% Abstain Page 5 of 8

50 16.) It appears that others may be successfully redefining their enterprise. (multiple choice) Responses 10% 6.2% % 8 10% Abstain % Totals % 83.8% Abstain 17.) Those that fall behind early will usually have more time to catch up. (multiple choice) Responses 2.1% 8.3% % % Abstain % Totals % 89.6% Abstain 18.) I have a smartphone within 3 feet of me 24/7. (multiple choice) Responses Strongly Agree % Agree % Neutral % Disagree % Strongly Disagree % Totals % 16.5% 10.1% 55% 4.6% 13.8% Strongly Agree Agree Neutral Disagree Strongly Disagree Page 6 of 8

51 19.) I am already more connected than I want to be. (multiple choice) Responses 13.3% 10.5% 38.1% Strongly Agree % Agree % Neutral % Disagree % Strongly Disagree % Totals % 21% 17.1% Strongly Agree Agree Neutral Disagree Strongly Disagree 20.) We are getting significant pressure to be more connected with our constituencies. (multiple choice) Responses % % Abstain % Totals % 21.1% 5.6% 73.3% Abstain 21.) Do you have a means to encrypt Protected Health Information (PHI)with patient and family s? (multiple choice) Responses 21.4% 16.7% % % I can encrypt an ? % Totals % 61.9% I can encrypt an ? Page 7 of 8

52 22.) Last clicker question. What do you want to know from your peers? (multiple choice) Responses 5.6%0.9% % % Abstain % Totals % 93.5% Abstain Page 8 of 8

Medication and Care Plan Adherence Technologies That Improve Patient Outcomes

Medication and Care Plan Adherence Technologies That Improve Patient Outcomes Bruce A. Kehr, M.D. Chairman and CEO InforMedix, Inc Tel: 301-984-1566 E-mail: bruce.kehr@informedix.com Too many medications