TECH CORNER: November/December 2013
We have seen a sector of healthcare, previously known for its lack of technology adoption, begin a complete about-face. One overall term for this sector is the “connected patient.” You may have known this sector as long-term care, nursing home, health services for the aging, independent and assisted living, or by other labels. This industry is truly reinventing itself in an effort to remain relevant and viable in a changing healthcare market. We have been getting invitations to speak at LeadingAge (http://www.leadingage.org/) state meetings for the past several years. We tell meeting participants at these conferences that everyone from the other sectors of healthcare specialties is interested in providing health services for our elders.
If you are a consultant pharmacist or are providing distribution services for clients who come from these long-term care sectors, whether they are nonprofit or profit, you may be more aware than others about the changes taking place in all aspects of long-term care. We have witnessed exhibit halls that featured 10 vendors marketing long-term-care-specific electronic medical records. The growth of tools for connecting these facilities to enable movement of patient information to and from healthcare systems and the physician community is occurring at an adoption rate similar to that of other sectors of healthcare. The emerging opportunity in this sector is the ability for LeadingAge members to enact business models that attempt to allow elder patients to live in their own homes and away from institutions for as long as possible. Isn’t this what we all desire for ourselves and those we love?
On a recent trip to Oregon, we discovered that some long-term care providers really “get it” — providing services that allow for networking that connects patients living independently with long-term care services supported by the technology. We have been getting pushback from other states that cannot get beyond the walls of their facilities to see how redefining the enterprise to include the home of the patient is a mandate. Insurance providers are increasingly more sensitive to patients in this regard when crafting policies. The question is, “What is the role of the pharmacist in these ventures?”
Of course, the medication-related needs of patients come to mind first. Just like every activity of daily living, having the medication needs of patients addressed appropriately is a huge determinant of the viability of a networked home being appropriate as a patient care setting. There is a government-funded resource site located at Technology for Long-Term Care (http://www.techforltc.org/). This site includes an excellent inventory of technology available for the support of long-term care settings. It addresses each need long-term care patients have for support in a variety of settings. We encourage you to look at the medication category. Another excellent collection of medication technology can be found at e-pill Medication Reminders (http://www.epill.com).
Connectivity within the home is being addressed by large, well-known companies such as General Electric and Intel, but smaller startup companies such as iHealthHome (http://ihealthhome.net) are using iPads to connect medication devices, motion sensors, door sensors, sphygmomanometers, blood glucose meters, and a host of other devices that collect results and produce data for connectivity with care networks. Additional resources for the connected home are being integrated by companies such as WellAware Systems (http://www.wellawaresystems.com) and This Caring Home (http://thiscaringhome.org)
We find it interesting that the same technology that allows us to remotely monitor Bill’s new grandson and Brent’s new daughter can be employed to check in on our parents. Whether we use a networked surveillance camera or employ a mobile app like the one called Summer Monitor, we can get visual and auditory views of how our loved ones are doing (once they give us permission to install the device). For example, Bill writes articles in the morning before most people are awake. He has a smartphone sitting on his desk to watch and listen to his grandson in his crib 150 miles away. He can text his son and daughter-in-law when his grandson needs a diaper change, if they need a little nudge to start moving in that direction.
Large health systems that include the Veterans Administration, Partners HealthCare, and Centura Health at Home are doing research on how to reduce care readmissions, costs, and utilization of higher levels of care. They are doing this by looking at the handoffs between levels of care, telehealth connectivity, and networking directly to patients’ homes. The Veterans Administration, in particular, has found that placement of a computer in an at-risk patient’s home can allow for more timely interventions and patient monitoring between home care visits.
It’s not a question of whether the technology is available — it’s more an issue of who will see the huge desire of patients to remain in their homes for as long as possible as a business opportunity. The adult children of these patients are seeking peace of mind regarding their parents. Health systems need to reduce patient readmissions, due to financial penalties in the form of reduced reimbursement from Medicare. We believe that pharmacists can play a crucial role in helping throughout this entire process. Whenever a loved one has a stroke, or a medical condition debilitates those we care about, every family finds itself in uncharted waters and in need of assistance. For community pharmacists, the products we have described could be a complement to the current durable medical equipment being provided. For the consultant pharmacist, helping long-term care clients redefine their enterprise could be an initial foray into this area.
Again, there are hundreds of resources that we have not had time to mention in this column. We see this networking of the patient home as a huge opportunity. We would like to hear your comments and questions on this topic. We welcome the opportunity to continue the conversation. CT
Bill G. Felkey, M.S., is professor emeritus, and Brent I. Fox, Pharm.D., Ph.D., is an assistant professor, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University. They can be reached at firstname.lastname@example.org email@example.com.
Web Site Resources
LeadingAge state meetings: www.leadingage.org
Government-funded site to find an inventory of technology available to long-term care settings: www.techforltc.org
E-pill Medication Reminders, for information on medication technology: www.epill.com
WellAware Systems and This Caring Home are two companies that integrate the connected home with care networks: www.wellawaresystems.com and thiscaringhome.org
iHealthHome is an example of a startup company that uses iPads to connect medication and safety devices to feed data to care networks: ihealthhome.net