Archive | July 2013

“Digital Aging”: Trend I – Remote Home Monitoring

For the last decades, development of Information Technologies (IT) and sensor technologies has resulted in a great number of new services such as smartphones, tablet PC’s, wireless video games, robotics, Skype to name a few. With some delay in time these technology advances started to change the way healthcare services are delivered with areas of mhealth (using mobile devices for healthcare service delivery) and telehealth (delivering healthcare over distance) gaining wider acceptance. So now it is time to create a series of blog posts under the common name “Digital aging” to highlight solutions that are already available and can be used. Stay tuned to the next blog posts, if You want to know more.

active senior boxing

Active Senior

One of the trends of applying new technologies is remote home monitoring of elderly people using a set of sensor devices and wireless data transfer. The main advantage of these tools is that it gives today’s active seniors and their families freedom, security and the ability to manage their health at home or away. Basic functionality of the remote home monitoring system can include:

  • automated fall detection
  • location tracking
  • remotely managed two-way voice
  • alert system

Additionally, some of the systems support integration with other health measuring devices and can track blood pressure, weight, blood glucose level and even transfer all these data to the patient’s Electronic Health Record (I will tell more about it in the later posts)

How it works?

A senior active citizen will wear a lightweight pendant everywhere he goes: inside the house, to the library, swimming pool, supermarket, park, etc. This pendant will be waterproof, easy-to-use and not necessary to be taken off even while charging and constantly serving as a part of a “Mobile personal emergency response service”, which will track the senior person movements, detect any case of possible fall and location of a senior and send alert to the caregiver/assistant.

As an example, Susanne, 82 years old, wants to live an active life and not be tied to her healthcare team, which includes her family and healthcare professionals. She wears a light device with her anywhere she goes. While walking in the park, Susanne feels dizzy and presses the help button on the device, thus initiating a two-way voice conversation with a support center. She tells about her condition and the support center assistant makes a decision, whom to send to help Susanne to get home safely. In case Susanne falls, the system will automatically track her location and an ambulance car will pick her up.

I believe such techniques are very inspiring and these types of solutions are already on the market with for example “GoSafe” and “Libris”. Moreover, in US, AT&T is offering “Libris” solution as part of a managed service for doctors and health insurers already. Why not set “free” both active seniors and their families?

References:

http://philipslifelinegosafe.com/new/

http://numera.com/platform-products/numera-libris

“AT&T and Numera Combine Personal Safety and Home Health management with New Personal Health Gateway”. Accessed at: http://www.att.com/gen/press-room?pid=23809&cdvn=news&newsarticleid=36052

Image : www.freedigitalphotos.net

2050 – Projecting the magnitude of demographic change worldwide

“I see old people” is how this chapter begins. I’m reading “The new North – The World in 2050” by Laurence Smith. Without having finished the book, I’m excited to share some of the thoughts. This chapter really struck me.

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Smith is a young professor in geography and earth and space sciences at UCLA. In his book, he analyzes four key “megatrends” – population growth and migration, natural resource demand, climate change and globalization – and projects how our world could look like in 2050.

The world is filling up with old people. Smith begins by describing the four stages of the demographic transition, which is happening everywhere in the world: 1. High and similar rates of birth and death (e.g., the preindustrial era, with a small and relatively stable total human population); followed by 2. Falling deaths but not births (initiating a population explosion); followed by 3. Falling births (still exploding, but decelerating); and finally 4. Low and similar rates of birth and death (population stabilization at a new, higher total number.

He states that most OECD countries have now passed through these stages – except for those allowing high levels of immigration like the USA – and have stabilizing or even falling populations. Most low- and middle-income countries are still in stage 2 or 3 though.

Smith summarizes that urbanization, modernization, and the empowerment of women push fertility rates downward. In other words, the urbanization of society (if associated with modernization and women’s rights) helps slow the rate of growth (with exceptions). In low-immigration developed countries like Italy and Japan, and regions like Eastern Europe, populations are falling. Consequently, if fertility rates continue to drop as they are now, the world population might be around 9.2 billion in 2050 – the population will still be growing, but about half as fast as today.

One of the most profound long-term effects of women having fewer babies is to skew societal age structure toward the elderly. Of course, improving healthcare also extends our life spans. This aging will hit some places faster and harder than others. Today, Japan is the world’s most elderly country with a median age of 44.6 years. In Pakistan, in contrast, the median age is just 22.1 years. Korea, Russia and China will join Japan as the world’s geriatric nations. Korea, Vietnam, Mexico and Iran will age radically by fifteen years or more. Countries like Afghanistan, Somalia and the Democratic Republic of Congo will still have youthful populations in 2050. Image

Smith asks: Is an elderly population a good thing or bad? He describes a possibly wiser and less violent society, which at the same time strains healthcare systems, and raises the economic burden on younger workers. The whole concept of “retirement” is about to undergo a major overhaul – people will have to work later in life. Big cultural shifts will be needed in the way we treat and value our elderly. Society must learn that aging and youth should be valued equally.

As the world grays, skilled young people will become a more and more craved resource, Smith concludes. Thus, those countries best able to attract skilled foreign workers will fare best. These young workers might come from Somalia, Afghanistan, Yemen, the West Bank and Gaza, Ethiopia, and much of sub-Saharan Africa, which will offer our world’s youth in 2050 based on current population structures.

Finally, the critical but open question that Smith poses is whether our poorest countries will be able to turn their forthcoming demographic advantages into the new skilled workforces needed to help care for an elderly world. This would require enormous improvements in education, governance and security. Women would have to start attending school and working in places where this is uncommon today. Terrorism would have to be sufficiently quelled. The countries that need young workers would have to accept immigrants from the countries that have them.

Hopefully, these things can be achieved.

PS: Check out Laurence Smith on Vimeo: http://vimeo.com/15715690

Innovating health through just-in-time evidence-based information

Hearing the term health care innovation, most people associate it with new technologies like robotic caregivers, digital imaging or breakthroughs in chronic disease treatment. The decision-making process towards the use of any of those innovative choices is based on the physician’s knowledge and experience.

“Healthcare innovation can be defined as the introduction of a new concept, idea, service, process, or product aimed at improving treatment, diagnosis, education, outreach, prevention and research, and with the long term goals of improving quality, safety, outcomes, efficiency and costs” (Omachonu et al. 2010). Thus, process innovations focus on improving quality of care for patients and enhancing health providers’ internal capabilities. However, innovation is difficult – the health field has rich evidence-based innovations, but they disseminate slowly, if at all (Berwick 2003). Six areas have been identified in making or breaking innovation in healthcare (Herzlinger 2006):

  • Policy
  • Stakeholders
  • Funding
  • Technology
  • Customers
  • Accountability

One opportunity to introduce innovation in healthcare is the use of evidence-based information, which is highly relevant to that particular patient – especially at the point-of-care. But how can the use of this kind of information be facilitated?

One tool that I came across is Elsevier’s ClinicalKey (www.clinicalkey.com). It is a tool that physicians can use to access evidence to make informed decisions at the point-of-care and throughout the patient journey. The ClinicalKey reference system links clinicians, medical librarians, and researchers to an online platform, which contains content from medical journals, books, multimedia, MEDLINE abstracts and other sources. Did you come across any similar tools?

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To me, fast access to high-quality research evidence to inform decision-making in clinical practice is absolutely important for innovating – improving – health. What do we need to solve this?

Maybe we need harder, better, faster, stronger tools as such, but what I wonder more about is the role of stakeholders as the leaders in these processes. How can leadership for evidence-informed decision-making in health be encouraged? How to cure resistance to change and innovation?

References
Berwick DM (2003). Disseminating innovations in healthcare. JAMA, 289(15):1969-1975
Herzlinger RE (2006). Why innovation in healthcare is so hard. http://hbr.org/web/extras/insight-center/health-care/why-innovation-in-health-care-is-so-hard
Omachonu VK, Einspruch NG (2010). Innovation in healthcare delivery systems – a conceptual framework. The Innovation Journal: The Public Sector Innovation Journal, 15(1):2.
www.clinicalkey.com
http://www.youtube.com/watch?v=gAjR4_CbPpQ
Image: http://www.tcd.ie