Prognosis Poor for Health Monitoring Technology

With my ombudsman hat on recently, I spent a morning doing an assessment of an assisted living facility. As is usually the case, the nurses showed us a thick patient chart book with handwritten status observations, penciled-in Xs tracking medication dosages and a yellow-highlighted list of discontinued drugs. The 24-hour log used by the aides showed their observations in longhand: “resident is complaining of pain…resident is combative today…resident ate 50% of lunch.” The nurse in charge expressed extreme distaste for the few computer records they must enter—when a resident falls, for example, policy requires that it be reported to the parent company.

After the assessment I watched the 2004 CAST Imagine the Future of Aging video and was struck by the stark contrast. If you don’t have the time to watch (although I recommend watching all three videos on the CAST website), here’s the gist: we are going to see a transformation in the world of health care into a tech-enabled partnership between patient and physician that incorporates online personal health records—appropriately privacy-protected, of course. With appropriate permissions, information about how a person is doing can be available to family members, monitoring nurses or doctors, and homecare agencies. Over the next ten years, through public programs and partnership with insurers, a national Internet for health care will transform prevention, health care delivery, and ultimately close the gap between caregivers, providers and seniors.

To achieve that vision, we need to be realistic about the likelihood of the technology being used by seniors and health care providers, we must assess the products that are currently on the market, and we must be proactive about managing the care we need on our own.

Most Seniors Averse to Monitoring Technology

The AARP Healthy@Home study told us that that other than personal emergency response systems (PERS) devices (66% of respondents 75–84 expressed willingness to use), less than 50 percent of seniors are willing to use telephone-based monitoring, TV-based monitoring, electronic pillboxes, Internet monitoring with provider communication or electronic pillboxes with provider communication. And as for password-protected online personal health records, just 11 percent of Americans use them today.

Providers Slow to Incorporate Technology

The assisted living facility I visited was not unique (although the stated average resident age of 90 was pretty amazing). Despite optimistic projection about the use of home health monitoring devices, monitoring technologies have not made it into the facilities where residents are the frailest. And let’s talk about doctors. According to the New England Journal of Medicine, fewer than 20 percent of all doctors have functioning electronic medical record systems in their offices, and only 9 percent of doctors in small offices. If they don’t have electronic medical records, odds are pretty good that they are not going to be sharing anything electronically with seniors or their families.

What You Can Buy Now

What technologies are available now for a forward-looking healthy senior or family member of a senior with chronic conditions? First, secure the home. Unless the home comes with a built-in alarm system, that means finding a home security vendor with an optional personal emergency response offering, like ADT, uControl and Visonic, that links to a list of responders, including Alarm.com’s link to EMTs and family members. Next, as needed, add the monitoring technology for various chronic conditions. This could include glucose, blood pressure, weight, or other conditions that can be tracked with wearable devices.

Managing Care Ourselves

Online technology makes this a lot easier. Many baby boomers have aging parents; according to the CAST video, for example, 50% of 60-year-olds have at least one living parent. To improve the quality of care that their parents receive, boomers should sign them up for a personal health record to establish a good list of conditions, medications, and drug allergies. Unless you, your family member or your employer or insurance company has a preference, start with WebMD’s Health Manager. Or if you’re a gmail junkie, look at Google Health. Or look at the information-rich Microsoft Health Vault. If you're managing the care of someone with a chronic condition, first fill out the personal health record, then ask the doctor if he or she will use it. Teach the senior to use a PC to search the Internet for information about health and disease. Or do it for them. Advocate with—and for—more information from the doctor, beyond the prescription. Ask whether the doctor takes e-mail questions.

The gap between solution reality in 2008 and technology vision from 2004 is real and worrisome; visionaries cannot close this gap by themselves. But it will surely narrow if, as consumers, we educate ourselves and vote with our pocketbooks, influencing policymakers (like state-based regulators of assisted living facility requirements), health care providers (especially the tech-starved medical community), and technology vendors who want to know what will sell and to whom.

Posted in Aging in Place Technology, Assistive Technology, Get Organized: Tools for Caregiving, Home Modification, Home Safety & Fall Prevention, Safety Equipment & Gadgets