I'm Eric Tinsley, the VP of Research & Development and Chief Technology Officer at My Health Care Manager.

My role here is to build systems and tools to make caring for seniors easier, more predictable, and help everyone involved in eldercare make the most informed decisions possible.

If you'd like to read more on my background click this about us link .

There has been a continuing increase in the number of new products surfacing to help with the issues of health management.  Everyone's getting into the act... even the iPhone!

MedScape is a new application for the iPhone that allows you to look-up information about medications you or your aging parent are taking.  You can review lots of information helpful in medication management - dosage, drug interactions, adverse effects, costs, and so on.  The application is currently free and can be downloaded using iTunes or directly from the App Store.

Similar information is available on the Internet from lots of resources.  WebMD is a well known example.  Most to the major pharmacy sites like CVS or Walgreens also have drug information available.

In earlier blogs, I've mentioned a variety of in home technology advances to assist people caring for aging parents who hope to remain living independently.  Among these are safety tools for monitoring the home environment intended to help seniors who are "aging in place". 

One thing that doesn't come up enough in the discussion of these tools is the question of ethics.  How invasive should family members, or monitoring services, be allowed to be?  There are people looking at both the technology and the surrounding ethical issues.  One such group is the Ethical Technology in the Homes of Seniors (ETHOS) effort underway at Indiana University.  The focus of the ETHOS team is developing tools and guidelines to protect the privacy of senors living at home.  According to the team, seniors often underestimate the risks to privacy involved with technology use.

You can read more about there efforts by clicking on this link http://ethos.indiana.edu/. 

Likely you have seen some variant or another of this article "Helping the Elderly Keep Their Driving Skills" talking about helping seniors keep their mind sharp.  Whole companies have cropped up like the one mentioned in this article, Posit Science, around the idea computers and software can help. 

Certainly games like these are interesting and often fun, but their claims are largely unproven.  Comments like the brain is "the most important muscle in the body" is, at best, metaphorical.  The brain is, of course, nerve tissue not muscle tissue.  "Exercising" the brain has little impact on senior memory loss brought on by Alzheimer's or other serious forms of dementia. 

Driving is one of the big safety issues with seniors and for those people who are not facing serious cognitive decline, they may find these games fun and somewhat beneficial.  Of course, physical limitations such as immobility are not impacted.  At a minimum, I would expect some gains in driving skill just from the heightened awareness.  Likely most of us could gain from that lesson.

See more on Posit at http://www.positscience.com/. 

The final installment of the SCANS 1.3 rolling release is complete.  The July release includes some 22 new and revised tools and resources.  The list includes:

• Medicare Summary
• Medicare A Information
• Medicare B
• Insurance Resource
• SHIP
• Medigap
• Medicare C and Advantage Plans
• Earwax
• Visual Impairment Websites
• Hearing Impairment Websites
• Visual Impairment Devices
• Optometrist vs. Ophthalmologist
• Bladder Training
• Foley Catheter Care
• Urinary Continence Education
• Incontinence Supplies
• Catheter Education and Support
• Brain vs. Bladder
• Incontinence – Foods to Avoid
• Tips to manage Incontinence with dementia
• Continence Bladder Diary
• Modify Environment to Assist with Continence

Thanks to the SCANS research team for this successful (and popular) release which included some 74 new tools!  You can read more about these topics from a caregiver's perspective directly from one of our researchers Karen Witt Kelsey.  Click here to read more in her Caregiver Support blog.  Karen is a key member of the research team as well a caregiver for her own mother.  You'll enjoy her unique perspective on senior health care.

No sooner than I posted my observations about the emphasis on aging and senior health care at the HCI International conference then one of the My Health Care Manager team sent along this article on the global impact of aging.

http://www.foxbusiness.com/story/globe-soon-geezer-central/

The article highlights a report commissioned by the National Institute on Aging and just released by the U.S. Census Bureau titled An Aging World: 2008.  It identifies the global problems of doubling the aging population in the next generation.  How will people get help with aging parents?  Can the current system of care support the change? 

As we stand today, the answers are - don't expect much help and don't plan on the current system being up to the challenge.

The good news is that this all means opportunity.  Opportunity for new approaches, new technologies, new innovation, new public policy... everything is on the table.

Last week I had the opportunity to present a paper at the Human-Computer Interaction International Conference.  This was the 13th occurrence of the conference and the event was well attended by key researchers and companies concerned about how computers interact with people. 

Jean Bandos co-authored the paper titled "Impacting the Continuum of Caregiving through Innovation in Informatics: Senior Care Navigation System (SCANS)".  Other members of the SCANS team contributed, as well.  You won't find the paper in the conference proceedings however, due to Intellectual Property concerns with the conference publisher's copyright requirements.  In spite of those restrictions the paper and the presentation were well received.

What struck me about the conference on a general level was the amount of attention being given internationally to the challenges of older adults and senior health care.  Conference attendees came from China, Japan, UK, Germany, India, Spain, and many other places - representing some 49 countries in all.  Support for seniors living independently and dealing with challenges like immobility, well-being, and cognitive decline surfaced as a major sub-theme to the conference.  World wide researchers are examining how computers can help with aging parents.  

The specifics were wide ranging from topics like augmented navigation for assistive mobility devices to ontologies for adaptive user interfaces to cope with the specific needs of the elderly. 

I was genuinely encouraged that so many top brains are looking for ways to improve eldercare services.

A colleague handed me a flyer today from a local cardiac physician group for cool little wallet sized CD they provide their patients with key medical information on it. 

The idea is that you carry this card in your wallet and in an emergency situation you can hand the card to a provider who can then view it on a computer capable of reading a data CD.  Even if you are unconscious, medical personnel can find the card style CD and view it.

The CD contains things like:

• medication lists
• current diagnosis
• current allergies
• discharge summaries
• diagnostic test results
• and even educational materials

All in all this is a good thing.  It also points out some of problems with "high tech" solutions to emergency information. 

• First, not all emergencies will allow time for medical staff to leave the patient in order to find a PC with a CD drive and review a set of unfamiliar computer documents.   
• Second, in order for this information to be easily read in an emergency situation, it is also easily read by anyone who steals or even simply has access to a person's wallet.  Because it's a CD, it's also not clear exactly what data is on the record; leaving seniors and families caring for aging parents to wonder what information is potentially disclosed.
• Additionally, the currency of the data may be questionable.  Frequent health and medication changes are common in older adults and this approach requires notification back to the provider, payment of an update fee, and the reissuing of the wallet CD.  Allowing reasonable times for such activity, it could be very difficult to keep this up to date.
• Even small scratches from "wallet wear" on the CD can render it unreadable.  Something that wouldn't be readily apparent until the CD was checked in a computer drive.  Often, I fear, at the time the information is most needed. 
• Lastly, the completeness of the data may be in question as it relies on the patient, often a senior with depression or memory loss, to report the activities of the disjoint senior health care system.

My Health Care Manager approaches this problem differently.  Our geriatric care managers collect, review, and update information across all of a client's health providers.  This Personal Health information (PHI) is then used to inform all providers engaged in the client's health.  For example, each of the client's physicians receives the medication list initially and then again for every medication update. 

For emergency situations, clients are given a Ready Reference Card which contains all the key medical information and alerts.  This PHI easily folds to the size of credit card for wallet use and multiple copies can be kept in other key areas, for example in a specially identified pocket on the client's refrigerator where emergency personnel are trained to look. 

Because the Ready Reference is a paper record it is immediately available to emergency personnel in settings where a CD reader may not be at hand such as the senior's home, as shopping center, and so on.  It is also quick and very inexpensive to reprint when updates are needed.

The point here is not that technology is bad.  On the contrary, technology enables both of these solutions.  We should put it to work in the most effective ways we can devise for seniors and their families.

Not to be out done by the Navigator development team, the SCANS team is continuing their "rolling release" of V1.3.  SCANS is the Senior Care Navigation System that provides geriatric care managers with expert advice, best practices, and practical tools to help families with the well-being or their parents.

The June edition of V1.3 includes 26 new resources, process, or tools.  The list includes items like these:

• Death in the Home – Information for Caregivers
• Tips for Alzheimer Caregivers
• Delirium vs. Dementia
• Transitioning an Individual with Dementia into a Facility
• Member Portal Instructions
• Continence Education – Constipation
• Urinary Incontinence – When to Seek Immediate Medical Attention
• Crime Prevention Education for Older Adults
• IADL (Independent Activities of Daily Living) Education
• Physical Therapy and Occupational Therapy
• My Medicare Matters
• Advance Directives for Mental Health Treatment
• Drug Review and Side Effects
• Geriatric Friendly Pharmacy
• Medicine Reconciliation:  Brown Bag Consultation
• Feeding Tube Education
• Special Diet Needs Education
• Defibrillator Education
• Diabetes Education
• Fibromyalgia Education
• Pacemaker Education
• Physician Planner Case Note
• Alternative Living Options Education
• Speech Therapy Education
• Social Participation Barriers
• Social Support Plan

These tools are available to the clients of My Health Care Manager and our affiliates.  Some of the content is also discussed in our blogs and can be accessed for free.  Check out Natalie Langley's blog titled "Healthy Aging".  Natalie is one of the principle researchers and authors of the tools in SCANS.  Her blog covers a holistic look at healthy aging and senior well-being.

My Health Care Manager's care management system (Navigator) has just been updated to version 1.9.  This is the core system that geriatric care managers use to assist families caring for aging parents.  From past blogs you may know that this includes the assessment, care planning, implementation, and tracking support for seniors and their families.

Navigator 1.9 includes:

• Key changes for work flow
• Assessment and tracking improvements in the following dimensions:
  • Client Designees
  • Financial
  • Advance Directives
  • Engagement – Social Support
  • Provider Information
  • Medication History
  • Family Medical Health History
  • Functional Status
  • Assistive & DME Devices
  • Sensory Status
  • Nutritional Status
  • Anxiety
  • Environmental
• Reporting enhancements in areas like legal and Insurance, personal health record outputs, services listing, and more

This system is available to our clients and clients of our affiliates and partners.  We also provide much of this information in our Guide for Senior Well-being and Eldercare.  This is a self help guide is available at http://www.myhealthcaremanager.com/guide/product.asp.

I've been seeing several ads for voice recognition phones, lately .  The idea is to provide both the sound through the ear piece and a text display of what's being said.  This can be a terrific tool for older adults with hearing problems. One example can be found at the CapTel web site.

This service can have impact on senior well-being in several ways.  The example shown by most of the advertisers is reducing feelings of isolation by making it easier for grandparents to speak with grand kids and other friends and family.  It can also play a very practical role in caring for aging parents, as well.  Caregivers can communicate more frequently by adding phone conversations to face to face interaction.  The text can also help assure that advice or instructions are more accurately understood.

These phones are another tool in the emerging market to help seniors who are  living independently. 

The SCANS content team headed by Jean Bandos along with the development team announced today that the SCANS Version 1.3 - May release is now available.  SCANS Version 1.3 is a major content release to the SCANS Knowledge Base.

In order to make more real-world tools for eldercare available more quickly, Jean and the team have devised a "rolling release".  For 3 months beginning in May another group of resources, processes, and tools will be made available to geriatric care managers at My Health Care Manager and our affiliates.

The May release contains 57 new and/or revised resources, processes and tools.  Some sample items include: 
 

• Behaviors and Alzheimer's Disease
• Grief Education
• Activities of Daily Living Education
• Depression and Alzheimer's disease
• Early Stages and Impact on Health
• Memory & Cognition Questions
• Memory Care Unit Checklist
• Memory Care Unit Education
• Mild Cognitive Impairment
• Sobriety Programs Resource
• Handyman Resource
• Private Handyman Contractor Checklist
• Smoke & Carbon Monoxide Detectors
• Daily  Money Management Education
• Financial Planning Education
• Trust Education
• Verifying Funeral Arrangements
• Veterans Benefit Information
• Elder Law Resource & Checklist
• Medication Management Procedure
• Medication Reconciliation
• Polypharmacy
• How to Find a Pain Specialist
• Pain Education
• Pain Resources
• Pain Visual Analog Scale
• Arthritis
• Heart Failure
• Hypertension Education
• Family History - Cancer Education
• Family History - Dementia
• Family History - Diabetes Education
• Family History - Heart Education
• Seat Belt Education
• Cataracts Education
• Glaucoma Education
• Hearing Aid Education
• Sensory Changes
• Assistive Devices
• Hospice Education
• Spiritual Connections

Stay tuned; the June release will include resources on incontinence, cognition, supporting services, and more processes.

Be sure to visit Jean's blog, click here.

Our Senior CAre Navigation System (SCANS) has released in a new edition - Version 1.2!
 
This version includes major extensions of the search functionality to make it easier for geriatric care managers to find specific tools and solutions.  This provides quicker access to hands on practical solutions for families caring for aging parents.  Of course, the structure and caregiver advice in each of the 25 Care Categories remains in place to assist the geriatric care manager overall care planning.

Also including in the 1.2 release are a variety new solutions, actions, resources and other content for helping with senior well-being and senior health care.

One of most touted areas of the Federal government's stimulus initiatives has been investment in Health Information Technology.  Unfortunately this has been focused heavily on infrastructure not caregiving tools (and certainly not tools for eldercare specifically).  Proponents of this investment believe that it will save billions of dollars in the long run on health care costs.  Typically they site things like the elimination duplicate tests, administrative efficiencies of an Electronic Medical Record (EMR) and other "back office" improvements.

Well, I'm skeptical.

I'm not alone,  the New York Times published an article a little while back raising some of the same concerns.  Titled "Doctors Raise Doubts on Digital Health Data" the article discusses how difficult a problem this really is.  Two significant issues surface.  First, how frequently these systems are used and second, do they actually make a difference in the quality of care and coordination between health care providers.

Read the full article at www.nytimes.com/2009/03/26/business/26health.html. 

Not surprising the use is very low - 9% of the nation's 3000 hospitals according to the article.  Data on quality or efficiencies really isn't even available.

For people caring for aging parents and the cost associated with senior health care.  I'm even more skeptical.  In reality the health situation for a senior really can change over night and repeat tests are necessary.  A senior with congestive heat failure or chronic obstructive pulmonary disease may require duplicate tests in very short time frames.

Transfer of information could provide some efficiencies, but often competitive hospitals, physician practices, and other competitive health providers are being asked to collaborate with no financial incentive. 

A number of people have been asking me about starting a Personal Health Record(PHR) with Google Health, Microsoft Vault, or other free tools.  The question eventually cycles around to, "Why would I pay for a PHR when I can get one for free?"

Good question.

Of course, the answer is as old as the health care business itself.  "There's no such thing as a free lunch" ... or even a free PHR.  It's simply a matter of what you are willing to trade for the service. 

If you build your own PHR you have to take extra time to build, maintain, and even think through all the necessary information to collect.  Likely you have to type everything by hand rather than pulling from medical records, pharmacy records, or other sources of ready data.  What you are "paying" is your time and what tools you decide to use.

I the case of Google Health of Vault you are "paying" with your personal information.  In particular, detailed information about your medical conditions, treatments, and health situation.  If you are caring for aging parents you are trading their information.  What you get in return is the result of hundreds of thousands of dollars of development and though.

But, where did all the development money come from?  Where does the money come from to pay for the computers, bandwidth, and support staff?  It comes from advertising dollars aimed directly at you, your parents, or you as a caregiver.  These advertisers love the idea of being able to get directly at you and the health problems you or your parents face.  Not all bad, really... but no so good either.

The other model of course is to pay for a PHR application yourself and eliminate the need for a "third party payer".  In this case, of course, you are paying with an annual or monthly access fee.  This is also true if you are using a geriatric care manager or other provider of eldercare services who is using a system on your behalf.

There isn't a right answer.  You simply have to evaluate the trade off between your time, your private health information, or your money.

A friend forwarded an email recently about something called the "Wellness Wizard".  This is system for automated reminders.  The caregiver records messages to be played at specific times and dates.  The idea is to provide reminders about medications or important appointments.  It also provides a mechanism for the senior ask for help from caregivers.

All-in-all this tool probably has some utility.   It's relatively inexpensive and could help people caring for aging parents who live independently feel more comfortable about their parent's situation.   

The only part of this that really bothered me was the claims about this product.  The company claimed it would:

• decrease avoidable readmissions
• maximize the well-being of their loved one
• reduce caregiver stress
• and more

The product can contribute to these, but it's really a stretch.

The truth is, it takes a coordinated effort.  Eldercare is not a tool.  Tools can only help.  Be wary of "over sell".  There's nothing that can replace a caregiver's involvement.  Even a geriatric care manager still needs the connection with family. 

Care managers and tools for eldercare can save time, improve situations and even well-being, but they are aides not replacements.

Natalie, one of your key researchers, just let me know about a long list of materials released to SCANS.  In previous blogs I mentioned the development that is underway for SCANS, but we are also improving the Knowledgebase of the current production release. 

Here is a sampling of some of the new material available to geriatric care managers and the families they are helping:

My Medicare Matters	Insurance – Resources
On-line Services at the Social Security’s Website	Financial – Resources
Food Pyramid for Older Adults	Nutrition
How to Find a Geriatric Physician – updated	Provider Coordination  - Protocols
How to Locate a Neurologist	Provider Coordination - Protocols
How to Locate a Speech Therapist	Service Coordination - Protocols
DME Resource – Updated	Communications, Continence, Environmental, Functional health, Physical Health, Sensory
Caregiver Support Resources – Updated
Pet Plan	Social
Tips on getting an older adult to the doctor when they refuse	Provider Coordination
How to locate a Urologist	Provider Coordination – Protocols
How to locate a Audiologist	Provider Coordination – Protocols
Medical Transport Services	Service Coordination - Protocols
Home Modification Resources	Environment
Tips to a Successful ER Visit	Service Coordination
Veterans Benefits Information	Financial

Continuing to explore the technology to help with aging parents, in home monitoring is becoming more and more visible. 

One of my blog readers recently called my attention to this article from the University of Missouri titled "Health-Monitoring Technology Helps Seniors Live at Home Longer, MU Researchers Find".  Click here to read the article.  Articles like this one are appearing more and more, and research in these areas is on the rise.

That's not a surprising trend given the demographic shifts and the desire for seniors to continue living independently.  The article, in fact, leads off with this premise.

Using sensors, video, and other tools researchers at MU have built an early warning system to help identify problems and alert health care providers before problems escalate to full blown emergencies.  The study examined data collect of two years at an affliated retirement community to identify patterns leading up to adverse events.  Real time data can then be monitored - watching for these patterns.

Systems like this can help to provide peace of mind to families who are caring for aging parents and provide meaningful data to senior health care providers.

I got several comments on my caregiver blog about Therapeutic robots.  Several people were intrigued and others where "cautionary".  The cautions are well founded.  If you are caring for aging parents, you have to view technology as a tool, not a pat answer.  Some dementia patients might find a robot a cause for paranoia or even an object of anger.  So instead of enhancing a sense of well-being it could actually damage it.

A professional geriatric care manager can help with these kinds of decisions along with other health professionals.

Here is another article about Paro which you may find interesting titled, Robot baby seals to replace cats and dogs as pets in hospitals, nursing homes. This article explores the artificial intelligence capabilities in a little more depth.

Just in case you thought the robot dog was too silly, I wanted to share this article from the Washington Post.  "Dementia Patients Find Comfort in Robot' discusses the use of a robot to provide comfort and companionship to dementia patients living in a retirement community.

This is not a whim, the National Institute of Advanced Industrial Science and Technology developed the robot called "Paro" over 12 years.  These same kinds of research are being explored at IUPUI in the schools of Informatics and Computer Science.  Creating animal like or child like responses in a robot seems to have significant impact in treating cases of dementia.  Sights, sounds, tactile sensation, and responsiveness all appear to be important influences.  This make a robot an ideal tool.

It's exciting to hear of real help with senior health care that doesn't involve extensive medication and actually enhances well-being.