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 .

Laurie recently posted a comment about her mom having problems mixing up her medications.  This is a very common problem.  The average person over age 65 is taking 8 prescription medications.  Someone who is battling chronic diseases may be taking many more. 

The number of medications is confusing in the best of circumstances, but clearly other challenges like declining vision, cognitive issues, or problems with manual dexterity make medication management a daunting task. 

Some of the posts in my blog can help.  See Technology in Day-to-Day Medication Management and Create Your Medication List Now.  You can also click here for our full blog list on Medication Management where you will find lots of additional advice and insight.

You can also ask question directly of a Health Care Manager by joining our Caregiving community.  Click here for that link.

My Health Care Manager has introduced a new FREE service that uses a little bit of technology to connect you to a lot of geriatric care research and experience. 

If you look in the upper right hand corner of this page you will see a "sunburst" linking you to a free service called the Caregiving Community.  By joining the Caregiving Community you can ask a question of our geriatric care management team and get an answer by the next business day.  Ask as many questions as you want, whenever you want.  In addition, once a month you will receive another Caregiving Community solution selected from best questions and answers we've tackled that month.  There is no cost for the service; all you need to provide is a name and email address.  We will not share or sell your name with others and we will not inundate you with any kind of high pressure sales.

So what's the catch?  Well, we do have a company interest here.  We believe that by providing valuable information to people caring for a senior in their life those caregivers will turn to us if they ever need help.  No tricks.  We know that if we can help families with the complex issues of aging everyone wins.

In past blogs I've talked about the 17 dimensions My Health Care Manager uses to build the Personal Health Record.

We've spent a lot of time on some of the most used data like the medication list, provider list, and other "current state" information.  By "current state" I'm referring to information which is primarily valuable for it's current data values.  For example, when you are caring for aging parents it may be of some very slight interest which doctors your parents went to 3 years ago, but the current doctors are far more important.  The same would be true in medication management.  It's the current prescriptions and treatment plans that are most relevant.

However, 10 of the 17 dimensions deal with "longitudinal data".  That is, data that should be measured over time.  If you are primary caregiver it is very easy to miss major changes because they happen incrementally. 

It's just like watching children grow up.  Parents, who see their kids every day, know they're growing, but its the Aunt from across the country who's stunned by how much they've grown each Thanksgiving.  Parents can get a sense of this themselves by looking at pictures.  So it is with eldercare.  The people closest to the situation need to take an actual "snapshot" of the key data items and periodically look at those for problem areas.

My Health Care Manager does this through the use of a formal assessment.  At least annually and at every major health event key areas like Activities of Daily Living, Socialization, and Cognitive Skills should be assessed, scored, and tracked. 

Let's return to the question of the impact of technology.  In particular, to the impact on a key issue facing seniors and caregivers, medication management.  We've touched on the fundamentals - preparing and communicating the medication list with simple computer tools.  What we haven't spent much time on is the day to day management of medications.

Technology can help.  For example, one of the tools My Health Care Manager makes available to seniors and their families is a weekly medication schedule.  This schedule provides a map of the all medications with the day and time and dosages they are to be taken over the course of the week.  This schedule can also provide a variety of additional information such as sliding insulin scales or even life style guidance for exercise or other activities.  In many cases our clients will actually record daily health monitoring results on the form (like blood sugars, blood pressures, and so on).  This is a great way to help aging parents and their care givers stay on top of the weekly regimen.  

There are some limits.  We have found that people dealing with Dementia (Alzheimer's disease or other forms) need the assistance of a caregiver to use a tool like this.  Often they will also need reminders through the course of the day to prompt taking their medications.  Technology can help here, as well.  There are a number of medication reminder systems emerging in the market.

I was just reading an article extolling the virtues of the Personal Health Record in helping seniors and their families.  It was all true … and I wanted it to say more.  The Personal Health Record is also a critical tool in knitting together geriatric care provided by the health system.

The current U.S. health system does not have a good way to connect all of facets involved in caring for elders.  Arguably, it doesn’t have a good way to connect itself for any of us.  There are professional initiatives underway like the Indiana Health Information Exchange, but these are major long term undertakings.  In addition, there is little or no reimbursement available to health care providers for extensive coordination of care.  Add to these obstacles the desire of most Americans to go wherever and whenever they choose for care and it’s not hard to see why this challenge isn’t easily solved.

The Personal Health Record, however, is a tool available immediately to help address the coordination.  With a complete record in hand you can dramatically speed and improve outcomes from the health system.  Knowing the specifics of treatments and medications your loved one is using, knowing the recent health incidents, just knowing the other providers involved in care - can mean a faster diagnosis, earlier treatment, and even saved lives.

You are the glue!  Make your parent’s Personal Health Record and have it available.  Carry the essential information with you and them.

Every so often we come across a product that turns out to be really useful in caring for aging parents.  Sometimes these are even fun for the family, as well.

One such product is the Presto Printer.  This printer works by itself to receive emails with no special Internet connection required.  There is a corresponding service that assures that no SPAM gets through and that it's easy to send messages, pictures, and more.  For more details click here for a PDF brochure. 

This can really help the family stay in touch and reduce feelings of isolation for seniors - improving well-being.  It's also away for grandchildren or even great grandchildren to take an active role in caregiving.

We've had enough success with this, we're able to pass along a special offer from Presto - two months free service.  Go to www.presto.com/myhealthcaremanager to take advantage of this deal.

While we're talking about resources for caregivers, I'd like to mention the revised resource section on our web site.  You can find information about several key topics:

- Blogs by topic and blogger
- UPDATES on key issues
- Subscription Requests, and
- Links to other quality information sources.

The page can be found at by clicking on the image to the left or by selecting Rescources tab on our main page at www.myhealthcaremanager.com

This week marks the 10th anniversary of the "Web Log" ... the genesis of the "Blog".  Of course, sharing ideas over the internet goes back to the dawn of the net itself.  The original idea of the then government sponsored network was to connect academic institutions and government agencies for the purpose of research and collaboration.

The Blog came along originally as a way to share information about where the "blogger" had been on the internet that day and what they had experience.  It quickly became an on-line diary of sorts.  This created the "stickiness" of the concept which since evolved in that dimension and many more.  

For My Health Care Manager the concept has been extended to caregivers helping aging parents and even seniors looking to improve the health and well-being.  Take a look at the blogs listed here - you'll find information on all of the most common heath challenges facing seniors and their families.  Some examples include falls, home safety, dementia, congestive heart failure, diabetes, and many more.

Having access to key thoughts on these challenges is valuable, but even more valuable is the key blogging concept of providing direct feedback to the author.  If you have a question of a comment on an article you've read, don't hesitate to use the "Comments" link right below the posting.  You can read comments and responses from others and best of all ask your question directly. 

If you don't see an article on the subject you're most interested in, post your question as a comment to the top entry in the Blog.  We'll answer the question in a future blog, comment, or email.

The Medication List is certainly the cornerstone for building a Personal Health Care Record (PHR) for yourself or for your aging parents.  Once you have the list be sure to share it with your geriatrician and other health providers involved in the health situation.

• Important names and numbers for physicians and other health care providers as well as emergency contacts.
• Heath Record Summary including medical conditions; key physicians; existence of important legal documents like Health Care Power of Attorney, Living Will, etc.; recent hospitalizations; and primary contact information.
• Legal and insurance detail identifying advance directives, dates, locations, legal representatives, end of life arrangements, Insurance policy information, and so on.
• Health provider details listing each physician, specialty, diagnosis, treatment plan, and key procedures.

How should a caregiver or a senior get started with this idea of a Personal Health Record (PHR)?  If you've been following my Blog so far you can already guess - The list of Medications.

The key elements to include are:

• Medication Name (Remember to include Over The Counter (OTC)medications and supplements, as well.)
• Prescription Number (if applicable)
• Dosage
• Frequency
• Route
• Prescribing Physician (if applicable)
• Refill Date
• Number of Refills, and
• Any Supplemental Information (It's often helpful to include the reason for taking the medication, special instructions, and so on.)

To download a simple excel spreadsheet you can use Click Here. 

Often families struggle to get these lists made accurately.  It can be very difficult to get complete and accurate information if your loved one is face cognitive decline, memory loss, or even simply struggling with declining eye sight.  This is especially true if you are living a long distance from one another.  A Geriatric Care Manager or a health professional can often help.

So what exactly is in a Personal Health Record (PHR)? 

You won’t be surprised to know that the answer varies depending on who you ask.  Let’s start by looking at what My Health Care Manager includes in its PHR.

We have identified 17 dimensions to examine as part of initializing a PHR.  These are:

1. Demographic:  General demographic information including but not limited too the senior’s current living and marital status; accessibility to bathroom, bedroom, and laundry; and work/volunteer history. 
2. Family: Family members deceased and living.  Family health history and availability.
3. Social support:  The family’s/friends’ level of support, communication techniques, and the senior’s engagement in social activities.
4. Representatives/Key Contacts: Individuals that the senior has identified to have permission to health and/or financial information, including the level of information they may access and the manner in which the information can be shared.
5. Financial:  The senior’s perception of his/her financial needs and if additional assistance is required to support health or alleviate stress.
6. Spiritual:  The senior’s perception of his/her spiritual needs and level of comfort/peace with current health status.
7. Legal: Arrangements for an individual to act on the senior’s behalf including the status and copies of the senior’s advance directives, funeral, and/or burial/cremation arrangements.
8. Insurance:  Current insurance information and identified gaps or needs for continued education.
9. Support Services:  Multiple service providers and the level of communication between the providers.
10. Caregiver Support: The stress level and needs of the caregiver.
11. Physical Health:  The senior’s past medical history, treatment plans, and current health status - capturing chronic illnesses, chronic pain, incontinence, weight loss/gain, nutritional status, and sleep habits.   
12. Functional Health Status:  The senior’s perception of and satisfaction with his/her health status while assessing the senior’s physical functional status including activities of daily living, balance, ambulation, assistive devices, and sensory status.
13. Emotional/Psychological:   The cognitive, emotional, and behavior status of the senior including screens for cognitive impairment, anxiety, depressive symptoms, and substance abuse.
14. Medication History:  Medications list, multiple providers, multiple pharmacies,   allergies, polypharmacy, and medication administrative needs. 
15. Home/Residential Environmental & Safety Assessment:  Visual assessment of the senior’s environment.  Assessing fall risk, elder abuse, disaster plans, fire/burn prevention, crime/injury, injury prevention, communication system, and support network.          
16. Preventive Health Activities:  Preventative recommendations and attending health screening activities. 
17. Wellness: The senior’s understanding of activities that promote improved health status such as wellness classes, tobacco use cessation, and/or intellectual stimulation.

This information can be gathered and assessed by an individual, a caregiver, or even a Health Care Manager.  We use a 3 ring notebook to collect and organize this information so that it can easily be updated and kept current.  The binder is easily taken along on medical provider appointments and is large enough to be difficult to misplace.

A friend here at My Health Care Manager sent me an article today with a very interesting statistic.  Science Daily reports that “Northwestern University's Feinberg School of Medicine has found that nearly 50 percent of patients taking antihypertensive drugs in three community health centers were unable to accurately name a single one of their medications listed in their medical chart.”  That’s right, not even ONE of their medications.  People simply can’t remember cryptic medical names, dosages, frequencies, and instructions for the multiple medications they’re taking.

It’s not hard to imagine that in a senior population where people may be dealing with cognitive decline that this statistic would be even worse.  Add to this, the fact that People over 75 take an average of 7.9 medications per day and someone struggling with health issues may be taking many more.  Nobody could remember all this, yet it may be one of the most critical elements to a geriatrician and other health care providers in determining treatment.

If you are a caregiver, encourage your loved one to get all their medications listed with the dosage, frequency, and any special instructions on paper.  Check it and make sure it's right.  If it's too complicated get help from a geriatric care manager or health professional.  Make copies for yourself, and all of the health providers your loved one contacts.

To read the full article “Patients Can't Recall Their Medications To Tell Doctors” Click Here.

At the center of the tools to help with geriatric care management you will find the Personal Health Record (PHR).  Wikipedia has this to say about the Personal Health Record: "The PHR is an ill-defined concept that has been developing over several years."  You'll be pleased to know that it doesn't stop with that.  In fact, it goes on to describe some of the key elements.

Perhaps the most common confusion is comparing the PHR to and Electronic Medical Record (EMR).  An EMR provides a hospital, doctor, therapist, or even insurance company with useful information.  It does little, however, to directly impact the people most affected - the senior and caregiver trying to understand a care regimen.  The few interactions with these systems which do exist, such as Explanation Of Benefit (EOB) statements, are often confusing and frustrating for aging parents.  Little or no information is available from these systems on care plans, medications, multiple disease states, life style, state of mind, living circumstances, support networks, caregivers, or the other complexities faced by seniors.  They do not represent a holistic picture of the environment impacting independence and quality of life.

The Personal Health Record (PHR) has developed in response to this need.  The PHR provides a way for individuals to build and maintain a health care record independent of their health care provider and easily understood by the family.  The reliance on the individuals' understanding of their health situation and care plans to populate the PHR means that great care must be taken with the completeness and accuracy of the record.

Most caregivers can build this PHR either as collection of paper documents or using a variety of computer tools.  A geriatric care manager can help by understanding all the materials to include, off loading the time consuming tasks from a caregiver, taking advantage computer tools, and providing a knowledgeable review of the contents.