Post CES reflection on role of technology and Alzheimer's.
Boston, mid-May, 2016
Tech is so yesterday, long live providers and solutions. 2012 was in some ways a dull technological year – the basic core technologies that are useful when applied to older adult consumers had surfaced in 2011 or before – think mobile PERS, GPS tracking, fall detection, voice activation (say Hi, Siri!), the rise of tablets, longer device battery life (except for smart phones). 2012, on the other hand, was the year in which there was new interest in aging and technology solutions – and thankfully, not just from startups, but included health insurers, communications carriers, and even pharmaceutical companies. As we peer into our 2013 crystal ball, here are some highlights of the past year and predictions about the year ahead:
Tracking growth in Internet and older adults – that’s so last year. Although I still make the case for 100% of the older adult population and Internet use, figuring out what that use is may be beyond industry analysts. This year was the first year that Internet use by older adults passed the 50 percent line as queried by Pew Research. When 26% of the 65+ are loading up photos, 27% of older boomers and beyond, according to Forrester, access the Internet through their TV, and in that context, through game consoles, what is the Internet anyway? Those folks looking at social media sites through their phones and tablets don’t perceive that they are even using the Internet – so let’s throw up our hands and say that the project goal of 'getting older adults online' has been met.
PREDICTION: 2013 IS THE YEAR OF THE ‘BIG DATA’ PLAN. Further growth in Internet usage through whatever wherever among the 65+ will be a given. Partly growth persists as boomers age into the demographic and as peers and family pressures are more insistent. But also -- now that cheaper tablets (or e-Reader/tablets like the Kindle Fire) are everywhere, it will be ever harder to resist that bright, visually appealing and picture-perfect gadget in the swiping hands of someone sitting near you as you are reading an e-Book on an airplane or in a train. As for paper books, sadly, fewer are reading them. The illusion that a low-cost photo-beautiful device is, uh, actually low-priced will be a myth perpetrated from Wal-Mart to Walgreens -- as arguments over data plan prices proliferate. Confusing the market will be device proliferation plus user interface fragmentation, and the race to offer bandwidth-gobbling media. Do we really need to watch a movie on our phone?
Say something – finally we can talk to ourselves and our devices. Maybe next year this will actually work well on all tablets and smart phones. We seem to be at version 1.5 on the way to truly useful. Apple’s Siri has been parodied this year in a very funny book (Siri & Me by David Milgrim) and Apple’s Maps meltdown added a notch to the belt clip of Google Maps and its remarkable NAV turn-by-turn directions. Soon traditional GPS devices will be as obsolete as dial thermostats. But let’s face this music – we really, really need voice commands for all of the gadgetry out there and we need it to work well. Next year will hopefully be better -- this description of a Japanese phone sounds exactly like what we need. In the US, smart phones for older adults are moving forward -- we have the Jitterbug Touch, GreatCall’s first smart phone, and its apps like MedCoach, shake for help feature, and most important, its no-contract monthly price are a good start and a good upgrade for their customers. While half of Americans are smart phone users, only 11% of the 65+ do. Maybe they're waiting for decent voice commands.
PREDICTION: MORE REVs NEEDED TO GET THE EAR OF SENIORS. So why did smart phone usage stats from Pew stay flat for the 65+ from 2011 to 2012? My theory – drawn from my own and family experience and observation, not to mention idiotic online reviews, is that smart phones are still just toys. They are something to amuse us (although not those we are with) in restaurants, at family events, in airports, on sidewalks, in cars, and on trains. Although they exacerbate our antisocial behavior, we still have chest pains when they don’t work. Yet our expectations about the user experience are very low – we hardly complain about their slippery form factor, the jumble of settings, low battery life, mediocre call quality...What did you say??? What? Can you repeat that? And the swerving of those texting drivers on the highway, all of those people bumping into walls and slipping off curbs should make us hope that older adults continue to view these devices as unnecessary.
Solutions, solutions everywhere – and even the doctors have bought in, sort of. So at least half of the doctors out there have iPads and iPhones. And the claim is, no kidding, that iPads make in-hospital patient care better – no doubt because the doctor can look up that med name and dose in real time -- assuming there is decent wireless access in the hospital so that the doc doesn’t have to hang out a window). And there are a gazillion smart phone apps to keep you, that is, the patient, mHealthy – the mHealth Summit had some nice new tech for seniors presented by AARP and Aging 2.0. Some, say some, might even lower the cost of health care. Wishful thinking?
PREDICTION: DOCTORS AND CMS MUST WANT TO LOWER COSTS. And that is unlikely to happen in 2013. Why so negative? Because, says Dr. Joseph Kvedar, head of the Center for Connected Health, "in today's US healthcare system, a dollar saved is a dollar of someone's salary lost." And that would include Dr. Kvedar, who is a practicing dermatologist as well as a telehealth visionary. Will the Medicare hospital readmission penalty make doctors and hospitals more interested in ways to cut costs? Well, it may make them more interested in what happens to the patient post-discharge. The penalty, and probably more compelling, the negative publicity associated with it will have to become a burden. Will this make the healthcare industry interested in telehealth chronic disease monitoring and remote activity monitoring? Maybe not in 2013, where it seems likely to result in more phone calls to the patient – so how’re you doing, Mrs. Smith? What will change the game is a change in reimbursement for telehealth visits – and the CMS innovation awards in 2012 do not hint that we have any real innovation ahead, but just more money to be spent on pilots and experiments.
Disruption in the emergency response market is underway – stay tuned. Two years ago, I spoke at an event comprised of PERS industry business execs – and I likely complained loudly about the "I’ve fallen and I can’t get up" slogan that has for too long characterized the industry’s marketing message -- which is born out of home security origins. I was assured by attendees that disruption from other tech trends was unlikely to impact the industry for at least a decade, i.e. not until 2021. The target market, stereotypically an 82-year-old woman living alone in need of the device in or near the home -- that would be a sustainable market, so folks said. Yeah, that might be true, except for a few small details, including the existence of cheaper and smaller sensors, better cell coverage, the entrance of mobile competition from carriers, smart phone apps, the now-emerged mobile health marketplace (see Philips caregiver app), and the changing interests and expectations of boomers, both for themselves and for their parents.
PREDICTION: Rather than waiting until 2021, we have every reason to believe that 2013 will be the first full year of a sea change across the emergency response industry. In 2013, we will see the intersection of vendor interest from multiple channels, carriers and expandable platforms, not to mention some new start ups as well as startup businesses from within large enterprise companies. Without going too far out on a limb, I even predict that LifeComm will launch in 2013! These newer folks will likely want to connect the usage of the button to other services, maybe some will connect to web-based environments or link to the most popular senior appliance, the TV. Some might offer learning technologies that can recognize and establish baseline patterns for comparison and alerting, versus a simple one-button-fits-all approach. However, we are in mid-survey and research about these Next Generation Response Systems – and will have much more to say about this topic later in Q1 2013.
Home care – not much tech for us – maybe next year. During 2012, we surveyed home care, home health care and geriatric care managers about their use of technology in their practices. The result we found is that there is little use made of in-home technology today, at least not telehealth and chronic disease monitoring tech, and even less use of video communication with either the care recipient or the family. You would think that some of that CMS innovation grant money would be directed at changing this status quo. Especially given the rapid pace at which seniors can be discharged to their home, readmitted, discharged to rehab, back to home or assisted living and so they go, around and around. Each time, these ever-frailer seniors seem new to the system they encounter. Perhaps they may even come back in with a 'new' diagnostic code. (See? They aren’t being readmitted at all!).
PREDICTION: HOME CARE BUSINESSES WILL EVALUATE TECH IN 2013. There will be more technology pilot initiatives and strategy formulations among leading home care agencies in 2013 – and why not? There will be too much pressure by the end of the year from hospitals and rehab organizations (all in mid- or post- EMR implementations) to live entirely in a paper/fax world. And family members will get more than a little fed up with the revolving door restart process ("What did you say your mother’s social security number was?"). Background checking, documentation and caregiving app startups like CareLinx, CareBinders, eCaring, CareZone (are you seeing a pattern here?) will wend their way into regional home care and home health care businesses. Now that Humana has finished inhaling SeniorBridge and its pilot of Care Innovations moves along (whew, there's another Care), more insurers with Medicare Retirement offerings will stop watching and waiting on the sidelines for their own technology projects.
A quantified senior self and senior-aware Big Data in 2013? So much data spilling off and out from Fitbits and their UP-itty ('you, at a glance, leaping onto your bike!') brethren – but these vendors are clueless and do not care about the potential use with seniors. For that matter, the UP page seems clueless about trying to relate to the people who could really use the device, like the 36% of adults who are obese. And regrettably, even though there is a boatload of data about behavior and movement of older adults, whether it is in senior housing or emanating from phones, pharmacies, and health care providers, today there is no big data push that distinguishes an older adult’s behavior from the crash-and-clutter of too much information.
PREDICTION: NO SENIOR QUANT OR BIG DATA – THIS YEAR. Forget about seeing a Fitbit for seniors in 2013 -- and that’s even with a published API for developers. These gadgets will still target the same texting-at-dinner smartphone users, for whom 'self' is an all-consuming concept. By 2014, though, marketers will be scanning for unsaturated markets – and boomers will be a few years older, possibly just a bit less svelte. (Can you predict 'needs knee replacement' without having to call the doctor?) Today’s 'big data prediction algorithms -- if you liked BLAH, then you will REALLY LIKE BLAH-BLAH -- are, as Steve Lohr notes in the NY Times, still pretty stupid. These so-called recommendation engines are not yet predictive, they're just trying to monetize purchase suggestions as a result of all that noise that has a loose resemblance to actionable information.Once online searches can be correlated with prescriptions, doctor visit propensity, slowing gait, health status and age – insurers will be sure that somebody makes big predictive use of that data to help them avert some very-avoidable and staggering cost.