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Healthcare has too much tech focus, too little benefit to seniors

It’s a new era – patient engagement – but does that include seniors? According to a recent health journal article, welcome to the era of patient engagement. What’s that?  “Empowering patients to actively process information, decide how that information fits into their lives, and act on those decisions is a key driver to improving care and reducing costs.” Like many of the heavily-invested Health IT improvements over the years, patient engagement strategies offer the industry a feel-good approach to preaching to and reaching the converted – those tech-enabled individuals with a fetish for looking stuff up and tracking it (see Google Health). Ah, but those with the least access to technology may need the most engagement -- they're not likely to peer at their patient portals. At last Pew count only 13% of the 65+ even looked online for information as a diagnostic tool. And fewer than half of those followed up with a medical professional based on what they found.

But there is a feeding frenzy for investment in the young and healthy.  Continuing along the lines of preaching to the converted, the lemming mentality of investors sent $1 billion in just the first half of the year chasing prospective returns in health tech – with the number 2 sector (after practice management) being – you guessed it -- patient engagement. Wish them luck – patients are not, apparently, too engaged with their own health, never mind the health tech that represents today's fuzzy definition of patient engagement. Fuzzy or not, of course there is now a measurement index to evaluate hospitals in California on their progress in providing this engagement. Key to success? You guessed it -- "electronic access to patient health records, but also provide resources for ongoing disease management support, including mobile, tablet and desktop tools." Sigh, see Google Health-- and did I mention that only 18% of the 65+ have tablets or smart phones?

Medicare – another form of patient engagement -- comes too late. Health care costs for seniors dominate health care expenditures – 37% of health care spending in 2010 – despite being only 13% of the population. So to better control those costs, CMS added a penalty to hospitals for serving seniors too well – that is, readmitting them. Now hospitals are spending millions of dollars to keep seniors from being readmitted to the hospital – committing their own staff (versus lower cost home health care and companion care organizations) to making follow-up appointments, arranging transportation, and calling to see how they’re doing. And naturally, consultants have leapt in to offer guidance on how best to avoid re-admissions and their penalties projected at $300 million in 2013. So far by one measure, re-admissions are down 18% -- ah, but but outpatient observation status (not counted) is up. Want to bet that total cost has not shrunk? 

Comments

hi Laurie,
Thanks for this post. Am right with you, wishing that the movement for patient engagement would better accommodate the needs of older adults and their families.

I think more and more seniors will have smartphones over the next 5 years; remains to be seen how user-friendly the apps and tech will be.

You have probably already seen it, but Pew recently release a report on caregivers and they are very involved in digital health and online activities, often on behalf of an older person.
http://www.pewinternet.org/Reports/2013/Family-Caregivers.aspx

I am 75 years old and, obviously, tech savvy. My only grandchild is 30 - and not apt to reach the age of 75. From what I'm seeing, online, her generation's life expectancy is less than my generation's. Please don't fret over us oldsters. Too much of the healthcare dollar is spent on the last few years of life. Let something be done to improve the lot of the youngsters.

I spoke yesterday to a small group of home healthcare providers about "Moore's Law and The Future of Healthcare," where I come at that future from a different perspective.(http://www.mhealthtalk.com/2013/07/moores-law-and-the-future-of-healthcare/)

They all shared a concern for not having enough time for the human touch, and we talked about reasons for that, including our for-profit healthcare system that keeps patients as paying customer by treating symptoms and being compensated for each visit, procedure, test, and prescription. We talked about technology, how it helped get us into the situation we're in now and how it might help get us out. And we talked about the pending doctor shortage as the tsunami of boomers retire and how tech can help, with telehealth, remote sensor monitoring, cloud computing, big data analytics, personalized medicine, and more.

As you can tell, I disagree that healthcare has too much tech focus. My issue is that practitioners, public policy and regulation can't keep up.

Actually my point, which could have been made more clearly, is that the investment community is very focused on tech, but the areas they focus on will not be particularly helpful to seniors -- who consume the largest share of health care spending.

Hospitals could first of all look at the obvious - the way their final paperwork to the patient is done. During the first hour of the entry process, it seems that a nurse comes in at every different stage to ask the patient's medication list - and dutifully enters it into the computer. Why then when the patient leaves and is given their list of medications is it so often wrong? So often the paper work will indicate to continue taking the medications they were taking when they entered the hospital - they are listed, and inevitably they are out-dated and wrong. Where does it go wrong? Do the over-worked nurses fail to "SAVE" their entries in the computer system? Far too often the elderly patient goes home, looks over the paper work and is totally confused. So the hospitals need to start there.

Next, the wording needs to be made simpler on the forms when the patient leaves. Too often the wording is vague and not specific enough to the patient's actual diagnosis. These simple facts could be a basis for improving care of the elderly at hospitals. Start at the beginning!

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