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If we wait for the healthcare industry to monitor our health, we'll just get older

With my ombudsman hat on yesterday, 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 its hand-written status observations, penciled medication tracking dosage X's and yellowed-out discontinued drugs. We saw the 24-hour log used by the aides, in which they noted observations in long-hand -- 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 up to the parent company.

In contrast, today I watched the 2004 CAST Imagine the Future of Aging video. 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 healthcare into a tech-enabled partnership between patient and physician that incorporates 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, or home-care agencies. Over the next 10 years, through public programs and partnership with insurers, a national Internet for healthcare will transform prevention, healthcare delivery, and ultimately collapse distance between caregivers, providers, and seniors.

So it's now 2008. We have 6 years to go to achieve that vision:

  • Let's get realistic about tolerance levels of seniors to participate. AARP Healthy@Home told us that that other than PERS devices (66% of those 75-84 expressed willingness to use), fewer than 50 percent of seniors are willing to use (if they existed) telephone-based monitoring, TV-based monitoring, electronic pillboxes, Internet monitoring with provider communication or electronic pillboxes with provider communication. And as for the Personal Health Record, one is in use today for just 11 percent of Americans.


  • Let's get realistic about use of technology by providers. 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% of all doctors have functioning electronic medical record systems in their office -- 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 electronic in any direction with seniors or their families.


  • Now -- let's take a look at what a consumer can buy now? So assuming a paper-intensive doc (or many docs), 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 systems, that means finding a home security vendor. with an optional Personal Emergency Response offering (most of them are headed there) -- like ADT, uControl, and Visonic -- that links to a list of responders, including's link to EMTs, 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.


  • We must manage care ourselves -- with online assists. We know that many baby-boomers have aging parents -- for example, 50% of 60-year-olds have a living parent, according to the CAST video. To improve the possibility that those seniors are getting good care, boomers should sign up for a personal health record for them. Just to establish a good list of conditions, medications, and drug allergies, this would be worth it. Unless you or your family member has a preference 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 or a relative has a chronic condition, first fill it out, then ask the doctor if they will use it. Teach the senior to use a PC so that they can search the 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 if the doctor takes e-mail questions.





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