This month’s Health Care Trailblazer, David Lindeman, PhD, is an influential leader in the field of aging and technology. In recent years, he has focused on help to speed the adoption of mobile technologies. New devices and apps are transforming health care — not only by supporting transitional care and reducing readmissions — but enabling patients to remain in their own homes even while dealing with difficult to manage chronic conditions. Recently, we caught up with Dr. Lindeman, who is based in the San Francisco Bay Area.
What are your current areas of focus and activity?
We’re focusing on technologies around telehealth, sensors and services, and gaming that can improve the wellbeing of older adults, as well as support the family caregivers and providers that work with them.
How do you define mobile health and what kind of technologies support care transitions?
Mobile health and e-health are part of a very broad set of information technologies or connected health technologies that really support healthcare in general. Specifically, in care transitions, we see a whole range of these technologies from Smartphone apps, to remote patient monitoring devices, to texting, to connecting with electronic health records that all support care transitions for individuals moving from acute care settings to community-based or home care settings.
What are some of the specific types of devices and functions that these can monitor?
Different diseases require different indicators of health status monitoring, ranging from blood sugar level, to respiration, to heart function, to ambulation. All of these vital signs can be tracked and measured by devices that are worn and which measure indicators directly or by having patients enter data through a remote device such as a mobile phone. The information is provided to family members and/or patients to help them understand what they should be doing to manage their health. The data can also be transmitted directly to providers or to electronic health records to provide information to a patient’s clinician.
On that note, please comment on the biggest challenges for seniors or persons with chronic conditions that make transitioning from an acute care setting to another care environment or home.
The key issue we see is the challenge facing older adults to be personally engaged in the care transition process and the need for self activation, that is to truly be part of the decision making process for their own care. But the challenges in care transition extend beyond personal engagement to the need to improve communications with family caregivers. And, another challenge is coordinating all the parties who are trying to make the best possible decisions for care transitions and, ultimately, when needed, appropriate placement.
Traditional modes of care have not provided much support for transitions, but today new models of care, new technologies, and payer expectations and incentives are demanding it.
Right. Change is being driven not only by insurers, hospitals and health systems, and physicians, but also by the preferences of patients who want to be in a less acute setting. There is a new face to healthcare and healthcare financing, primarily driven by the Affordable Care Act as well as the quality-driven imperative to move patients from acute care settings or hospitals into appropriate settings where they can receive care at a more appropriate level.
What do hospitals need to do to adopt more widely and effectively use some of the technologies you’ve referenced?
Hospitals need to both know their care transition process and information systems in order to identify and move toward more patient-centered care and better coordination with non-acute settings and community caregivers. Information available at the right time, in the right hands, and at the right place is essential to effective care transition and achieving greater independence. Technology is the means for getting essential information to all the parties that are involved in care transitions in the most efficient way possible.
Is there a particular gap or barrier at the top of your list that providers must tackle when it comes to working with post acute care providers or settings?
A key barrier for providers continues to be the lack of timely, accessible information about different care settings and specific providers’ availability and characteristics. Historically, providers and community agencies have worked in silos, creating communication and information barriers to a seamless transition.
What has the Center for Technology and Aging done to advance adoption and use of e-health technologies?
We’ve supported technology-enabled pilot projects in different healthcare settings — including hospitals and health systems, aging services, home and community-based care programs, and residential programs — to identify best practices and ways to scale transition programs. We’ve published online a number of tools that can help providers more easily design technology-enabled solutions to dramatically improve chronic disease management (available at http://toolkit.techandaging.org).
Could you highlight the benefits for a patient, a family, or providers if e-health technologies are used appropriately? What are the top line benefits?
I think the majority of benefits of e-health technologies are the same for all stakeholders. First and foremost, e-health can lead to better care and better outcomes for patients. Second, e-health improves communication among everyone in the care transition process, allowing people to not only understand what needs to be done, but how they can do it better. Third, e-health is empowering. It gives both family members and providers more control over the process. . Finally, of course, e-health technologies can make care processes more efficient, saving funding for both families and society.
If you had a magic wand and could change one thing, what comes to mind?
The ideal would be that technologies would seamlessly link patient information and data so that at every step it could be used as fast as possible by providers, family members, and patients to improve care and smooth care transitions. Technology interoperability will ultimately be one of the most effective means of achieving improved care and transition outcomes.
About David Lindeman, PHD:
David Lindeman, PhD, is Co-Director of Health Care at the Center for Information Technology Research in the Interests of Society (CITRIS) at the University of California and Director of The Center for Technology and Aging (CTA), a joint effort of CITRIS and the Public Health Institute. Since 2010 CTA has worked with health care providers, aging service organizations, payers, foundations and technology companies to enable them to accelerate the deployment of proven technologies.
Dr. Lindeman has worked in the field of aging and long-term care for 30 years as a health services researcher and administrator. Prior to joining the Center for Technology and Aging, he was the founder and director of the Mather LifeWays Institute on Aging in Evanston, IL. Previously, he held positions as Associate Professor of Health Policy at the Rush Institute for Healthy Aging, Rush University Medical Center and Co-Director of the University of California, Davis Alzheimer’s Disease Center. Dr. Lindeman has been a principal investigator on numerous aging related studies. He received his PhD and MSW in social welfare, health services research, and gerontology from the University of California, Berkeley, and his BA from the State University of New York, Binghamton.
About the Author:
Daniel Danzig is a principal at the HealthTech Communications Group (www.healthtechcg.com) and has been supporting the strategic communication needs of health care organizations for more than 20 years.