The State of Technology in Aging Services in Pennsylvania · 2016-07-22 · 5.1.3 Keystone Home Health & Hospice ... Pennsylvania homecare providers are regarded as national leaders

The State of Technology in Aging Services in Pennsylvania

Primary Author: Scott Peifer,Center for Aging Services Technologies (CAST)American Association of Homes and Services for the Aging (AAHSA)

in partnership withPennsylvania Association of Nonprofit Homes for the Aging (PANPHA)

October 2008

A program of theAmerican Association of Homesand Services for the Aging (AAHSA)

2519 Connecticut Ave., NWWashington, DC 20008-1520Phone (202) 508-9416Fax (202) 220-0032

Web site: www.agingtech.org

© Copyright 2008 AAHSA


Table of ConTenTs Page

1. Introduction .............................................................................................................................................2

2. Executive Summary .................................................................................................................................3

3. Current Technology Adoption Rates in Aging Services .......................................................................4

4. Policy & Legislative Context ...................................................................................................................7

4.1 ExecutiveBranchInitiatives................................................................................................................ 7

4.1.1 PennsylvaniaHealthInformationExchange(PHIX)............................................................. 8

4.1.2 MedicaidAgingWaiverTelecareReimbursementProgram.................................................. 8

4.1.3 Long-TermLivingTrainingInstituteandVideoconferenceInitiative................................ 11

4.1.4 DepartmentofAgingVirtualCareManagementPilot......................................................... 11

4.2PendingLegislation............................................................................................................................ 13

5. Early Adopters of Aging Services Technologies (ASTs) ......................................................................16

5.1AgingServiceProviders..................................................................................................................... 16

5.1.1 ActsRetirementCommunities............................................................................................... 16

5.1.2 DiakonLutheranMinistries.................................................................................................... 17

5.1.3 KeystoneHomeHealth&Hospice........................................................................................ 21

5.1.4 NewCourtlandElderServices................................................................................................. 24

5.1.5 VNAofWesternPennsylvania............................................................................................... 30

5.1.6 ProviderRecordSystemsIntegration:PHI,PhoebeMinistries,WesleyEnhancedLiving.... 33

5.2PublicAgingServicesPrograms........................................................................................................ 35

5.2.1 AlleghenyCountyAreaAgencyonAging.............................................................................. 35

5.2.2 Bradford,Sullivan,SusquehannaandTiogaAreaAgencyonAging................................... 38

5.2.3 ClearfieldCountyAreaAgencyonAging.............................................................................. 39

6. University Aging Services Technology Research Initiatives and Provider Partnerships .................40

6.1CarnegieMellonandUniversityofPittsburgh................................................................................ 40

6.2UniversityofPennsylvania................................................................................................................ 45

7. Opportunities and Resources in Pennsylvania ...................................................................................48

8. Call for Action ........................................................................................................................................50

8.1Providers............................................................................................................................................. 51

8.2GovernmentandPrivatePayers........................................................................................................ 51

8.3TechnologyCompanies..................................................................................................................... 52

9. Conclusion .............................................................................................................................................53

Center for Aging Services Technologies (CAST)

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1. InTroduCTIon

Thepurposeofthispaperistodescribethecurrentstateofaffairsoftechnologyinagingservices

andrelatedpolicyintheCommonwealthofPennsylvania,particularlywithregardtothe

advancementoftechnology-enabledservicesinlong-termcareandindividualhomesettings.

Thispaperseekstohighlightinnovativepracticesofstategovernment,agingservicesorganizations,

universitiesandothersandidentifyopportunitiestofurtheradvancetheuseofagingservices

technologiesinPennsylvania.Itservesasafoundationforacalltoactionforproviders,technology

companies,andgovernmentandprivatepayerstoadvancetechnologydevelopmentandapplication.

Thispaperispartofaseriesofpapersthatfocusonindividualstates’progresstodateandpotential

opportunitiesforadvancementintheuseofagingservicestechnologies.Itisalsointendedthatthiseffort

willserveasapracticeandadvocacyguideforuseinstatesnationwide.

ThispaperwascompletedinpartnershipwithPANPHAandbenefitedfromtheinsightsand

experienceofitsmembersandstaff.

ItalsobenefitedgreatlyfromtheassistanceofthePennsylvaniaHomecareAssociation,the

PennsylvaniaAssociationofAreaAgenciesonAgingandseveralAreaAgenciesthroughoutthestate.The

contributionsofCASTmembersandallthoseinterviewedwereinvaluableandaregreatlyappreciated.

defInITIons

TheNationalAllianceforHealthInformationTechnology,whichmanagedafederallyfundedinitiative

toseekindustryconsensusontheuseanddefinitionsofspecificinformationtechnologyterms,has

publishedthefollowingdefinitionswhichmaybereferredtointhispaper.

Electronic Health Record: Anelectronicrecordofhealth-relatedinformationonanindividualthat

conformstonationallyrecognizedinteroperabilitystandardsandthatcanbecreated,managedand

consultedbyauthorizedcliniciansandstaffacrossmorethanonehealthcareorganization.

Electronic Medical Record:Anelectronicrecordofhealth-relatedinformationonanindividualthatcan

becreated,gathered,managedandconsultedbyauthorizedcliniciansandstaffwithinonehealthcare

organization.

Health Information Exchange:Theelectronicmovementofhealth-relatedinformationamong

organizationsaccordingtonationallyrecognizedstandards.

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The State of Technology in Aging Services in California

Health Information Organization:Anorganizationthatoverseesandgovernstheexchangeofhealth-

relatedinformationamongorganizationsaccordingtonationallyrecognizedstandards.

Personal Health Record: Anelectronicrecordofhealth-relatedinformationonanindividualthat

conformstonationallyrecognizedinteroperabilitystandardsandthatcanbedrawnfrommultiple

sourceswhilebeingmanaged,sharedandcontrolledbytheindividual.

Regional Health Information Organization: Ahealthinformationorganizationthatbringstogether

healthcarestakeholderswithinadefinedgeographicareaandgovernshealthinformationexchange

amongthemforthepurposeofimprovinghealthandcareinthatcommunity.

Inaddition,thefollowingaredefinitionsofkeytermsusedinthispaper:

Aging services technologies (ASTs): Technologiesthatcanbeusedbyolderadults,caregivers(both

professionalandinformal),healthcareprovidersandagingservicesproviderstoimprovethequalityof

care,enhancethecaregivers’experience,efficienciesandcost-effectiveness.Thesetechnologiesbroadly

includeassistive,telemonitoring,telehealth,telemedicine,information,andcommunicationtechnologies

thatintendtoimprovetheagingorcareexperience.Agingservicestechnologiescanbecategorizedinto

threebroadareasbasedontherelationshipthesetechnologiesaddressbetweentheolderadultandhis/

herenvironment(safety),oneself(physicalandmentalhealth/wellbeing),andothers(socialinteraction).

Formoreinformationonspecifictypesofagingservicestechnologiesseewww.agingtech.org.

Health information technology (HIT):Hardwareandsoftwareusedtostore,retrieve,shareanduse

healthinformationtotreatpatientseffectively.

2. exeCuTIve summary

TheCenterforAgingServicesTechnologies(CAST)developedthispapertodescribethecurrent

stateofaffairsoftechnologyinagingservicesandrelatedpolicyintheCommonwealthofPennsylvania,

particularlywithregardtoadvancingtechnology-enabledservicesinlong-termcaresettings,including

thehomesofindividualsinthecommunity.Italsoservesasafoundationforacalltoactionfor

providers,technologycompanies,andgovernmentandprivatepayerstofurtheradvancetechnology

developmentandapplication.

Currentratesofagingservicestechnologyadoption,primarilybyhomecareorganizationsbased

onexistingsurveyresearch,werereviewedtoprovideanoverallbaseline.Severalexamplesofearly

adoptersarediscussedindetail.Theinvestmentsofbothprivatenon-profitprovidersandpublichome

andcommunitybasedservicesproviderswerehighlighted.Examplesrangefromwirelesspointofcare


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systemstocognitivefitness,totelehealthmonitoringandvideoconferencingforsocializationandcare

coordination.Theseearlyachievementscanserveasapointofreferenceforotherprovidersinthefield,

aswellasafoundationtoevaluateandimprovetheapplicationofspecificemergingtechnologies.

ThepolicyandlegislativecontextforHITandagingservicestechnologiesinPennsylvaniais

presentedtocapturesubstantialpolicyadvancestodate,pendinglegislationtoaddressdeficienciesin

currentpractice,andremaininggaps.GovernorEdRendell’sadministrationhasbegunseveralmajor

agingservicesinitiativesoverthepastfewyearsthataretobecommended,includingaMedicaid

reimbursementprogramforagingservicestechnologiesthatisamongtheveryfirstandmost

comprehensiveinthenation.Theseeffortsrequirecontinuedfocusanddevelopment.

Inaddition,animportantcomponentofthispaperisareviewofrecentandcurrenteffortsbyresearch

universities.CASTbelievesthatrobustresearchinpartnershipwithagingservicesprovidersina“living

testbed”approachiscrucialtothedevelopment,validationandevaluationoftechnology,andhencethe

effectiveproliferationofthesetechnologies.Followingthisreviewisasamplingofopportunitiesand

resourcesforproviders,technologycompaniesandconsumers.

Finally,acalltoactionisgiventoproviders,governmentandprivatepayers,andtechnology

companies.Pennsylvaniaissignificantlyfurtheradvancedinagingservicesinitiativesthanmanystates.

Thereareabundantopportunitiestobuilduponexistingeffortsandfurthersuccesseswillrequireall

partiesinvolvedtotakeaction.CASThopestohelpbringaboutfurtheradvancements.

3. CurrenT TeChnology adoPTIon raTes In agIng servICes

PresidentBushin2004issuedanExecutiveOrdertoestablishthegoalofnationwideadoptionof

interoperablehealthinformationtechnologyinfrastructure,includingelectronichealthrecordsystems

(EHRs),by2014.HecreatedthepositionofNationalHealthInformationTechnologyCoordinatorin

theU.S.DepartmentofHealthandHumanServicestoleadthecountryinachievingthisgoal.Ifthat

goaliseventuallytranslatedintofirmmandates,allhealthfacilities,includingnursingfacilities,could

berequiredtoimplementelectronicrecordsystemsbythatdate.PennsylvaniaGovernorEdRendellin

MarchofthisyearsignedanexecutiveordertocreatethePennsylvaniaHealthInformationExchange,

whichisintendedtodeveloptheinformationtechnologyarchitecturenecessarytosupportinteroperable

electronichealthrecordsandelectronicprescribingstatewideby2012(seesection4.1.5).

WiththeexceptionofmandatedMinimumDataSet(MDS)electronicreportingandelectronic

billingbyMedicare-andMedicaid-certifiednursinghomes,adoptionratesofelectronichealthrecords

amongagingservicesprovidersinPennsylvaniaistodatelargelyunexamined.Currentresearchinthis


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areawillprovidegreaterclarity.Adoptionratesoftechnologiesotherthanelectronichealthrecordsby

Pennsylvaniaprovidersiswelldocumentedforhomecareproviders,showingextensiveuseofmultiple

technologies(seebelow),butnorecentsurveyshavebeenconductedofotheragingservicesprovider’s

adoptionoftechnology.

Furtherresearchisneededtodevelopabaselineoftechnologyadoptionbythefullrangeofaging

servicesproviders.Inadditiontohomecare,settingsthatshouldbescientificallysurveyedinclude

nursinghomes,assistedliving,independentliving,andaffordableseniorhousing.Sectionfiveofthis

paperhighlightsseveralexamplesofagingservicesprovidersemployingvarioustechnologies,including

EHR-likesystems,andoneexampleofalong-termcareproviderparticipatinginaregionalhealth

informationexchangetodeveloparobustEHRsystem.

Pennsylvania Home Care Providers’ Use of In-home Technologies

Pennsylvaniahomecareprovidersareregardedasnationalleadersinusingtechnologyinconsumers’

homesasdemonstratedinresearchfindingsbelow.Thisisdue,inpart,tothreeCongressional

AppropriationsawardedinrecentyearstothePennsylvaniaHomecareAssociation(PHA),totaling

$800,000,whichprovidedagencieswithseedfundingtopurchasetelehealthequipment.PHAhasbeena

strongadvocateofincreasedadoptionofagingservicestechnologiesandwasinstrumentalindeveloping

thePennsylvaniaMedicaidTeleCarereimbursementpolicy(seesection4.1.6).

Datafroma2006surveyconducted

byresearchersattheUniversityof

PittsburghDepartmentofHealthPolicy

andManagementonbehalfofPHAshows

extensiveuseofin-hometechnologiesby

Pennsylvaniahomecareproviderstoalargely

olderadultpopulation.1Surveysweresent

toallhomecareprovidersinPennsylvania,

includingMedicare-certifiedhomehealth

agencies(HHAs),privatedutyagencies

andhospiceproviders.Atotalof167completedquestionnaireswerereceivedfromHHAs,67from

hospiceagencies,and121fromprivatedutyagencies,resultinginanoverallresponserateof53percent.

ThesampleisrepresentativeofallhomecareprovidesinPennsylvania.In-hometechnologyadoption

ratesexaminedinthesurveywerefortelehealthremotevitalsignsmonitoring,electronicmedication

� Pennsylvania Home Care Association and University of Pittsburgh, N. Castle and J. Engberg, “The State of the Homecare Industry in Pennsylvania: Bringing Care Home”, 2007

Use of Telehealth Vitals Monitoring

05

10152025303540

HHAs Private Duty Hospice

Provider Type

Perc

ent

Currently UseConsidering


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dispensers,activitysensors,andpersonalemergencyresponsesystems(PERS),aswellaselectroniccare

documentationandschedulingsoftware.

Whenaskedabouttheusetelehealthforremotevitalsignsmonitoring,38percentofHHAs,24percent

ofhospiceand17percentofprivatedutynursesindicatedtheyareusingremotevitalsignsmonitoringin

deliveringcare.Anestimated6,336certifiedhomehealthagencyclientsinPennsylvaniauseremotevital

signsmonitoringtechnologies.Another19percentofcertifiedhomehealthagencies,fourpercentof

hospiceagencies,andfivepercentofprivatedutynurseagenciesindicatedtheywereactivelyconsidering

usingremotevitalsignsmonitoring.

Electronicmedicationdispensersareusedby19

percentofHHAs,12percentofprivatedutynurse

agenciesandfivepercentofhospiceproviders.

“Smarthouse”oractivitysensortechnologiesare

usedbysevenpercent,fourpercentandtwopercent

ofagencies,respectively.Personalemergency

responsesystems(PERS)havehigherutilization

ratesat17percentofHHAs,29percentofprivate

dutyagenciesand32percentofhospiceagencies.

Interestingly,manymorehospiceproviders

useelectroniccaredocumentation(71percent)thandoHHAs(36percent)andprivatedutyagencies

(fourpercent).However,adoptionratesoftelephonysystems(i.e.,timeandattendanceverification)is

virtuallyevenacrosshomecareprovidertypesat23percentofHHAs,21percentofprivatedutyand24

percentofhospiceagencies.

Itshouldbenotedthatprivatedutyhomecare

agenciesandregistriesmostlyprovidenon-medical

servicessuchashelpwithactivitiesofdailyliving

(ADLs),includingassistancewithbathing,grooming,

transportationandmealpreparation.Recently,

Pennsylvaniapassedalawrequiringtheseagencies

andregistriestobelicensed.Also,whilemosthospice

agenciesprovideend-of-lifecaretoindividualsin

privatehomes,hospicecarealsoisprovidedinnursing

homes,hospicehousesandinpatienthospicefacilities.

Use of Remote Technologies

05

101520253035

HHAs PrivateDuty

Hospice

Provider Type

Perc

ent Medication Dispenser

Activity SensorsPERS

Use of Staff Efficiency Systems

01020304050607080

HHAs Private Duty Hospice

Provider Type

Perc

ent

Electronic Care DocTelephony


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4. PolICy and legIslaTIve ConTexT

ThisoverviewofpolicyandlegislativeactivityrelatedtoHITandagingservicestechnologiesprovides

acriticalcontextfortheproliferationofthesetechnologiesinPennsylvania.Significantexecutivebranch

initiativeshavebeenimplementedandmajorlegislationhasbeenproposedinrecentyears.

4.1 Governor’s Policy Initiatives

GovernorRendellandhisAdministrationhavebeenactivelypromotingeffectiveutilizationof

technologyinthecontextofhealthcareandlong-termcare(or“Long-termLiving”)reformin

Pennsylvania.WhenGovernorRendellfirsttookofficein2003,heestablishedtheGovernor’s

OfficeofHealthCareReform(GOHCR)byexecutiveorderwiththegoalofimprovingaccessibility,

affordabilityandqualityofhealthandlong-termlivingservicesinPennsylvania.Hisfirstpriority

fortheOfficewascreatingmeaningfullong-termcarereform.Severalreforminitiativesensued,

including“rebalancing”ofstatetraditionalandcommunity-basedlong-termcareresources.

Pennsylvaniaismakingasignificantfinancialinvestmentinhomeandcommunitybasedservices:

between2002and2007,theamountofmoneyspentontheseservicesmorethandoubled.The

numberofolderPennsylvaniansserved

athomegrewfrom12,000in2002-03to

morethan18,300*inFY2006-07(*number

representsconsumersage60andolderinfour

ofthestate’sMedicaidwaivers).

Asagovernmentalmanifestationofthis

reformagenda,theOfficeofLong-termLiving

(OLTL)wascreated.Itiscomprisedofstaff

fromtwostatedepartments–theDepartment

ofPublicWelfare,thestate’sMedicaidagency,

andtheDepartmentofAging.Consistentwithitsgoalstoremovebarrierstoprovidingcarein

homesandcommunitiesandtoserveasmanyconsumersaspossiblewithhigh-qualitycareand

services,theOLTLhaslaunchedtworecentmajortechnologyinitiativesforpubliclong-termliving

providers(see4.1.6and4.1.7below).Additionally,anewPennsylvanialong-termlivingwebsite

wasrecentlylaunched(www.Ltlinpa.com)andwhileitisnotspecifictotechnology,technologywill

playanimportantroleinfutureOLTLefforts.TheOfficeispartneringwiththeHousingFinance

Authoritytocoordinate,expandandimproveusinghomemodifications,includingpilotingsmart

homeandothertechnologies.

Number of Older Pennsylvanians Served at Home*

02,0004,0006,0008,000

10,00012,00014,00016,00018,00020,000

2002-03 2003-04 2004-05 2005-06 2006-07

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EffectiveDecember1,2007,theDepartmentofPublicWelfaremodifiedtheMedicalAssistance

(MA)ProgrambyaddingatelehealthtechnologyprocedurecodeandtotheMAProgramFee

Schedule.Theproceduralchangeisforconsultationsrelatedtohigh-riskobstetricalcareand

psychopharmacologyperformedusingtelecommunicationtechnology,includingvideoconferencing

andtelephone.TheDepartmentofAginghasembarkeduponapilotprojectusingtechnologyto

delivercaremanagementinaruralcounty(see4.1.8below).

4.1.1 Pennsylvania Health Information Exchange (PHIX)

OnMarch27,2008GovernorRendellbyexecutiveordercreatedthePennsylvaniaHealth

InformationExchange,or“PHIX”–toprovidetheinformationtechnologyarchitectureto

supportstatewideinteroperableehlectronichealthrecordsbysharingdatathatiscapturedatthe

pointofcareinaphysician’sofficeorhospital.ThePHIXwilleventuallyallowmostdoctors’

offices,hospitals,laboratoriesandpharmaciestoshareinformation

withvarioushealthcareprovidersandotherauthorizedcare

providers,includinglong-termcareproviderssuchasnursing

homes,assistedlivingandhomecareprovidersfortreatment

purposesby2012.TheinitiativealsowillpromoteElectronic

MedicalRecords(EMRs)andElectronicPrescribing(eRx)by

workingwithlocalcollaboratives,leveragingfederalactions,and

findingwaystoprovideseedmoneytoregionalefforts.Achronic

careinitiativeofPHIXistoprovidephysicianswithafreeweb-

basedpatientregistryandprovideapooled-claimsdatabaseformeasuringperformance.

ThePHIXprogramreceived$4,483,000inthe2008/09statebudget.Thesefundswillallowthe

programtohirestaffandsecureaconnectivitypartner.TheGovernor’sOfficeofHealthCare

Reform(GOHCR)willoverseethePHIXinitiative.

4.1.2 Medicaid Aging Waiver TeleCare Reimbursement Program

Pennsylvaniaisoneofthefirststatesinthenationtoprovidereimbursementforhome

“TeleCare”throughaMedicaidwaiverforolderadultsages60andolderunderapprovalfrom

theCentersforMedicareandMedicaidServices(CMS).OnSeptember1,2007theOfficeof

Long-termLivingbeganademonstrationTeleCarereimbursementpolicytocoverarangeof

servicesprovidedbyhomehealth,durablemedicalequipmentproviders,pharmaciesorhospitals

throughcontractswithlocalcountyAreaAgenciesonAging(AAAs).

AnewMedicaidagingwaiver(“PDA60+Waiver”)beganinJuly2008thatincludesplace-

holderlanguageforapermanentTeleCarereimbursementprogram.ThedraftTeleCarepolicy

wasrevisedandsubmittedforapprovaltoCMSforfinalinclusioninthenewfive-yearwaiver

program.Finalprovisionsareexpectedtobesubstantiallysimilartothedraftpolicy,with

improvementsinclarityofprotocolsandrespectiveresponsibilitiesforAAAsandproviders.

Underthedraftpolicy,reimbursementforTeleCarenotonlycoversuseofequipmentthat

performsremotevitalsignmonitoring(telehealth)

butalsocoverstelemonitoringwithactivitysensors

bywhichafamilymembercanaccessawebsite

anddetermineactivitystatussuchaswhenthe

consumerawakesinthemorning,thefrequency

ofrefrigeratoropenings,howmanytimesthe

bathroomisused,ifmedicationsweretakenand

whetheraconsumersuffersapossiblefall.State

officialsexpecttheTeleCareprogramtohelpwith

aworkforceshortagebyincreasingthenumberofpersonsthatcanbeservedbyhomecarestaff,

whileenablingstateMedicaidsavingsbyallowingmoreconsumerstoremainsafelyintheir

homesanddelaymovestomoreexpensiveskillednursingcare.Whileitisoftennotfeasibleto

provideanin-homeaide24hoursaday,thetechnologiescanmonitorconsumers’wellbeing24

hoursaday,sevendaysaweek.

TeleCare Demonstration Reimbursement Policy Requirements:

• Demonstratedmedicalneed(physician’sorder)fortheservicesandevidencethatservicesare

notcoveredunderMedicare,StatePlanorotherthirdpartyresources

• Participant’shomemustbeevaluatedforsuitabilityforthetechnologyapplication

• Participantsmust:

– Meetnursingfacilityclinicallyeligible(NFCE)determination

– Meetatleastthreeofthefollowingneedscriteria:

• Three(3)ormorehospitalizationsinthepastyear

• Frequent,recurrent,repeatedorregularuseoftheemergencyroom

• Pooradherencewithphysicianordersormedications

• Formalorinformalsupportsystemsarelimitedorabsent

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The State of Technology in Aging Services in California

PA TeleCare Medicaid Waiver Demonstration Reimbursement Rates

Health Status Measuring & Monitoring: $10/ day Activity & Sensor Monitoring: $200/ install

$79.95/ mo. Medication Dispensing & Monitoring: $50/ mo. PERS: $30/ mo.


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• Documentedhistoryoffallswithinthelastsixmonthsthatresultedinaninjurythat

requiredmedicaloremergencycare

• Livesaloneorisathomealoneforextendedperiodsoftimeorcareaccesschallenges

exist(forexample,RNshortage,ruralaccessissues,etc.)

• Becognitivelyabletooperateequipmentifneededorhaveacaregiveroperate

equipment.

Thepolicychangeisexpectedtospuranincreasingnumberofagenciestoadoptthetechnology.

BecauseadministrationofthepolicyrequiresAAAstodevelopcontractsforTeleCareservices

intheircounty(s),ramp-upoftheprogramwilllikely

takeacoupleofyears.AAAsneedtocollectivelybecome

morefamiliarwiththeparametersoftheprogramand

developstandardsofpracticeforenteringintocontracts

within-homeprovidersandtechnologycompanies.Itwill

alsorequirerevisingexistingmodelsofcaremanagement

anddevelopingnewwaysofinteractingwithproviders

regardingtrackingthewellbeingofolderadultsreceiving

careathomeundertheMedicaidwaiver.TheOfficeofLong-termLivingplanstocomparepre

andpost-TeleCareuseandclientassessmentdatatorevealanyrelevantcareoutcomes.

Early Demonstration of Value Fostered State Policy Change:

ThePennsylvaniaHomecareAssociation(PHA),representingthestate’svisitingnurse

associations,homehealthagencies,hospicesandprivatedutyagencieshaslongadvocatedforthe

advancementoftechnologytoimprovecareandefficiencyoflimitedhealthcaredollars.Through

testimonyatadvisoryandlegislativebodies,PHAcitednationalandlocalresearchfindingsto

makethevaluecaseforusingtechnologyandforstatereimbursement.Asdiscussedabove,PHA

alsocommissionedrecentresearchonthecurrentproliferationoftechnologyadoptionamong

homecareproviders.

InadditiontoPHA’sgroundwork,KeystoneHomeHealth&HospiceandtheLiving

IndependentlyGroupInc.,themakerofthe“QuietCare”remotemonitoringsystem(www.

quietcare.com),wereintegralinthedevelopmentofthePennsylvaniaTeleCarereimbursement

programbydemonstratingvalueoftelecaretechnologiesinlocalcaredeliverymodels.Thehome

healthproviderandthetechnologycompanypartneredtodemonstratetheuseofthistechnology

forcomparablestateclientpopulationsandtocultivateawarenessandpositiveregardamong

stateofficials.Theysuccessfullyshowedthepotentialtoimprovebestpracticesandmaximizethe

PA Telecare Medicaid Waiver Demonstration Use DataSeptember 1, 2007 to June 30, 2008

18 Counties Authorizing TeleCare Services105 Consumers Authorized to Receive TeleCare

Services

33 Providers of Service


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abilityforthosewithchronicconditionstostayathomeforaslongaspossible,whileminimizing

cost(seesection5.1.3forfurtherdetails).

Workgroup Approach Used to Craft TeleCare Policy

Afterstateofficialswereconvincedofthevalueofusingtelecaretechnologiesanditspotential

forcostefficiencieswiththestate’sburgeoningolderMedicaidpopulation,theDepartmentof

PublicWelfareandDepartmentofAging(whichtogetherformedanewOfficeofLong-Term

Living)convenedaworkgrouptodevelopvariouscomponentsofanewtelecareprogram

andcraftreimbursementpolicyforMedicaid60+Waiverconsumers.Representedonthe

workgroupwerehomecareproviders,AreaAgenciesonAging,seniorserviceproviders,andstaff

fromthedepartmentsofPublicWelfareandAging.Theworkgroup’smissionwasto:Develop

an infrastructure for a TeleCare program for older Pennsylvanians that helps them to remain

independent in the community.UponcompletionofthedraftTeleCarepolicydiscussedabove,

stateofficialsheldthreeregionaltrainingsessionsforAAAstaffandproviders.

4.1.3 Long-Term Living Training Institute and Videoconference Initiative

ThisyearthePennsylvaniaOfficeofLong-termLivingcreatedaLong-termLivingTraining

Instituteforthestate’saginganddisabilityserviceprovidernetworks.Atotalof$3millionwas

allocatedfortheefforttoincreasepreparationofthestate’sworkforcetocareforanincreasing

populationofolderanddisabledindividualswithongoingcareneeds.Approximately$1million

hasbeendesignatedforvideoconferencingequipmentforall52AAAsand25disabilityproviders

throughouttheCommonwealth.Itisintendedtoprovideubiquitouscapacitytoprovide

trainingandcommunicationsinallagenciesandbuildcriticalstaffskillswithoutburdening

agencieswithtravelcostsandlostworktime.Itispossiblethetwo-wayvideoequipmentcould

beusedforotherpurposes,suchasmulti-disciplinarycareteams,formoreefficientcomplex-

careplanning.

4.1.4 Department of Aging Virtual Care Management Pilot

ThePennsylvaniaDepartmentofAgingispiloting“PDAVirtual,”avirtualnetworkof

informationoutreachandtele-caremanagementservicestobettermeettheneedsof

Pennsylvania’sexpandingseniorpopulation.Thepilotwillbeconductedatfivelocationsina

verylargefour-countyruralareainwesternPennsylvania.ThepilotwillusetheFamilyVirtual

VisitstechnologybyAgeServeCommunications(www.familyvirtualvisits.com).

InthePDAVirtualmodel,virtualcenterswillbeestablishedinselectedSeniorCentersand

inselectedaffordableseniorhousing(i.e.,HUDSection202)communitiestolinkAAAstaff,

caremanagersandresourcesdirectlytoseniors.OlderadultswillaccessAAAcaremanagers


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remotely–yetface-to-face–fromtheirhousingcommunityoranear-bySeniorCenterinstead

ofhavingtotraveltoAAAofficesorhavecaremanagerstraveltomeetthem.Thepilotalsoaims

toempowerseniorswhoarenotcurrentlyutilizingpublicresourcesthatareavailabletothem.

Eliminationoftravelexpenseandtraveltimewillenablecaremanagerstoreachmoreseniors

thancurrentlypossiblebyreducing“windshieldtime,”withoutimpactingproviderincomesor

exceedingserviceexpensecapsforanyonesenior.Inaddition,morepersonalizedsessionsby

trainedpersonnelwillpotentiallyprovideolderadultswithahigherlevelofcaremanagementfor

thesamecaredollars.

ThePDAVirtualnetworktechnologycomponentsinclude:

1) ThePDAVirtualCenter:videoconferencingequipmentthatiscompletelyhands-freefor

seniors.

2) Webcam-enabledserviceproviderresourcescontractedbytheAAA’stodeliversenior

services,includingcasemanagement.

3) AdirectphonelinkfromthePDAVirtualCentertotheappropriateAAAofficeservicingthe

locations’seniors.Thiswillenableseniorstocallandscheduleservice.

4) Afaxmachinetotransmitdocumentsandauthorizationsignaturestoandfromthesenior’s

location.

ThevideolinkagewillbebetweentheAAAserviceprovidersandthePDAVirtualCenterlocation.

SomeprovidersmayinfactbeAAAstaff,whileotherswillberemotelylocated,contractedservice

agencies.Asenior’sphonecallrequestwillbeprocessed/triagedbytheAAAreceptiondeskto

anavailablevideo-enabledresourcepersonwhocanthendirect(video)dialintothePDAVirtual

Centerwheretheseniorislocated.Thisenablesaliveperson-to-personvideoconferenceto

addresstherequest.Featuresoftheprograminclude:

• Onecaremanagercanserveolderadultsinseverallocations,and/ortriagetospecialized

providerviavideoconference(mentalandbehavioralhealth,legalaid)

• Providescapacityfor“walk-in”AAAservicesatseniorcentersandincreasedutilizationof

centerprograms

• Follow-upconferencescanbeconductedbyappointmentwiththeresourcepersonas

needed,withoutneedingtoroutethroughthetriagephonelink

• HUDNeighborhoodNetworksfundingisavailableforvideoconferencetechnology

installationcostsandmonthlyfeeataffordableseniorhousingcommunities

• Freevideovisitswithseniors’families


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4.2 Pending Legislation

PendinglegislationinboththePennsylvaniaStateSenateandHousewouldenablesubstantial

advancementsinutilizingagingservicestechnologiesintheCommonwealth.Advocatesand

legislatorshaveinvestedsignificanttimeandenergytodevelopandconsiderthebillsdiscussed

below.However,nonecurrentlyhaveaclearpathtoenactmentthislegislativeyear.

SB 8 (Wonderling) Medical Safety Automation Program for EHRs

IntroducedbySenatorRobertWonderlingandsubsequentlyintroducedintheHouseby

RepresentativeMarkCohenasHB2564(printer’s#3415),SB8wouldestablishamedicalsafety

automationprogramandgrantsforregionalhealthinformationorganizations.Amedicalsafety

automationsystemisdefinedbythebillasaninteroperablesystemthatutilizeshealthinformation

technologytointegratehealthinformation,clinicalactivitiesanddatasharinginanyofthefollowing

areas:pharmacyorderingandtracking;laboratorytestingandresults;physicianordermanagement;

accessbyclinicians;accessbyconsumers;telemedicine;datasharingamonghealthcarefacilities,

physiciansandhealthinsurers;orothertransactionmonitoringorhealthinformationexchangethat

promotespatientsafetyandefficiencyindeliveringhealthcare.Grantsofupto$1millionwould

beprovidedtoregionalorganizationstopurchasethehealthinformationortelecommunications

technologynecessarytocreateaninteroperableandintegratedmedicalsafetyautomationsystem

andtocovertrainingphysiciansandpersonnelinusingthesystem.SB8iscurrentlypendinginits

firstcommitteeandissaidtobeassociatedwithconsiderationofphysicianmedicalliabilityfund

(“MCARE”)legislation.

AschairoftheSenateCommunicationsandTechnologyCommittee,SenatorWonderlingalso

hasformedthePennsylvaniaTechnologyinHealthcareWorkingGroup,whichbringstogether

stateleadersinacademia,technology,healthcareandgovernmenttofindwaysinwhichthe

Commonwealthcanbetterintegrateandpromotetechnologyinhealthcare.

SB 340 (Browne) Medicaid Rates for Telemedicine

IntroducedbySenatorPatrickBrowneandsubsequentlyintheHousebyRepresentativeMarkCohen

asHB2545(printer’s#3794),SB340wouldestablishthatanyratesestablishedbytheDepartmentof

PublicWelfarefortelemedicineservicestoMedicaidbeneficiariesshallbeequaltothoseforservices

providedin-person.ThebillhaspasseditsfirstpolicycommitteeandispendingbeforetheSenate

AppropriationsCommittee.

SB 1094 (Williams) – ePrescribing Requirement for Health Facilities

IntroducedbySenatorConnieWilliams,SB1094wouldrequireallhealthfacilities,includingskilled

nursingfacilitiesandhospiceproviders,todevelopafullimplementationplanwithin60daysto


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provideeasyandtimelyaccesstoane-prescribingsystemforusebyallmedicalstaffwhohave

prescriptionauthorityintheCommonwealth.Thesystemwouldneedtobeabletomonitorand

notifystaffofpotentiallyharmfuldruginteractions.ThebillalsowouldrequiretheStateBoard

ofMedicinetoestablishguidelinesforusinge-prescribingbyeveryphysicianthatchoosestowrite

prescriptionselectronically.SB1094wouldappropriate$25millioningrantstoassisthealthfacilities

inacquiringthesystems.Thegrantswouldbecappedatnomorethan50percentofthefacility’s

costsforthesystemandtheDepartmentofCommunityandEconomicDevelopmentwouldbe

requiredtoreviewthefiscalconditionofthehealthfacility.SB1094hasbeenreferredtocommittee

butisnotexpectedtobeacteduponthislegislativesession.

HB 1849 (Cohen) Requirement of Telemedicine/ Telehealth Coverage by Health Insurers

IntroducedbyRepresentativeMarkCohen,HB1849wouldrequireallhealthinsurersin

Pennsylvaniatoprovidecoveragefortelehealthifahealthcareprofessionalcertifiesthatcertain

conditionsaremet.Thebilldefinestelehealthastheremoteinteractionbetweenahealthcare

professionalandapatientthroughtheuseofvideocameraorcomputervideotransmission;an

electronichealthmonitoringdevice;oranothertelecommunicationsdevicethatdelivershealth

informationconcerningapatienttoahealthcareprofessional.Qualifyingconditionsincludethe

following(allmustbemet):

1) theuseoftelehealthisappropriateforthepatient;

2) thehealthcareprofessionalwillbeabletomaintainproperdirectexaminationofthepatient

orthatdirectexaminationofthepatientisnotnecessary;

3) andtheuseoftelehealthwillresultinlowerhealthcarecoststhanifitwerenotused.

HB1849ispendingbeforetheHouseInsuranceCommitteeandhasreceivedthemostpublicdebate

ofanyofthebillsabove.OnApril15,2008thecommittee,chairedbyRepresentativeAnthony

DeLuca,heldapublichearingonHB1849toreceivetestimonyfromrepresentativesoftheinsurance

industry,visitingnurseservicesandotherhomecareproviders,hospitals,andthePAMedicalSociety

todeterminewhetherornotinsurancereimbursementoftelemedicinemakessenseinPennsylvania.

Inhisopeningremarks,RepresentativeDeLucastatedthat“Astechnologyevolves,thepracticeof

medicinemustadvancealongwithit.Itisincumbentuponustoinvestigateandconsiderthese

technologiesandadvancesandhowtheycanbenefitourconstituents.”DeLucafurtherassertedthat

itappears“theuseoftelehealthmedicinewouldbemoreconvenientforboththeprovidersandthe


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patients”andthatit“wouldreducethedemandsforhealthcareservicesandsavethepatientstime

andmoneygoingforthedoctors’visits.”2

Highmark,alargehealthinsurerinPennsylvania,testifiedthattheycurrentlyprovidelimited

coverageforclinicalapplicationsoftelemedicinethatdonotrequireface-to-faceencountersbetween

theclinicianandpatient.Suchusecasesarelimitedtoradiologyforthetransmissionofmedical

imagestoaradiologistforinterpretation,pathologyimagestransmittedthrough“storeandforward”

imagetechnology,andincertaincasespatientmonitoring–mostlyforcardiacmonitoringaswell

assomecasesoffetalandpulmonarymonitoring.Highmarkdoesnotprovidecoverageforclinical

applicationsnormallyinvolvingface-to-faceencountersthatwouldrequirecognitiveskillssuchas

visits,consultations,counseling,therapysessions,andon-linemedicalevaluationsorassessments

citingalackofscientificevidencedemonstratingthatcognitivetelemedicineservicesaremedically

anddiagnosticallyequivalenttoface-to-facecare.HighmarkopposesHB1849becausetheybelieve

ithasthepotentialtoexposehealthcareconsumerstoservicesthatcouldbeharmfulifnotprovided

duringdirect,face-to-facecontactwiththeirphysician.Theyalsocontendthatthebroadnatureof

thebillraisesquestionsaboutcostsandmedicalliability.

TheNorthPennVisitingNurseservicetestifiedonbehalfofhomecareprovidersinstrongsupport

ofthemeasure,citingresearchfindingsofcostefficienciesthroughdecreasedrehospitalizations,

particularlyforchronicheartfailurepatients.Theagency,whichbeganitstelehealthprogramin

2006andnowutilizes60remotevitalsignmonitoringunits,hasbeenabletoreducethenumberof

in-personvisitsper-patient(oneormoreperweek)whilesafelymonitoringpatientrecoveryand

avoidingunnecessaryrehospitalizations.Becausethereisnorequirementforinsurers,including

long-termcaremanagedcareplans,toreimbursefortheuseofsuchequipment,nearlyalldonot.

NorthPennassertedthatforaslittleas$10perdayapatientwithMedicareorMedicaidcanbe

evaluatedremotelybyanurse,receivequickresponsetoanimpendingmedicalemergencyandavoid

anunnecessaryvisittoanemergencyroomorhospitalization.

LargehospitalnetworkscoveringwesternandeasternPennsylvaniaandtheHospitalandHealth

SystemAssociationofPA(HAP)testifiedinsupportofHB1849.However,HAPcontendedthat

thelegislationcouldhaveasomewhatlimitedimpactbecauseitdoesnotcoverfederalprograms,

suchasMedicare,andmanyprivateinsurerswouldnotberequiredtofollowtherequirementssince

federallaw(ERISA)wouldexemptthemfromfollowingthisstatemandate.Therefore,HAPfurther

advocatedforthepassageofSB8andSB340,discussedabove,tofurtheradvancetheproliferationof

telehealth.ThePennsylvaniaMedicalSocietyalsotestifiedinsupportbutassertedthatthelegislation

2Transcript of PA House Insurance Committee Public Hearing on HB �849, April �5, 2008


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doesnotgofarenough,andsuggesteditbeexpandedtorequirereimbursementfortelemedicinefor

real-timeinteractivephysiciantreatmentinadditiontotelehealthservices.

5. early adoPTers of agIng servICes TeChnologIes

Severalprovidersandpublichomeandcommunity-basedserviceprovidershavebeen“earlyadopters”

inASTsbecauseoftheirearlycommitmenttotheuseoftechnologytoachievetheirservicemissionand

goals.ThefollowingisasnapshotoftheeffortsofafewearlyadoptersinPennsylvania.

5.1 Aging Services Providers

ThefollowingaredetailedexamplesofcareproviderstoolderPennsylvaniansthathavemade

strategicinvestmentsinagingservicestechnologyinfrastructureandtools.Itshouldbenotedthat

thissummarydoesnotpurporttocaptureallexamplesofearlyadopterproviders,butratherpresents

afewkeyexamples.Therearemanyotherproviderswhohavemadeinvestmentsintechnology,

someofwhicharereferencedinsection5.1.6andotherswhoarenotdiscussedinthispaper.

5.1.1 Acts Retirement-Life Communities

BasedinSoutheasternPennsylvania,ACTSRetirement-LifeCommunitiesisthelargestnot-for-

profitbuilder,ownerandmanagerofcontinuingcareretirementcommunities(CCRCs)inthe

UnitedStates.Begunin1972,ACTSnowhasmorethan7,800residentsand5,600employeesin

18ACTScommunitiesinseveralstates.ACTS’agingservicestechnologyadoptiontodatehas

beenfocusedonmakingimprovementsinquality,serviceandefficiencyintraditionalsettingsof

carewithintheCCRCmodel.Withregardtotechnologyadoption,seniorstaffrefertoACTSas

“conservativelyproactive,”meaningtheyarecontinuallyexploringthetechnologyhorizonbut

arerarelytheveryfirstadopter–butmaybethefirstevaluatorofthetechnology.Ithasexcelled

initsareasoftechnologyfocus.

Sincethelate1990s–early2000s,allofACTS’coreoperationalservicesareashavebeen

electronic,includingfront-linesystems.Forexample,forsevenyearsitsfoodmanagementand

maintenanceworkershavebeenusinghand-heldelectronictoolstomanagetheirday-to-day

operations.Securitysystems,hospitalityservices,andclinicalsystemsareallelectronic.

Foritsclinicalpointofcaresystem,ACTScurrentlyusesCareTrackerbyResourceSystems

(http://www.resourcesystems.net/caretracker.htm).WhatmakesACTS’implementationunique

isthatthesystemextendsacrossalllevelsofcare.ACTShaskiosksthroughoutitsCCRCs,even

infitnesscenterstodocumentresidentphysicalactivityinindependentlivingsettings.

WithCareTracker,front-lineworkersareabletochartresidentinformationusingtouch-screen

kiosks.Tosimplifystaffworkflow,thesystemidentifiesrequiredactivitiesanddocumentation


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withhighlightedyellowiconsandvisuallyalertsstaff

topast-duecareactivitiesandsituationsthatrequire

theirattention(i.e.,whenaresident’sbiometric

measurementsindicateanunhealthytrendorshow

insufficientnutrition).Byautomaticallyidentifying

at-riskresidentsandcommunicatingresident

information,CareTrackerfacilitatesqualitycare

andallowsforimmediatefollow-up.CareTracker’s

reportingfeaturesallowACTStoanalyzethequality

ofcareandcompliance–fromthefacilitytothe

corporatelevel–againstitsowninternalquality

standards.ThoughCareTrackerprovidesACTSwithapseudoelectronicmedicalrecord(EMR),

leadershipiscurrentlypursuingamorecomprehensivesystemtomovethemclosertoward

adoptionofafullelectronichealthrecord(EHR)andaplantodeployanewplatformoverthe

nextyear.

ACTSisnowplanningsignificanttechnologyupgrades.Informationtechnologystaffare

beginningtoprovideall5800employeeswithhand-heldandtouch-screenaccess,through

multiplepointsofcontactincludinghand-held,voiceandkiosktechnologies.ACTShastaken

thisstepbecausetheybelieveitisimperativethatallrelevantservicesbesupportedatalltimes

bytoolsandinformationsothattheyaremeasurable.Theyarecurrentlybuildingawiredand

wirelessdatacommunicationsinfrastructuretosupportaramp-upfromthecurrentpersonnel

footprintof1000dailytechnologyusersto5800.

Fromthisbroadplatform,ACTSalsoplanstoprovideself-serviceresidentaccesstoallcampus

services.Thiswouldincludeschedulingandorderingentertainment,healthandwellness,safety

andsecurity,energymanagementandcommunicationssystemstonameafew.ACTSbelieves

thattechnologywillprovideaconnected,collaborativecommunitythatwillempowergreater

synergyofcareandagreatlyenhancedqualityofserviceandexperienceforresidents.Eventually,

ACTShopesthatthiskindofcoordinatedvirtualandphysicalspacewillenablethemtobuild

moreflexibleandconfigurablelivingenvironmentsratherthancare-specificrigidsettingsthat

currentlyarethenorm.

5.1.2 Diakon Lutheran Social Ministries

DiakonLutheranSocialMinistries(www.diakon.org)isamongthelargestnot-for-profit

retirementcareprovidersservingPennsylvania,MarylandandDelawareandhas3200employees.


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Italsoserveschildren,youth,adults,familiesandcommunitygroupsthroughavarietyof

programsandservices.DiakonoffersCCRCs,retirementlivingaccommodations,assistedliving

services,dementiacare,nursingcare,memorycareandoutpatientrehabilitationservices.

Diakonistwoyearsintoa10-year“repositionplan”inwhichitisbuildingnewindependent

livingproduct,forbothhomesandapartments,andrenovatingitsexistingpersonaland

healthcarefacilitiesatsixof13locations.Theybelieveitisimportanttodesignseniorlivingin

awaythatwillbeattractivetothecomingagewave,andascribetothe“aginginplace”design

approach.

Thecompanyseekstoutilizetechnologytosupporttheexistingstaffandservicesonitscampuses

andthenusethismodeltoreachoutinthecommunitywithitsnewhomeservicesprograms.

Itsstrategicactivitiestowardthisgoalincludeparticipatinginproductresearchanddevelopment,

activelyparticipatinginCAST,collaboratingwithvendorsandotherserviceproviders,and

conductingsmallpilotprojectsofpotentialsolutions.Internally,Diakonisholdingdiscussions

anddemonstrationswithstaff,itsboard,andresidentsandfamiliestoeducatethemon

technologiesandservicesthatareavailable.

Consortium for the Future of Senior Living

Inorderforalllevelsoftheorganizationanditspartnerstousethesamelanguageoroverall

plan,Diakondevelopeda“futureofseniorlivingpyramid”thatincorporatesitskeyareasof

focus.Theyare:

• Infrastructure –physicalconnectiontoothers,Internet,caregivers,databasesandincludes

fiberoptic,copper,coaxial,andwirelesstechnologies

• Living Environment – physicallivingenvironmentincludesuniversaldesign,lighting,

temperature,security,access,fire/smoke,callassistance

• Personal Safety –falldetection,activitiesofdailylivingmonitoringandassessment,mobility

aids

• Social Connection –phones,email,intranet,portals,privatecablechannels,two-wayvideo,

messaging,TV

• Physical/Mental Wellbeing –wellnessmonitor,telehealth,cognitivestimulation,reminder

systems

Specifically,Diakoniscreatingalocalpartnership,namedthe“ConsortiumfortheFutureof

SeniorLiving,”amongseveraltechnologycompanies,aseniorlivingcontractor,anarchitect,

adesignfirmandaleadinguniversity.TheConsortiumwilladdressknownexistingobstacles,


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discoveradditionalunmetneedsandfindsolutions

toassistindividualstoremainindependentlonger.

TheConsortiumplanstobuildamodelapartmenton

Diakon’sLutherCrestcampusinAllentown,Penn.and

amodelhomeonitsToptoncampusinTopton,Penn.

campus.Thesemodelswillbeusedaseducationcenters

forseniors,families,staffandthelocalcommunityto

showcasetechnologythatiscurrentlyavailableandhow

itcanassistpeopleintheirhomes.TheConsortium

alsowillpilotnewtechnologieswiththegoalto

incorporateprovensolutionsandservicesthroughoutDiakon’sindependentandassistedliving

communitiesandeventuallyintotheneighborhoodhome.

Cognitive Impairment - Brain Fitness

OneofthetechnologiesDiakonhastestedandadoptedforimprovedresidenthealthand

engagementistheDakim[m]Power(www.

dakim.com).Positionedasfunandeasyto

use,[m]Powerisacognitiveexercisesystem

thatprovidesresidentswithachallenging,

entertainingandenjoyablementalworkout.

Itemploystouchscreentechnologyand

combinesoriginalcontentwithmemory-

invokingimagestostimulateparticipants’minds.Itisaselfcontainedcomputertouchscreen

thatrequiresnokeyboardormouse.Thechallengelevelisselfadjustingandnewcontentis

downloadedandinstalledautomaticallyeachnight.Diakonhasfoundthatthe[m]Poweris

senior-friendlywithanautomatedloginandmakescognitiveexercisealeisureactivity.Diakon

pilotedsixunitsoverthelastyearattwoofitscampusesandrecentlyinstalled32moreunitsthe

firstquarterof2008.

Monitoring Activities of Daily Living

DiakonispartneringwithGrandCare(www.grandcare.com),topilotanewtechnologydevice

calledComoforassistingindividualstoremainindependentinthehomes(nomatterwheretheir

homeis).GrandCareComoisanintelligentsystemthatincludesasuiteofsensorstomonitor

thehomeofanelderlyindividualinanon-intrusivemanner.Thesystemsendsnon-visual

informationviatheInternetaboutbasicactivityinthehouseholdofasenior.Diakonwillhost


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auser-friendlywebpageforbothformalandinformalcaregiverstomonitoractivityandtosend

communicationsdirectlytothe

senior’stelevisionscreen.The

caregiverscanspecifyhowthey

wishtobenotifiedintheevent

ofahouseholdirregularity.

UsingInternettechnology,GrandCarealsoallowsthefamilytostayintouchwiththeirlovedone

fromanylocationortimeofday.

Lighting Technologies for The Aging Eye

DiakonisworkingwithLutron(www.lutron.com),aleadinglightingcontrolcompanyand

Diefenderfer,alocalelectricalcontractortoprovidelightingandcontrolstoassistwiththevisual

changesthatoccurtooureyesasweage.DiakonandLutronareexploringwaystoimprovethe

qualityoflifeofolderadultsbyunderstandinghowlightingcompensatesforthechangesthat

commonlyoccurinagingeyes.Asweage,ourvisionexperiencesmanychanges:sensitivity

toglare;decreasingabilitytoreacttochangesinlightlevels;reducedabilitytodiscerndetails;

restrictedfieldofvisionanddepthperception;andreducedsensitivitytocontrastandcolor

recognition.Lightingcanmakethedifferencebetweenseeingandnotseeingforolderadultswith

deterioratingvision.

Diakonplanstochangelightingenvironmentstoincreaseambientlightlevels,increasetaskarea

lighting,minimizeglare,increasecontrast,balanceluminancelevels,improvecolorperception

andprovidegradualtransitionsbetweenspacesinthecommonareasofitsLutherCrest

community.Othergoalsincludeminimizinghoursoflightingoperationinsomeareasbyusing

lightingcontrollers,andthelightingpowerdensitybyusingenergyefficientlightingproducts,

whileprovidinglightingthattheresidentsfindattractiveandcomfortable.

Somelightingcontrolstrategiescurrentlybeingconsideredarewallbox“singlezone,”scene,

bedside,hand-heldremote,occupancy,andastronomicaltimeclockcontrol.Diakonalsois

exploringtechnologythatwillprovidedaylightcompensation,automatedwindowshades,light-

leveltuning,centralsystemcontroland/orintegration,andenergymonitoringthatincludespeak

powerdemandmonitoringandmanagementaswellasenergyusage.

Resident Information and Communications

DiakonispilotingaresidentinformationandcommunicationsproductwithTouchTownTV

(www.touchtown.tv)thatcanbebroadcastoverexistingcabletelevisiononaprivatechanneland

providesdigitalsignageinformationlocatedthroughoutthefacilityonflatpanelTVs.


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TouchTown TV+ and Resident Web Portalworktogethertounifythecommunicationthroughout

retirementcommunities.TV+isapassivesystem,deliveringcommunityinformationtoviewers

ontelevisions,websitesandprint.Itgivescommunitiesthepowertoconnectwithresidents,

familymembersandprospectiveresidents–evenifthosepeoplearenotphysicallyinthe

buildingorcampus.Itletsacommunitycreateanddeliveraprofessionalqualitychannel

automatically,generatingthefinalresultfromadatabaseoflocalinformation.Theuniquevalue

ofTV+derivesfromitsabilitytounifycommunicationsthroughoutaretirementcommunity.

TheResident Web Portalisaninteractivesystem,engagingresidentsinonlineactivitiessuch

asemail,discussionforums,signingupforactivities,schedulingmaintenancerequests,dining

menus,residentdirectories,etc.Touchtown Digital Signagesendscommunityinformation

toviewersviadigitalsignageinpublicareas.Thetechnologyprovidesamulti-window,

highdefinitiondisplaythatcombinesmultipleinformationsources:brandmessage,daily

announcements,activityschedules,diningmenus,transportation,time,date,weather,etc.

Donor Recognition / Diakon Information Kiosk Stations

Diakonwillinstallatouch-screenkioskbasedsystemfordonorrecognition,buildingdirectory

andotherDiakoninformationoneachcampusinconjunctionwithitsrepositionplan.Quality

Attributes(www.qualityattributes.com)isthesoftwarecompanyprovidingwebbasedsoftware

tobepresentedonthetouchscreenkiosks.IBDonor,thedonorandsponsorrecognition

managementpackage,providesweb-basedadministrationofdonorsandallowsup-to-date

recognitionofdonorswhilereducingphysicaldécorspacecommitments.iBDirectory,avisitor

managementtool,offersvisitorsandresidentsrealtimeinteractionwithDiakon’sinformation

includingbuildingdirectories,waypointfindings,campusmapsandeventcalendaring.

5.1.3 Keystone Home Health & Hospice

KeystoneHomeHealth&Hospice,basedinthegreaterPhiladelphiaregion,providesprivate

dutynursing,skilledhomecare,diseasestatemanagementprograms,telecare,palliativecare,

homehospiceandresidentialhospiceservices.

AsreferencedaboveinthediscussionofPennsylvania’sTeleCareMedicaidreimbursement

program,Keystonehasbeenanearlyleaderinusinginnovativeandlow-costtechnologyto

addresstheproblemoftheincreasingnumberofindividualswhoareagingandlivewithchronic

disease.Keystonepursuedusingtechnologybecauseitrecognizedthesignificantchallengesto

maintainingthehealthofanolderpopulation,whichisoftenahardshipforindividualsand

families.Withtheuseofsimpletechnologytomonitoractivityandambienttemperatureinthe

livingenvironment,trackanddispensedailymedicationdoses,andremotelymonitorvitalsigns,


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Keystonefounditcanalleviatesomeoftheescalatingcostsandsocialpressuresofmaintaining

thehealthandindependenceofthechronicallyillandagingpopulation.

Passive Monitoring System

KeystonedevelopedtheKeystoneTelecareProgram,combiningclinicalcasemanagementwith

theQuietCarepassivemonitoringsystemfromLivingIndependently(www.quietcare.com),a

motiondetectionsystemforthehomethatisspeciallydesignedtoanalyzepatternsofactivity

surroundinganindividual’snormaldailyroutine.Individualswhoareagingorwhohave

chronicdiseasehavecontinuedandpredictableepisodesofchangewithintheillness,relatedto

lifestyle,livingconditions,accesstofamily,communitysupport,andhealthcare.Patternsof

behaviorcanbecardinalsignalsofimpendingcrisiswithinchronicillnessandaging.

Fivediscreetwirelessmotiondetectorscollectandtrackanindividual’snormaldailyroutine

aswellasambienttemperatureinthehome.Informationfromthesensorsissenttoasecure

websitewhereitistranslatedintofunctionalstatus.Abaselineanalysisoftheindividual’ssafe

independentstatusathomeisrecordedandsubsequentinformationiscomparedtodetermine

changesinactivity.Installationofthesesensorsiscost-effectiveandimportantly,non-obtrusive

intheexistingenvironment.Informationgeneratedbythepassivemonitoringsystemisviewed

bothonadailybasisandthroughtrendanalysis,topinpointchangesinbehaviorthatcould

indicateaproblembeforeitbecomesacrisis.Passivemonitoringsystemincludesa24-hour

emergencyresponsebuttonwithoversightbyADT.Thepassivemonitoringcanbeeasily

integratedintosupportivehousingorprivateresidencestobettermanagethecostsofcareand

isasimpleandcost-effectiveplatformforothertechnologiestoenableindividualstoremainat

home.

Remote Monitoring of Vital Signs

Keystoneutilizeslowcost,FDAapprovedbiometrictools(glucosemeters,bloodpressurecuff,

incentivespirometer,digitalscale,etc.)thatcanbelinkedtoawirelessmodemtosendvital

measurementsoverphonelinestothephysicianandhomecarenurse.Thesemeasurements

createalongitudinalrecordforgreateraccuracyofdiseasestateassessment.Thefrequentvitals

monitoringathomeaffordsconstanttrendingandearlyinterventionbyaphysicianornurse

andcanavertworseninghealthstatus.In-homemonitoringdevicesconnectedtoanadaptable

modemcanguidepatientsinthedailyexchangeofimportantclinicalinformationsuchasblood

sugarlevels,bloodpressure,weight,andlungfunctioning.


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Medication Adherence

Keystone,alongwithotherproviders,foundthatfailuretotakemedicationbecauseofcost,

forgetfulness,confusion,orotherreasonsgreatlyunderminesthesuccessoftreatmentand

increasesthecostsofcare.KeystonehasusedtheMD2medicationsystemforoverthree

yearswithindividualswhohadbeenhospitalizedduetonon-adherencewithmedicationthat

complicatedotherhealthrelatedissues.Adherenceinthisgrouphasbeenincreasedonaverage

20percent,andforoneindividual,hospitalizationwasavertedformorethanayear.

Demonstrations and Research

Forseveralyears,Keystonehasworkedtoadvanceadoptingagingservicestechnologiesby

demonstratingtheirvaluewithvariouspopulations.Thefollowingisabriefsummaryofthese

efforts:

• KeystoneHospicewaspartofastudywithDr.EllenTedaldiatTempleCancerCenterto

trackmedicationadherencewiththeMD2inindividualsinfectedwithHIV-1whohave

asignificanthistoryofnon-compliance.ThisstudypassedtheTempleIRB(Institutional

ReviewBoard)inFebruary2004.

• KeystoneHospicereceivedIRBapprovalinOctober2005fromtheCityofPhiladelphia,

DepartmentofHealth,tobeginaprojectwithfundingfromtheAIDSActivities

CoordinatingOffice(AACO)todemonstratethecostandcarebenefitsofusingthese

technologiestoenhancecareandimproveclinicaloutcomesforindividualswhoare

chronicallyillwithHIV/AIDS.Thisstudyisongoing.

• InDecember2005,KeystonereceiveddiscretionaryfundingfromthePennsylvania

DepartmentofAgingtobeginasix-monthpilotprojectusingthepassivemonitoring,

medicationadherenceandremotevitalsignsmonitoringtechnologieswithhomecare

nursingsupervision,todemonstratethebenefitsforthehealthandwelfareofindividuals

whoareaginginMontgomeryCounty,Penn.

• InJune2006KeystonereceivedfundingfromTheChestnutHillHealthCareFoundationin

supportoftheTelecareProgramtooffertelecareservicesto12chronicallyillindividualsin

thezipcodessurroundingChestnutHillHospital.

Aftersixmonthsofpilotingtechnologieswith12frailelderlyindividualsnearChestnutHill

Hospital,Keystoneprovidedanaverageof119daysofcare.Individualswerereferredforcare

forfragilemedicalconditionsandnon-adherencetomedicationandwereconsideredatriskfor

nursinghomeplacement.Thefollowingaresummaryhighlights:


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• Demographics:average76yearsofage;75percentCaucasian;66percentfemale;50percent

werephysicianreferrals;and50percentwerereferredfromthelocalOfficeonAging.All

individualshadmultiplediagnosesincludingcancer,congestiveheartfailure,hypertension,

anddiabeteswith50percentcomplicatedbydementia,bi-polardisorderordepression.

• Elevenindividualsusedthemedicationdispensingtechnologybetweenoneweekandsix

months.Theaverageadherenceratefortheseindividualswas98.2percentwhile45percent

ofindividualswereadherent100%ofthetime.

• Tenindividualswereusingthepassivemonitoringsystem.

• Threeindividualswithcongestiveheartfailureandonewithdiabetesutilizedremotevital

signsmonitoring.

• Twoindividualswerehospitalizedduringthesix-monthperiodforatotalofsixdays;onefor

afall,andoneforahematomaatthesiteofself-injection.

• Noparticipantswereplacedintolong-termcare.

Bykeepingtheseindividualssafelyathomeusinglowcosttechnologyatapproximately$16a

dayversusnursinghomeplacementat$180aday,Keystonebelievedthecostandqualityoflife

benefitwasevident.Onepatientwhohadoriginallysaidthatshe‘justwantedtodie’because

ofherillness(congestiveheartfailure)andhadanunpredictablehealthstatusathome,enjoyed

independencewiththesupportofthepassivemonitors,amedicationdispenserandanurse

remotelymonitoringhervitalsignsdaily.Severaltechnology-informedinterventionsbythe

nursehavekeptthispatientwellandwithoutacrisisforthemonitoringperiod.

5.1.4 NewCourtland Elder Services

TheNewCourtlandElderServicesnetwork,foundedonJuly1,1995,isacareproviderformore

than2,000peopleinthePhiladelphiaarea.Itownsandoperatessevennursinghomes,provides

affordableseniorhousingcottagesandapartments,operatesaPACE(ProgramofAllInclusive

CarefortheElderly)programcalled“LIFE” in Pennsylvania (LivingIndependentlyForElders),

andprovideshomecareservicesthroughCourtlandatHome,itscertifiedhomehealthagency.

Itusesaninnovativeandindividualizedapproachtoprovidinghealthcareandsocialservicesin

fulfillingitsmissiontocareforthoseinneed.CourtlandatHomeprovidesskillednursing,home

healthaide,andskilledrehabilitativeservices.NewCourtlanddistinguishesitselfbyuniquely

blendingthecompassionofahighly-trained,dependable,andfriendlystaffwiththeinnovation

ofeasy-to-useassistivetechnology.


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NewCourtlandleadership–whosemissionistoprovidethebestqualityofcare–recognized

aconfluenceoffactorsincludinganursingandworkershortageandarapidlygrowingolder

populationanddecidedalargepartoftheanswerwastoadoptwhatevertechnologieswere

neededtoenablecaregivingexcellence.Thechallengewastobringtechnologytoeverylevelof

operationsandcareinanarenawherepeoplearenotgenerallyfamiliarwithtechnology(both

staffandolderadults).In2000whenthesearchbeganforadvancedagingservicestechnologies

therewaslimitedavailability.Butleadershipwasdeterminedtofindwaystomaximizethe

technologythatdidexisttomeetitsgoalsandchargedahead.Asevidencedbelow,NewCourtland

hasneverlookedback.

Clinical Systems and Resident Account Management

Unlikemostlong-termcareproviders,NewCourtlandin1998beganitsuseoftechnologywith

aclinicalinformationpackagebeforeitimplementedanelectronicresidentcensusandbilling

managementsysteminJulyof2006.ForbothofthesesystemsNewCourtlandusedVistaKeane,

byKeanecare(http://www.keanecare.com),anintegratedclinicalandfinancialsoftwarethatis

tailoredspecificallyforlong-termcare.TheVistaKeanesuiteofsoftwareallowsforaccuratereal-

timecensus,electronicresidentassessmentsandaccurateresidentfundsandbillingmanagement.

Point-of-Care System

InJune2005,NewCourtlandchangeditsnursinghomeclinicalsystemtotheCareTracker

point-of-caresystembyResourceSystems(as discussed in section 5.1.1 above)intheirseven

skillednursingfacilities(http://www.resourcesystems.net/caretracker.htm).Usingtouchbased

kiosks,CareTrackermakesiteasyfornursesandothercarestafftoquicklyandaccurately

documentresidentcareandobservations.NewCourtlandfoundthatusingCareTrackerled

tobetterresidentcareandmoreaccurateMDSsubmissions.Staffreportedthatthebiggest

benefitisabilitytospendmoretimewithresidentsandlesstimecompletingchartingandother

paperwork.NewCourtland’simplementationplanwasstaggered,beginningwithtwofacilities

andthenplacingitinonefacilityeveryothermonth.Amulti-disciplinaryteamapproachto

implementationwascriticaltosuccessandincludedanITprogrammanager,clinicalleadership,

operations,andactualusersforeachnursinghome.

Homecare Clinical and Financial System

InJuly2008,NewCourtlandimplementedHorizonHomecare,asuiteofhomecare

documentationapplicationsbyMcKesson(http://www.mckesson.com),whichintegratesclinical,

financialandadministrativedatainitshomecareagency.NewCourtlandbelievesithashelpedto

improvequality,manageclinicalcostsandotherresources,andcoordinatecare.


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Electronic Nurse Call System

NewCourtlandrecentlyinstalledCornellCumulaNurseCallSystems(www.cornell.com)ineach

ofitsskillednursingfacilities.TheCumulaNurseCallSystemisa

programmable,PCbased,addressablecallsystemequippedwith

Cornell’sAURAMonitoringSoftware.Inadditiontoservingthe

classicalfunctionofthenursecallsystem,itcanmonitoralltypes

of“alert”devices,equipmentandsystemsand,inanemergency,

sendamessageviacellphone,pager,email,messageboardortwo-

wayradiototheappropriatepersonnel.Allmonitoringandalert

activityisstoredinahistoricalreportingsystemthatprovidesaccountability,staffmanagement

andrecordkeeping

Time and Attendance Technology

Inanefforttodevelopaculturewhereallstaffbecomefamiliarwithusingtechnologyonaday-

to-daybasis,NewCourtlandimplementedtheKronosautomatedtimeandattendance

softwarein2006.Kronos(www.kronos.com)utilizesadvancedbiometric-enabled

timeclockstoimproveaccuracyandmanagelaborresourcesinreal-time.Atouch

identificationterminalverifiesemployees’identityusingbiometricfingerscanning,not

fingerprints,forincreasedaccuracy.ThepackageallowedNewCourtlandtoautomate

businessprocessesandeliminatemanyadministrativetasksaswellasmonitorlabor

activitiesinrealtimeforbetterinformedlabordecisions.Moreover,itfurtherenabled

theculturechangeNewCourtlandwasseekingandallowedstafftospendmoretime

withresidentsratherthanmanuallycompletingtedioustimesheetsandforms.

Infrastructure Enhancements and Electronic Record Systems

ByOctober2007allsevenofNewCourtland’snursinghomesandoperationalbuildingswere

convertedto100percentwirelessconnectionsandtools(laptops/handhelddevices/kiosks),

witharobusttnformationtechnologybackbonetolinkallfacilities.Thenetworkinfrastructure

utilizesstateofthearthardwareandqualityofservice(QOS)basedroutingtoensuredatais

deliveredtoend-usersinthemostefficientandtimelywaypossible.

EMR System

InMarch2007,NewCourtlandadoptedafullyelectronicmedicalrecordsystemcreated

specificallytosupportitsLIFE/PACEprogram.Aftersearchingunsuccessfullyforwhatit

deemedasuitablesystem,NewCourtlandteamedwithMediture(http://www.mediture.com/

lifeconnect.html)andanotherPACEproviderinBostontodevelopacustomizedsolutionto


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meettheuniquemedicalrecordschallengesthatfacePACEprograms.Throughthispartnership

“TruChartLIFEConnect”wasdevelopedtounifythevariousandcomplexcomponentsofPACE

programs.ThissoftwareallowedNewCourtlandtoopenandmaintaina100percentpaperless

environmentinitsLIFECenter.Asafullyintegratedsolution,thesoftwarecoversend-to-end

needsincludingassessments,interdisciplinarycareplans,authorizations,billing,scheduling,

orderentryandtransportation.NewCourtlandcurrentlyisdoingafullsystemsreviewto

determinewhetherthissystemcouldbeimplementedacrossitsotherprogramsandservices.

eMAR System

Alsoin2007,NewCourtlandimplementedafullyintegratedelectronicmedicationadministration

record(eMAR)systemthatprovidesmedicationmanagementanddeliveryinitsnursing

homes.MillenniumMPSRx(http://www.mpsrx.com)isawirelessweb-basedsystemthatallows

NewCourtland’snursestodeliverbar-codedmedicationsviacart-basedlaptops.Ataskforce

wasusedtoinvolvealargeusergroupandmanagementplannedtheroll-out.Toimplement,

NewCourtlandtrainedstaffingagencynurseswhohelpedrollitoutineachbuilding.The

approachwassosuccessfulthatMillenniumutilizedthetrainedagencynursestocompleteroll-

outsinotherlong-termcarecommunities.NewCourtlandhasrealizedimprovedefficienciesand

reducedmedicationerrorsasaresultofthispaperlesssystem.

SharePoint Dashboard and Resources

InApril2008,NewCourtlanddeployedMicrosoftSharePoint

homespagesforemployeesacrossalllocations,providing

asingleintegratedlocationwhereemployeescanfind

organizationalresources,manageelectronicformsand

workflow,andhaveaccesstodashboardsandreportsofkey

clinicalandoperationalmetrics.AnyNewCourtlandemployee

loggingontotheInternetencountersastartpagethatincludes:

theuser’sfacilitylogo;announcementsspecifictotheuser’s

facilityorprogram;alistofrecentNewCourtlandnewsandpublications;humanresource

documents;andrelevantqualitymeasures.

Telehealth Technologies

NewCourtlandalsohasbeenanearlyadopterofvarioustelehealthtechnologies.Severalyears

agoitpilotedwiredtelehealthdevicesthatwereconnectedtophonejacksandwiredtobiometric

tools.Theorganizationdeterminedthatthedevicesweretooexpensiveandwouldnotenable

thedevelopmentofanaffordableandcomprehensivesetoftelehealthtools.


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Telehealth Sensor Technologies

BeginninginJuly2006,NewCourtlandbeganusingadvancedtechnologiesfromHealthSense

(www.healthsense.com)andothervendorsinresident’shomes.Theseincludebedsensors,

refrigerator/stovesensorsandgeneralmotiondetectors.Currently

theHealthSenseeNeighbortechnologyisinplaceatseveralofthe

NewCourtlandLIFEandaffordableseniorhousingunitsandhas

allowedNewCourtlandtechnicianstobeproactiveinmonitoring

carebyprovidingaccuratealertsofkeyactivitiesofdailyliving.

Thirty-threetelehealthsensorsystemswereoriginallydeployed

intheaffordableseniorhousingresidences.Whilemanagement

foundthattheycouldhardly“giveaway”thefirst33units,they

couldn’tgetthenext33quickenough.Demandspreadbyword

ofmouthbecauseolderadultsusingthetechnologyfeltsaferand

moreconnectedtotheirneighborsandtheircommunitythanthey

didwithoutit.TheLIFEcommunityalsowasanearlyadopterofthetechnology,withhalfofthe

80membersusingtelehealthsensors.

NewCourtlandfoundthatthetechnologyenabledthemtoprovidehighqualitycarecost-

effectively.Whiletheyhavenotyetformallyquantifiedthecosteffectiveness,ithasbecome

self-evidentoverthepasttwoyears.Lessonslearnedincludemakingsurethereisachampionat

eachsite(housingcommunitymanager,servicecoordinator,etc.)andseekingthetrustofolder

adults.Theyfoundthatonceresidents’trustisearned,acceptanceofthetechnologyquickly

growsacrossthecommunity.

Oneofthepatients,a77yearoldretiredpharmacytechnician,hadlostherlegtodiabetes.She

movedintotheseniorhousingcommunitybecauseshecouldnolongermaneuverthestairsin

herfamilyhome.Inherapartment,shechecksherbloodpressurewithacuffthatautomatically

andwirelesslysendsthereadingtothemonitoringcenter,whichnotifiesherandherdoctorof

anytroublingchange.SensorsplacedineachroomkeeptrackofhermovementsandADLs,and

shehasabuttontosummonassistance,whichsheusedinAprilwhenshefell.Inaninterview

withamajornewspapershestatedthat“I’malonebutIknowI’mnotallbymyself,”andadded,

“AndIreallylikemyindependence.”

ResearchreleasedbyHealthsenseandNewCourtlandconcludesthatseniorswhorelyonremote

monitoringtechnologytohelpthemremainsecureandindependentadaptwelltolivingwiththe

technologyanddonotseeitasintrusiveorimpersonal.Conductedbyanindependentresearch


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consultingfirmatfourlocationswithintheNewCourtlandNetwork,thestudymeasured

theeffectivenessofHealthsense’seNeighborremotemonitoringtechnologyandcaptured

theperceptionsofresidents,familymembersandstaff

employingit.

Participantsinthesurveyreportedanoverwhelmingly

positiveattitudetowardtheeNeighborSystem.Seniors,

someofwhomhavelivedwiththetechnologyintheir

residencesformorethantwoyears,unanimouslyagreed

thatthesystemmakesthemfeelsaferandmoresecurewhile

enablingthemtoliveindependentlyforlonger.Ofthose

surveyed,onlyoneelderlyresidentreportedaconcernabout

intrusiveness.Staffmembersinterviewedforthestudy

unanimouslyagreedthattheeNeighborSystemallowsthem

tobetterassessthecareneededbyresidents,helpsthem

providetheappropriatelevelofcare,andimprovesthe

qualityofcareoverallthatresidentsreceive.

NewCourtland’sleadershipthoughtthatadaptingtothetechnologymightbeamajorissuefor

theirresidents,butclearlyitwasnot.Rather,theresultsofthesurveydemonstratethateven

seniorswithlittleornopriorexposuretothistechnologycanreadilyadapttoitoncetheyrealize

theimprovedqualityoflifeitoffers.

Telehealth Biometric Technologies

InOctober2006,NewCourtlandbeganimplementingbiometrictoolsasanadditional

enhancementtothesensorprogram.Biometricdevicesweredeployedtoremotelymonitorkey

vitalssuchasweight,bloodpressureandglucose,etc.NewCourtlandnowisbeginningalarge

demonstrationincooperationwithhealthinsurancecompanies,continuingcareretirement

communitiesandotherhomehealthagencies,installingbiometricmonitoringdevicesin

upto1,000residencesoverthenextsixmonths.TheyarepartneringwiththeUniversityof

Pennsylvaniatoconductevaluativeresearchforthepilot.

Cognitive Fitness

SinceJune2008,theDakim[m]Powersystem(seesection5.1.2)hasbeenusedatNewCourtland

LIFE.Asdiscussedabove,[m]Powerisanelectroniccognitivefitnesssystemforolderadults.

Thesystememploystouchscreentechnologytodisplayoriginalcontentwithmemory-invoking

images,movies,musicandsoundsofthepast.NewCourtlandhas30systemusersandasurvey


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founda90percentusersatisfactionrate.Plansnowcallforimplementingthesysteminits

nursinghomes,andthenew“homemodule”ofthesystemisbeingconsideredforothersenior

livingsettings.

Videoconferencing for Hi-Tech Staff Training, Telemedicine and Resident Socialization

Withtheassistanceofgrantfunding,NewCourtlandin2004openedahigh-tech41,000square

foottrainingcenterequippedwithwirelessconnectivityandwiredhigh-speedvideoconferencing

equipmentinallrooms.Thetrainingcenterispartoftheprovider’scommitmenttostaff

trainingandtechnologyuse.NewCourtlandalsohasoutfitteditssevennursingfacilitieswith

stateoftheartvideoconferencerooms.Furthermore,NewCourtlandispilottesting“Upstairs

Solutions”(www.upstairssolutions.com),acomprehensive,interactiveonlineweb-basedtraining

andcompliancesystemfornursesandseniorcareprofessionals.Itallowsforcollaboratedistance

learningandmulticastingofNewCourtlandevents.Thevideoconferencingtechnologyalso

hasenabledNewCourtlandtobeginapilotprogramwithphysicianstoremotelyinteractwith

patientsinnursinghomes.

NewCourtlandhasusedtheteleconferencingequipmentinoneofitssocializationprograms,

calledComfort&JoyTM.Inamulti-yearprojectwiththeMulticulturalYouthExchange

(MYX),olderresidentsarepairedwithlocalstudentstocreatequiltsbasedontheirsharedlife

experiences.Eachpaircraftsapatchofquiltandrecordsthoughtsandfeelingsontheircreation

viavideoconference.PatchesfromeachNewCourtlandNetworknursinghomewillbesewn

togethertocreatesevendifferentquilts,whichinturnwillbesewnintoonelargequilt.Aweb

pagealsowillbecreatedcontainingapictureofeachquilt’spatchandalinktotherecorded

messagefromtheelderandstudentartiststhatstitchedit.Plansalsoareintheworkstocreate

quiltsviavideoconferencewithotherintergenerationalgroupsoverseaswithinthenexttwoyears.

5.1.5 VNA of Western Pennsylvania

BasedinruralButler,Pennsylvania,theVNAFamilyofServicesconsistsoffivedivisions

includingVNA,WesternPennsylvania,VNAHospice,VNACompleteCare,VNAMedical

EquipmentandSupplies,andVNAHomeTech.SpecializedareaswithintheVNAFamilyof

Servicesincludehomehealthcare,hospice,personalcare,privateduty,healthandwellness

services,homemedicalequipmentandhometelemonitoring.VNAofWesternPenn.isanother

exampleofahomecare’searlyadoptionoftechnologytoenhanceservicestoolderadults.


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Home Telemonitoring:

Since2002theVNAofWesternPenn.hasbeenutilizingHoneywell’sHomMedhome

telemonitoringtechnology(www.hommed.com).WiththehelpofaUSDepartmentof

Agriculture(USDA)grantof$500,000overseveralyears,theVNAwasabletopurchase

telemonitoringequipmentandcreatearobusttelemonitoringprogramforitsservicearea.Most

ofitstelemonitoringpatientsareMedicareFee-for-Service,whileseveralreceivereimbursement

throughaMedicaidManagedCareinsurer,GatewayHealthPlan.Todate,theVNAhasone

patientinthePDA60+WaiverTeleCareprogramthroughtheButlerCountyAreaAgencyon

Aging,buthopestoincreasethatnumbersignificantlyoverthenextcoupleofyears.

Onaverage,200oftheVNA’spatientsaregettingacheck-upeverydayintheirownhomes.

WiththeHomMedsystem,theyareabletogatherclinicaldataregardingtrends

inindividuals’healthstatus.Theunitsareindividuallyprogrammedforpatients

accordingtoparametersestablishedbytheirpersonalphysicians.TheVNA’s

technicianssetuptheunitandteachthepatienthowtouseit.Atthesametime

eachday,avoicepromptwillinstructthepatienttotakevitalsignssuchas

weight,bloodpressure,pulse,oxygensaturationandtemperature.Thevoiceguidesthepatient

step-by-stepthroughtheprocessofpushingoneofthreecolor-codedbuttonsthatenablethe

systemtocollectvitalsignsdata.DataiscollectedeachdayandtransmittedtotheVNAwhere

trainedstaffreviewstheresults.Ifanyvitalsignsfalloutsideofthereadingsthephysicianhas

recommended,theunitwillsignalcliniciansandalertthemtothepatient’scondition.The

problemcanthenbeidentifiedandtreatedbeforeitbecomesserious.TheVNAalsoprovides

physicianswithweeklyormonthlygraphsofeachpatient’svitalsigns.Thesereportsallow

physicianstoseesubtlechangesinconditionsandschedulefollow-upofficevisitsaccordingly.

TheVNAofWesternPenn.iscarefultoinformpatientsthatthetelemonitoringsystemisnot

meanttoreplace,butrathertocomplementvisitsbytheVNAhomecareprofessional.The

systemallowsthemtomonitorhowthepatienthasbeendoingonadailybasisevenifthey

aren’tvisitingthehomeeveryday.TheVNAfocuseditsuseoftelemonitoringmostlyon

diagnosisgroupssuchaschronicheartfailure,diabetesandCOPD,wheretheyhavefoundthe

greatestreductioninrehospitalizationratesbecauseofthetechnology.Theyarefurtherfocused

onpreventinghospitalizationforthoseindividualswhoareintheearlierstagesoflivingwith

chronicconditions.

Typically,theVNAofWesternPenn.phasestelemonitoringtechnologyintoaperson’scareplan.

Whenbeginningapatientontelemonitoring,theagencywillmaintainatwoorthreein-person


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visitsperweek.Oncethepatienthasadjustedtousingtheequipmentandvitalsarebeingread

andtransmittedaccurately,theVNAwilltypicallyreduceitsin-personvisitstooneperweekbut

withdailyvitalsmonitoringandfrequentphonecontact.

TheVNAfoundthattelemonitoringforhealthvitalsisawin-win-winforpatients,providersand

payers.Itprovidesthepatientwithconstantmonitoringthatoffersminimalinterferencewith

theirdailyactivitiesandhasprovenaneffectivemeasureforpreventinghospitalre-admittance

andcontrollinghealthcarecosts.Itoffersthepatient’sfamilypeaceofmindknowingthattheir

lovedoneisbeingcloselymonitoredinthehomebyhealthcareprofessionalsonaconsistent

basis.Andlastly,itallowsprimarycarenursesandphysicianstofocusontreatingthepatient’s

conditionratherthanthedetailsofdiagnostictesting.Inaddition,theVNAfoundthatthe

technologyhelpspatientstodirectlyseetheresultoftheirpersonaldecisionsandlifestyleactions

(e.g.,dietary)andempowersthemtomakemorehealthydailylifestyledecisions.

Inoneexample,telemonitoringtechnologywassuccessfullyusedwithanoldermanwhohad

beeninandoutofthehospitaltwoormoretimesamonthforsixmonths.Hewasbedfastwith

multipleexacerbationsfromheartfailure.ThroughtheVNA’sservicemodelmadepossiblewith

telemonitoring,thisgentlemanstayedoutofthehospitalforaperiodexceedingsixmonths,

whenhewasdischargedfromtheagencysincehewasnolongerhomebound.Hereportedlywas

abletoagainenjoyhisfavoritehobbyoffishing.Inanotherexample,anoldermanstillworking

inhisowncompany,usesthemonitoringequipmenteveryMonday,WednesdayandFriday.If

themonitoridentifiesaproblemtheVNAwillcallhim.Asaresult,heisagainabletogetup

everydayatsixa.m.andworkasixtotenhourday,fivedaysaweek.Hestatedinaninterview

withnewsmediainastoryaboutthetechnologythat“mylifeisbetterbecauseoftheVNA;

they’vehelpedmekeeponliving.”

Medication Compliance and Monitoring

TheVNAofWesternPenn.alsohasutilizedmedicationcomplianceandmonitoring

systemswithitsclients,includingtheMD.2™,Honeywell’sMedPartnerandmost

recentlytheMedReady(www.medreadyinc.com).TheVNAbelievessuchdevicesarean

integralpartofanin-homecaremodelandplanstoincorporatethemintoitsservices

whereverappropriate.TheyhavefoundtheMedReadydeviceparticularlyaffordable,

easytouseandcompact.


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5.1.6 Provider Record Systems Integration

Someagingservicesprovidersintegratedpointofcare(POC)systems,electronichealthrecord

systemsandpharmacysystemswitheachotherandwithotherhealthcareproviderstoimprove

managingandutilizingkeyresidenthealthinformationandprovidebetterqualityofcare.Afew

ofthesearebrieflyhighlightedbelow.

Integration of Electronic Health Records with Health Care Systems

PHI Retirement and Senior Care Services,basedinDillsburg,Penn.istheparentcompanyof

PresbyterianHomes,Inc.andemploys2400peoplein14communities.PHIisimplementing

majortechnologyinitiativesincludingawirelessinfrastructure,anelectronicmedicationdelivery

system,anelectronicpoint-of-caresystemandintegratedsecurityandwanderingsystems.Its

philosophyregardingtechnologyhasbeentoavoidthe“cuttingedge”butstayonthe“leading

force”oftechnologyadoption.

PHIisontheleadingedgeofintegratingitselectronichealthrecordswithregionalhealth

systems.OneinitiativeintheLehighValleyiswithSaintLuke’sHealthSystem.PHInowisable

toreceivetheelectronicrecordsofupto700residentsfromfourhospitalsinthehealthsystem.

Itiscurrentlydevelopingitscapacitytoexchangeelectronichealthrecordsfromitslong-term

carecommunitiestothefourhospitals.

Inalargerregionalinitiative,PHIislikelytobethe“beta”long-termcareparticipantinthe

KeystoneHealthInformationExchange(www.keyhie.org).LedbyGeisingerHealthSystem,the

KeyHIE™formedin2005andnowinvolvesseveralhealthsystemsandphysiciangroupsinrural

NorthcentralPennsylvania.Undertheplannedinitiative,PHI’ssixlong-termcarecommunities

willbelinkedtoallparticipatinghealthcarefacilitiesandphysicianstoexchangecompletehealth

recordsinformation.Thiswillprovidethe“fullcontinuum”ofhealthcareintheregionalhealth

informationexchangedemonstration.

Point of Care Systems Integration with Health Care Providers

Phoebe Ministries,whichhas16communitiesthroughouteasternandcentral

Penn.offeringlong-termcare,short-termrehabilitation,respitecareand

programsforthosewithcognitiveimpairment,isworkingtotakeitsPOC

systemtothenextlevel.ItiscurrentlyimplementingthePointClickCare

electronicmedicalrecord-likePOCsystem(www.pointclickcare.com).

PointClickCareallowscaregiverstotrackvitalstatistics,recordcareplansand

doallrecordkeepingonwirelesstouch-screentabletsorlaptopcomputers.


34

It also has certain electronic medical record and electronic medication administration record

capabilities. Phoebe Ministries is in the process of making sure the system meets the health

record information needs of residents’ physicians. To do so, Phoebe has partnered with a

physician who provides medical care to residents living at its Allentown campus to be closely

involved in the implementation rollout of the POC system. Phoebe Ministries also is seeking to

tie the PointClickCare system with information from acute care referrals. Its goal is to begin

the process of gaining the buy-in of physicians and hospitals with the POC system they are now

implementing in order to position themselves to more readily take advantage of the benefits of a

full electronic medical system when it becomes available.

Multiple Systems Integration

Wesley Enhanced Living (WEL), an aging services provider based in Southeastern Penn. with

seven senior living communities, is actively engaged in integrating technology at several levels.

Among its key platforms are AccuNurse by Vocollect Healthcare

Systems (http://healthcare.vocollect.com), PointClickCare

(discussed above), and an external pharmacy system used by

Synergy Pharmaceuticals. Ken Franiak, WEL’s CFO, when

speaking about the need for technology integration in aging

services, stated that “we are an information-driven business and

we have no information. Essential information is everywhere but not together in one place where

we can press a button and get what we need.”

AccuNurse is a voice-driven communications, care management and documentation tool that

opens a two-way dialogue between care staff and the resident care plan information. With simple

voice requests, staff can hear plan of care details and document activities as they are

completed. Providers have found the system to lower operating costs (e.g., higher

staffing efficiency) while providing better quality of care. At first WEL leadership

found that nurse aides did not want to use the AccuNurse technology and felt it

was imposed upon them. Once the purpose and usefulness of the system was better

understood and care staff became more comfortable with the system, they found it

to be an invaluable tool in providing care to residents.

Wesley Enhanced Living applied what it learned about the importance of seeking

care staff buy-in at the outset of technology selection to its search for a robust point

of care and electronic records system. In this case, executive staff had one system in

mind but gave the choice to care staff who favored PointClickCare.

“We are an information-driven business and we have no information. Essential information is everywhere but not together in one place where we can press a button and get what we need.”

– Ken Franiak, CFO, Wesley Enhanced Living


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WELworksdiligentlywithallitstechnologyvendorsandpartners,includingitspartner

pharmacynetwork,toefficientlyinterfaceitsmultiplesystemswithoneanother.Itbelieves

takingtheintegrationapproachfromthebeginningofmajorsystemadoption,suchas

PointClickCare,iscrucialtosuccessfulintegration.WEL’spointofcareandelectronicrecords

systemsupportsthepharmacysystem’sinventorytracking,eRxordersandpostingofcharges.

5.2 Public Aging Services Programs

Pennsylvania’snetworkof52AreaAgenciesonAging(AAAs)isavitallinktoagingservices

formanyolderPennsylvanians,particularlylow-incomeseniors.Theagingnetworkhasbeen

increasinglyfocusedonwaystoleveragevarioustechnologiestobetterservethispopulationand

reachmorepeoplewithlimitedpublicresources.Asdiscussedinsection4.1.2AAAshavebeen

involvedinshapingtheCommonwealth’sMedicaidWaiverTeleCareProgram,andwillbesolely

responsiblefordevelopingcontractswithproviderstochannelreimbursementsfortechnology

useintheprogram.Alsodiscussedaboveinsection4.1.3,thenetworkiscurrentlyimplementinga

videoconferenceequipmentandtraininginitiative.

InrecentyearsthestateDepartmentofAgingchangeditselectroniccareplanningandassessment

systemtoanewin-houseweb-basedinterfacenamed“Agenet”fortheSocialAssistanceManagement

System(SAMS)(www.harmonyis.com).CaremanagersatAAAsuselaptopstoconductelectronic

consumerneedsassessmentsinthefield.

ManyAAAshavebeeninvolvedinplanningorimplementingvariousagingservicestechnology

initiatives,someofwhicharehighlightedinafewexamplesbelow.

5.2.1 Allegheny County Area Agency on Aging

TheAlleghenyCountyAreaAgencyonAging,basedinPittsburgh,isaproactiveadvocate

forincorporatingtechnologyintocareforolderadults.Whiletheagencytodatehasmostly

providedonlythosetechnology-enabledservicesthathavebeenreimbursedthroughthe

priorAgingWaiver,includingpersonalemergencyresponsesystems(PERS)andmedication

dispensers(seetablebelow),itispreparingtomoveaheadwiththebroaderarrayofaging

servicestechnologiestobereimbursedinthenewMedicaidWaiverTeleCareprogramaswellas

withtheuseofdiscretionaryfundsfortelehealthtechnology.

AlleghenyCountyleadershipassertedthatseveraloperationalchallengeswiththedraftMedicaid

TeleCarepolicyarebeingaddressedintherevisedpolicyinthenewwaiver.Theybelievethere

aretwopossiblereasonswhyagingservicestechnologieshavenotyetexperiencedgreater

growthwithitstargetpopulation:thereseemstobegreaterresistanceorlessreceptivitytothese

technologiesbylower-incomeolderadults;andthearea’shousingstockisamongtheoldest


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inthenationwhichpresentscertaintechnicalchallenges.Toovercomethesechallengesthey

emphasizetheneedforthoroughtrainingofstaffandconsumers.Forstaffandprovidertraining

theybelieveitwillbeimportanttodemonstratehowthevarioustechnologiescanbeusedinthe

home.Whiletherewillbealearningcurve,theagencydoesnotanticipatesignificantbarriers.

Intermsofconsumerorientationandtraining,theagencyanticipatesitwillneedtomonitor

thecomfortofconsumersverycloselyandgraduallychangetheworkflow(numberofvisits)

accordingtoconsumers’levelofcomfortwiththetechnologyandthenewmodelofcare.

Allegheny County AAA TeleCare Activities(prior to new expanded TeleCare reimbursement program)

Program Service DeliveryJune 2008

(Unduplicated consumers)

Service DeliveryFY 07 – 08

Annual CostFY 07 – 08

Options Program (non Medicaid)

Options PERS monthlymonitoring fee

528 715 $154,345

Medicaid Waiver Program

Waiver Program PERSmonthly monitoring fee

653 854 $194,393

Medication Set-up by Pharmacist(Service cost is only for monthly medication dis-penser)

46 60 $ 20,765

Med Dispenser Home Health–LPN*

30 - $ 46,644

Med Dispenser Home Health–RN*Skilled Nursing

5 - $ 8,316

Total costs $424,463

*Most RN and LPN prescription visits involve multiple services and are not solely made for the purpose of filling med dispenser. For example, checking vital signs or changing a dressing could also be included.

Four-Year Agency Plan Focused on Aging Services Technologies

OneofAlleghenyCounty’sfivegoalsdetailedinitsrecentfour-yearplanistoimplement

assistivetechnologyandtelecareservicesinsupportofin-homeservices.Thisisanexcellent

exampleofhowapublicagingservicesprogramcanbeintentionalaboutincorporatingtheuse

oftechnologyintoitsregularprocessofprovidingcaremanagementandintoitsexpectationsfor

careproviders.


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Thefirstobjectiveofthisgoalistomakecurrentandemergingtechnologiesavailableto

consumersbydevelopingandimplementinganongoingcost-benefitandevaluationprocess

basedonobjectivefactorssuchasequipment,training,personnelandalternativeplacement

costs,andsubjectivefactorssuchasconsumerinput.Itsstrategiestoaccomplishthisobjective

are:

• CreateatechnologyteamincludingAAAstaff,providers,communityexpertsandconsumers

toadvanceandevaluateimplementingassistiveandtelecaretechnologyresources.

CoordinatewiththeCarnegieMellonUniversityandUniversityofPittsburghQualityofLife

Center,andtheTelerehabilitationResearchCenterattheUniversityofPittsburgh.

• Correlatetechnologiestoserviceareasincludinghealthstatusmeasuringandmonitoring,

activityandsensormonitoring,andpersonalemergencysystems.

• Adjustutilizationofassistiveandtelecaretechnologysystemsbasedontheireffectivenessin

maintainingqualityoflifeandsafeconsumerindependence.

Thesecondstrategicobjectivesetforthbytheagencyistoestablishastrongnetworkof

providerstofullyimplementtheseinnovativeservicessothattheywillcomplementtraditional

homecareservices.Toaccomplishthisobjectivetheagencyplanstoidentifyandputinplace

providerswiththeresourcesandexpertisetoeffectivelyprovideassistivetechnologyandtelecare

servicestoconsumers.

AlleghenyCounty’sthirdstrategicobjectiveistoeducateAAAandproviderstaff,especiallycare

managersandnurses,tofullyunderstandthepotentialandapplicationsofassistiveandtelecare

technologiesusedtosupportconsumersseekingtoremainindependent.Toaccomplishthis,the

agencyplanstotrainstaffanddevelopimplementationguidelinesforassistivetechnologyand

telecareservicesincludingthespecificcriteriaforappropriateconsumerutilization.

Theoutcomestheagencyisseekingfromthesestrategicactionsare:

• Consumerswillhaveaccesstoappropriateassistivetelecaretechnologyservicestohelp

sustainandpromotetheirindependence,andfacilitateearlyidentificationandintervention

regardinghealthproblems.

• Useofassistiveandtelecaretechnologyserviceswillconservepersonalresourcesof

consumersinhelpingthemtomaintaintheirqualityoflife.

• Newassistiveandtelecaretechnologieswillcontinuetobedevelopedandmadeavailablefor

consumeruse.


��

5.2.2 Bradford, Sullivan, Susquehanna and Tioga Area Agency on Aging

WhiletheB/S/S/TAAAhasbeeninvolvedinexploringtechnologiesonavarietyoflevels,what

moststandsoutisitsroleasabetasiteforthePennsylvaniaDepartmentofAging(PDA)virtual

caremanagementpilotprogramdubbed“PDAVirtual”(seesection4.1.8).TheB/S/S/TAAA

reportsitisfacingasharpriseindemandforitsserviceswhilefundinghasseenonlyhadmodest

increases.AccordingtoprojectionsdevelopedbythePDA,thenumberofadultsage85and

olderintheB/S/S/TAAAfour-countyserviceareagrewfrom2,949in2000to3,534in2006,a20

percentincrease.

Aspartofthe“PDAVirtual”pilotprojectfundedbythestate,fiveaffordablehousingand/or

seniorcenterlocationsinthetownsofSayre,Dushore,Westfield,MansfieldandLanesborowill

soonbecomesiteswhereseniorcitizenswillbeabletousehigh-techequipmenttointeractwith

socialworkersandbeconnectedtotheservicestheyneed.TheSayrelocationwillbeatKeystone

Manor,anaffordablehousingcommunityownedbythePennsylvaniaHousingAuthority.The

Westfield,LansboroandDushorelocationsareallaffordableseniorhousingcommunitiesand

seniorcenters.

UsingtechnologyandaservicepackagebyAgeServeCommunications(www.familyvirtualvisits.

com)includingflat-screentelevisionsets,Internet-controlledcomputers,andecho-canceling

microphones,camcordersandspeakers,olderadultswillbeabletoapplyformedicalassistance,

PACE,propertytaxrebates(andotherentitlementprograms)withthehelpoftheAAA’ssocial

workersfromfourofficelocationsinTowanda,Montrose,LaporteandWellsboro.Thevirtual

visitswillreducetraveltimebybothsocialworkersandolderadults,becausetheywillnothave

totraveltoseeeachother,andwillsaveongascosts.

Thesametechnologywillallowolderadultsattendingthecenterstovisitwithfamilymembers

forfree.Participatingfamilymembersneedaccesstobasictechnologyincludingapersonal

computer,ahigh-speedInternetconnection,awebcam,andamicrophonetohaveavirtualvisit.

Visitscanbescheduledonlineandtheolderadultwillonlyneedtobepresentatthescheduled

timeandthetechnologywillautomaticallyturnon.

B/S/S/TAAAleadershipplanstoinstallthetechnologyatotherlocations,ifpositiveconsumer

resultsareforthcomingfromthefirstfivelocationsandiffundingisavailable.Theagencyis

alsoworkingwithNorthPennLegalServicestoconductvideoseniorlegalcounselingservices

throughthevirtualcenters.


��

5.2.3 Clearfield County Area Agency on Aging

ClearfieldCountyAAAisaveryruralagencyincentralPennsylvania.Assuch,effectiveuseand

proliferationofagingservicestechnologiesofferstremendousvaluetoisolatedolderadultsin

ruralareasandpermitsthemtoremainsafelyintheirhomes.Initsrecentfour-yearplan,the

agencystatesthattechnologyisa“necessity”anddeclaresitsintentto“usetechnologytoits

fullest.”TheagencywasamongthefirstAAAstotakeadvantageofthestate’sMedicaidwaiver

TeleCaredemonstrationprogram.

ClearfieldplayedakeyroleinbetatestingtheDepartment’snewcentralizedweb-based

assessmentandcaremanagementsystem.Stafftrainingonspecific,appropriatejobcomponents

ledtoacceptancebystaffandwasconsideredsuccessful.Akeyfeatureisthe“alwayson”

functionalityfortheadultprotectiveserviceprogramthatoperates24/7.On-callstaffcanpull

upaclient’scaremanagementrecordsandtriagethecareneedtoappropriateserviceproviders.

ClearfieldCountyalsoisoneofthefewAAAstousetheBeaconIRelectronicinformationand

referralsystem(www.synergysw.com)andhopestoupgradetotheBeaconWebweb-based

systemfor24/7capability.

TheagencybeganutilizingthenewMedicaidwaiverTeleCareprograminApril2008yearusing

QuiteCare(www.quietcare.com),andcurrentlyhasfourconsumerhomesoutfittedwiththe

motionsensortelemonitoringsystem.AlertsregardingabnormalitiesinADLstypicallygofirst

totheAAA-contractedprovideragencybutalsototheAAAcaremanagementstaff.TheAgency

hassetprotocolsforresponsetimebyproviders,uniquelydeterminedforeachindividualolder

consumer.Dependingonanolderadult’ssupportnetwork,familymaybethefirstcontact,then

careproviders.

TheClearfieldAAAhasnotyetbegunusingvitalsignsmonitoringtools,butispresentlyexamining

opportunitiesandintendstoskippilottestingandproceedwithfulladoptionasappropriatefor

itsconsumers’needs.Theagencyfeelsitisnotaquestionofifthetechnologyworksorhasbenefit,

butratherisamatterof“hittingastridewithit,”orlearninginwhichcareenvironmentsitworks

thebesttomeetconsumers’needsandwhereitisnotaseffective.Clearfieldhasbeenusing

medicationmanagementforacoupleofyearsthroughtheMedicaidwaiver.Whileithasfoundthe

technologybenefitsmanyconsumers,italsofoundthatitdoesnotworkforeveryone(i.e.,those

whoarenotcognitivelyabletorespondtotheautomatedcues).


�0

6. unIversITy agIng servICes TeChnology researCh InITIaTIves and ProvIder ParTnershIPs

Theworkofresearchuniversitiesiscriticaltoassessingthestateoftechnologyofagingservicesin

Pennsylvania.CASTbelievesthatrobustresearchinpartnershipwithagingservicesprovidersina“living

testbed”approachiscrucialtoeffectiveproliferationofthesetechnologies.Pennsylvaniaclearlyhasthat

kindofresearchcommunityasdiscussedbelow.

6.1 Carnegie Mellon and University of Pittsburgh Quality of Life Technology Center

VerymuchinlinewiththeCAST“CenterofExcellence”model,theQualityofLifeTechnology

(QoLT)Center(www.qolt.org),apartnershipbetweenCarnegieMellonUniversity(CMU)andthe

UniversityofPittsburgh,isaNationalScienceFoundationEngineering

ResearchCenter(ERC).Itsmissionistotransformthelivesofpeople

withreducedfunctionalcapabilitiesduetoagingordisability.The

QoLTbringstogetheracross-disciplinaryteamoftechnologists,

clinicians,agingservicesproviders,industrypartners,endusers

(i.e.,olderadults),andotherstakeholderstocreaterevolutionary

technologiesthatimproveandsustainthequalityoflifeforallpeople.Its

fourprimarygoalsareto:

• Enablepeoplewhoareagingandpersonswithdisabilitiestoindependentlyparticipateinthe

community

• Assistprofessionalandinformalcaregivers

• Delayorpreventthemanifestationoffunctionalimpairment

• Empowerallpeopletocontributetosocietyandtheeconomy

TheCenterbelievesthatbyintegratinginformationtechnologiesandbiomedicalinnovations,the

resultingsystemsallowpeopletoindependentlyperformvaluedandnecessaryactivitiesofdaily

livingsothattheycanmorefullyparticipateinsociety.Futurecompassionateandintelligent

QoLTsystemsrangingfromindividualdevicestotechnology-richenvironmentswillmonitorand

communicatewithpeople,understandtheirneedsandprovidesafe,reliableandwelcomeassistance

bycompensatingorsubstitutingfordiminishednaturalhumancapabilities.Technologiesdeveloped

bytheQoLTCenterareaimedatenablingpeopletolivemoreindependently,pursueindividualgoals

andmorefullyparticipateinsociety.

Research Partnerships with Aging Services Providers

QoLTiscombiningsensing,perception,robotics,machinelearning,

communicationsandminiaturizationtechnologieswithadvancesin

rehabilitationandgeriatricstodevelopnewcapabilitiesthatimprovelives.

Mostimportantly,theCenteriscreatinganewscientificandengineering

knowledgebasethatenablessystematicdevelopmentofhuman-centered

intelligentsystems.Todoso,theQoLTpairsitsknowledgeresourcesin

robotics,rehabilitationengineeringandrelatedclinicalareaswithreal-world

testbedproviderpartnersincludingindependentlivingprograms,nursing

homes,vocationalrehabilitationcentersandotherlivingenvironments.As

mentionedabove(seesection5.2.1)theAlleghenyCountyAreaAgencyon

AgingisactivelyplanningacollaborationwiththeQoLTtobetheresearchpartneronitstechnology

teamincludingAAAstaff,providers,communityexpertsandconsumerstoadvanceandevaluatethe

implementationofassistiveandtelecaretechnologyresources.Anotherproviderpartnershipiswith

theCommunityLife-LivingIndependentlyforElders,aPACEPrograminWesternPenn..The

QoLTwillworkwiththeLifeprogramtointroduceandevaluateemergingtechnologiesforthose

livingindependentlybutreceivingremoteservices(e.g.,Medicare/Medicaid)asanalternativeto

nursinghomecare.

Throughthesepartnerships,theQoLTworkstoexaminetheimpactofqualityoflifetechnologieson

individuals,healthcareenterprisesandsocietyasawhole.

Education

TheCenter’seducationgoalistofacilitateagrowingcommunityofengineers,scientists,

practitionersandconsumerswhoareintellectuallypreparedandmotivatedtocreate,assessand

applytechnologythatbenefitspeoplewithdisabilitiesandolderadults.Itseducationactivitiestarget

thefullspectrumofpopulationgroups:K-12,undergraduate,graduate,postgraduate,industry,

end-usersandthegeneralpublic.QoLTparticipatesinandproducesworkshopsandconferenceson

QoLT-relatedthemesforawideaudience,particularlyprospectiveendusersandsupportproviders.

Theseactivitiesservetoincreaseawarenessofqualityoflifetechnologiesamongthosestakeholders

andtoinformitsresearchabouttheirneedsandrequirements.

IntheCareMediaproject,QoLTisdevelopingmachineperceptionfortrackingindividualsandmeasuringactivitiesofdailyliving




�1

Research Partnerships with Aging Services Providers

QoLTiscombiningsensing,perception,robotics,machinelearning,

communicationsandminiaturizationtechnologieswithadvancesin

rehabilitationandgeriatricstodevelopnewcapabilitiesthatimprovelives.

Mostimportantly,theCenteriscreatinganewscientificandengineering

knowledgebasethatenablessystematicdevelopmentofhuman-centered

intelligentsystems.Todoso,theQoLTpairsitsknowledgeresourcesin

robotics,rehabilitationengineeringandrelatedclinicalareaswithreal-world

testbedproviderpartnersincludingindependentlivingprograms,nursing

homes,vocationalrehabilitationcentersandotherlivingenvironments.As

mentionedabove(seesection5.2.1)theAlleghenyCountyAreaAgencyon

AgingisactivelyplanningacollaborationwiththeQoLTtobetheresearchpartneronitstechnology

teamincludingAAAstaff,providers,communityexpertsandconsumerstoadvanceandevaluatethe

implementationofassistiveandtelecaretechnologyresources.Anotherproviderpartnershipiswith

theCommunityLife-LivingIndependentlyforElders,aPACEPrograminWesternPenn..The

QoLTwillworkwiththeLifeprogramtointroduceandevaluateemergingtechnologiesforthose

livingindependentlybutreceivingremoteservices(e.g.,Medicare/Medicaid)asanalternativeto

nursinghomecare.

Throughthesepartnerships,theQoLTworkstoexaminetheimpactofqualityoflifetechnologieson

individuals,healthcareenterprisesandsocietyasawhole.

Education

TheCenter’seducationgoalistofacilitateagrowingcommunityofengineers,scientists,

practitionersandconsumerswhoareintellectuallypreparedandmotivatedtocreate,assessand

applytechnologythatbenefitspeoplewithdisabilitiesandolderadults.Itseducationactivitiestarget

thefullspectrumofpopulationgroups:K-12,undergraduate,graduate,postgraduate,industry,

end-usersandthegeneralpublic.QoLTparticipatesinandproducesworkshopsandconferenceson

QoLT-relatedthemesforawideaudience,particularlyprospectiveendusersandsupportproviders.

Theseactivitiesservetoincreaseawarenessofqualityoflifetechnologiesamongthosestakeholders

andtoinformitsresearchabouttheirneedsandrequirements.



TheNursebot,evaluatedwiththehelpofpartnerPresbyterianSeniorCare,isaprototypepersonalrobotassistant


��

Technology Partnerships

TheQoLTalsohasformedaconsortiumoftechnologycompanieswhoshareitsvisionoftechnology

enablingolderadultsandpeoplewithdisabilities.Currentmembersare

engagedinassistivetechnology,medicalgoodsanddevices,information

technology,robotics,consumerelectronicsandappliances,healthcare

products,andhealthservices.TheQoLTCenterisavehicleforcorporate

interactionbothacrossandwithinthosemarkets,providingopportunities

forcompaniestoshareinformationwhileprotectingconfidentiality.

Consortiummembersactivelyparticipateinthecenter,helpingshapeboth

thelongandnear-termresearchagendas.Theyenjoyfacilitatedaccessto

theCenter’sfaculty,students,testsitesandend-users.Throughunique

licensingprograms,membersathighergradescanquicklytranslatethecenter’sresearchresultsinto

practice.

QoLT Foundry – Commercialization and Start-Up Companies for ASTs

WithagrantfromtheBenedumFoundationandinitialfinancialsupportofCMU’sVicePresident

forResearch,the“QoLTFoundry”wasestablishedinMarch2008asapilotprogramtoaccelerate

thecommercializationofresearchprojects

associatedwithQoLTandtoadvancethe

proliferationofagingservicestechnologiesand

technologycompanies.TheFoundryisled

byanexecutive-in-residencewithexperience

asafounderofatechnologystart-upand

hasheldmanagementrolesinthemedical

deviceindustry.StudentsintheMBA,law,

engineeringtechnologyinnovation,healthcare

policy,andbiotechnologymanagement

programsatCarnegieMellonandthe

UniversityofPittsburghassisthim.

Thefirstobjectiveistorigorouslyqualifynew

productconceptsintermsoftheirgenuinemarketpotential.Thisprocesswilltakeseveralfactors

intoaccount.Technicalfeasibilityanddevelopmenttimewillbeassessedbygroupsofresearchers

withaggregateexpertiseintherequisitetechnologies;marketpotential,sizeandavailabilityof

WithpartnerBlueroofTechnologies,QoLTiscreatingintelligenthomesandneighborhoodsthatsupportindependentliving


��

Technology Partnerships

TheQoLTalsohasformedaconsortiumoftechnologycompanieswhoshareitsvisionoftechnology

enablingolderadultsandpeoplewithdisabilities.Currentmembersare

engagedinassistivetechnology,medicalgoodsanddevices,information

technology,robotics,consumerelectronicsandappliances,healthcare

products,andhealthservices.TheQoLTCenterisavehicleforcorporate

interactionbothacrossandwithinthosemarkets,providingopportunities

forcompaniestoshareinformationwhileprotectingconfidentiality.

Consortiummembersactivelyparticipateinthecenter,helpingshapeboth

thelongandnear-termresearchagendas.Theyenjoyfacilitatedaccessto

theCenter’sfaculty,students,testsitesandend-users.Throughunique

licensingprograms,membersathighergradescanquicklytranslatethecenter’sresearchresultsinto

practice.

QoLT Foundry – Commercialization and Start-Up Companies for ASTs

WithagrantfromtheBenedumFoundationandinitialfinancialsupportofCMU’sVicePresident

forResearch,the“QoLTFoundry”wasestablishedinMarch2008asapilotprogramtoaccelerate

thecommercializationofresearchprojects

associatedwithQoLTandtoadvancethe

proliferationofagingservicestechnologiesand

technologycompanies.TheFoundryisled

byanexecutive-in-residencewithexperience

asafounderofatechnologystart-upand

hasheldmanagementrolesinthemedical

deviceindustry.StudentsintheMBA,law,

engineeringtechnologyinnovation,healthcare

policy,andbiotechnologymanagement

programsatCarnegieMellonandthe

UniversityofPittsburghassisthim.

Thefirstobjectiveistorigorouslyqualifynew

productconceptsintermsoftheirgenuinemarketpotential.Thisprocesswilltakeseveralfactors

intoaccount.Technicalfeasibilityanddevelopmenttimewillbeassessedbygroupsofresearchers

withaggregateexpertiseintherequisitetechnologies;marketpotential,sizeandavailabilityof

CarnegieMellonandUniversityofPittsburghQualityofLifeTechnologyCenter’sIllustratedResearchModel


��

competingproductswillbegaugedbypartnerserviceproviders;andtime-to-marketwillbe

estimatedbybusinessexpertsincludingtheIndustrialAdvisoryBoardandotherkeyopinionleaders.

Theproductconceptswillbeputthroughduediligence:intellectualpropertyevaluationandmarket

analysis,pricepointanalysisandpreliminarybusinessmodeldevelopment.Thentheprojectsare

evaluatedbyanadvisorygroupcomprisedofexecutivesinindustry,investorsandrepresentatives

oflocaltechnology-basedeconomicdevelopmentorganizations.Thefoundrywillworkwitheach

CentertoidentifyandcreateanIndustrialandPractitionerAdvisoryBoard(IPAB)andotherKey

OpinionLeaders.

Thepurposeofthescreeningphasesdescribedaboveistoevaluateopportunitiestocreatestart-

upcompanies.TheQoLTFoundry’ssecondobjectiveistoform companies that actually pursue the

identified opportunities.Thechallengesofthatstepwillbedramaticallyreducedbythevisibility

andtransparencyofthisprogramtothetechnologists,entrepreneursandeconomicdevelopers

whoactivelyparticipateintheprogram,aswellasothersinthecommunity,allofwhomwillshare

firsthandknowledgeofthesequalifiedbusinessopportunities.TheQoLTFoundryteamwillreach

outtothemtomatchpeoplewithproducts.

TheFoundryhasestablishedworkingrelationshipswithregionalentrepreneurs,investorsand

technology-basedeconomicdevelopmentorganizationsthatprovidecapitalandseedfunding,

businessexpertise,andothervitalresourcestostart-upcompanies.InJune2008,severalQoLTnear-

termcommercializationopportunitieswerepresentedtoagroupofmorethan30organizations.

TheQoLTFoundrywillfacilitatethecommercializationprocessbyprovidingsupportthrough

businessplancreation,prototypedevelopment,establishingstrategicrelationships,buildingqualified

andexperiencedmanagementteams,andobtainingseedmonies.Currentlyinprogressarespin-off

companiesbasedonQoLTvirtualcoachesandperception/awarenesstechnologies.

Initiatives with the University of Pittsburgh Medical Center (UPMC)

QoLTiscloselyassociatedwiththe$7.3billionUPMCHealthSystemaspartofitscommitmentto

partneringwithhealthcareandhomeandcommunitybasedservicedeliverysystems.TheUPMC

HealthSystemisoneofthelargestacademicallyaffiliatedmedicalcentersintheworld,withits

networkof19integratedhospitalsandmajorclinics,and400outpatientsitesanddoctor’soffices.

Furthermore,theUPMCHealthsysteminitiateda10yearagreementin2002withHighmarkInc.the

region’slargestcommercialinsurerandisitselfacommercialinsurerwithover400,000members.

UPMChasoneofthemostsophisticatedelectronicrecordsanddatamanagementsystemsofany

healthcaresystemintheworldandcurrentlyhasa$400millioneight-yearagreementwithIBMfor

informationtechnologyinfrastructuretoenhanceinnovationandadaptability.


��

TheimpendingagewaveofolderadultsinspiredtheUPMCHealthSystemtoestablishoracquire

17freestandingretirementandlong-termcarefacilitiescaringforapproximately40,000people.

SeveralQoLTresearchershaveestablishedresearchcollaborationswithUPMC’slong-termcare

communitiesandcommunity-basedprograms.

UPMCisexploringanumberofapproachestousetelehealthinthecareofolderadults.UPMC

SeniorLiving,togetherwiththePittSchoolofNursing,Pitt/UPMCInstituteonAgingandtheRand

Corporation,ispilotingtheuseoftelemedicinekiosksinhighriseapartment

buildingsoccupiedprimarilybylow-incomeseniors.Theinitialimplementation

usesViterion100telehealthstations(www.viterion.com)withbloodpressure

andbodyweightperipherals.Withone-touchimplementationandvoice

prompts,theViterion100TeleHealthMonitorguidesthepatientthroughits

functionsincludingmeasuringbloodpressure,bloodoxygen,bloodsugar,

weight,temperatureandpeakflow(lungcapacity).

Sincethebeginningofthepilot,participationhasincreasedfromeightpercenttonearly40percent

oftheresidents.UPMCalsoisusingtelemedicinetomanagecongestiveheartfailurepatients.

InUPMC-managedskillednursingfacilities,newinformaticstechniquesarebeingdevelopedand

appliedtopredictadverseeventssuchasadversedrugreactionsandinteractions.Currentlythe

systemtapspharmacyandlaboratorydatawithclinicaleventmonitors:softwarethatgeneratesalerts

inresponsetodetectedconditions.Furthermore,aprocessisunderwaytoextendthesystemtohelp

detectandsignalelevatedriskoffalling.

6.2 University of Pennsylvania

TheUniversityofPennsylvania(UPenn)SchoolofNursinghasbeenaleaderinresearch,testing

andevaluationoftechnologiestoserveolderadults,primarilyintelehealth.Amongcollegesof

nursing,PennNursingconsistentlyranksnearthetopofthosereceivingfundingfromtheNational

InstitutesofHealth(NIH),enablingPennresearcherstoaffectthecourseofillnessthroughout

thelifespan,promotehealthandincreasediseaseprevention,enhancethequalityoflife,eliminate

healthdisparities,andsetdirectionforend-of-lifecare.Todoso,facultymembershaveadopted

andadaptednewtechnologies,includingtelehomecare.Inseveralofitsevaluativeresearch

initiatives,UPennhaspartneredwiththePennStateUniversityDepartmentofHealthPolicyand

Administrationandwithseveralagingservicesproviders,mostlyhomecare.

Forexample,from1998to2000,UPennresearchersandcliniciansfromtheVisitingNurse

AssociationofGreaterPhiladelphia(VNA)developedexpertiseintelehomecarethroughseveral

researchprojectsconductedattheVNA.ThefirstprojectwassponsoredbytheDepartmentof


��

Commerce’sTelecommunicationInformationInfrastructureAssistance

ProgramnowknownastheTechnologyOpportunitiesProgram.This

project,ledbyaPennStateUniversityresearcher,studiedtheuse

oftelehomecarewithelderlydiabetics.UPennprovidedtheclinical

coordinationfortheprojectandwentontoleadtwoadditionalpilot

projectstoexpandtheuseofthetechnologytocongestiveheartfailure

patientsandtotesttheeffectivenessandefficiencyofavarietyoftreatmentpatternsforelderly

homeboundpatientsrequiringfrequentmonitoringoftheirchronicconditions.

UPennhasutilizedseveraldifferentdevicesforitstelehomecareresearchandpilotstudies,

includingHomMed(www.hommed.com)(see section 5.1.5),

AmericanTelecare(www.americantelecare.com)andCareMatrix

(www.carematrix.com).ItiscurrentlypilotingtheCareMatrix

system.Thecoreproductisawirelessmonitoringsystemforvitals

likebloodpressure,pulse,temperature,weight,etc.Thesystem

consistsofRFenableddevicesthatcommunicatewithahub

locatedsomewhereinthehome.Thehubinterfaceswirelesslywith

multipleperipheralstoguidepatientsthroughseamlessvitalsign

retrieval.Oncethehubreceivesthereading,itispushedviaaphone/PCtotheInternetserverwhere

itisaddedtotheuserschart.Theuserorcaregivercannowtracktherelevantdata,graphit,monitor

trends,annotateitforvariances,setalertcriteriaandreceivealerts.Usersorcaregiverscaneasily

monitorthebasicwellnessparameterslikebloodpressure,pulse,temperature,weightandsugarlevel.

ContinuingwiththethemetouseITtoimprovethecareofolderadults,UPennutilizeditstelehealth

equipmentinaprojectwithchronicheartfailure(CHF)patientsinapartnershipwithPennHome

Care&Hospice,aUniversityofPennsylvaniahomecareagencyandfundingfromtheNIH.Theyare

currentlyintheirfourthyearofclinicaltrialswitholderadultswhohavebeenrecentlydischarged

fromthehospital.Fourvideointeractionsarerequiredtocountasoneepisodeofhomecare.Todate,

160patientsareenrolledintheprogram.EnrollmentswillcontinueasappropriateuntilJuly,2009.

UPennhasseenasignificantreductioninhospitalandemergencyroomuseforparticipantsaswellas

anincreaseinconsumerknowledgeandawarenessofhowtomanagetheirchronichealthconditions.

However,tryingtomakecosteffectivechangepatternsofhomecarehasprovedverychallenging.

InastudyfundedbytheCenterforDiseaseControl(CDC)andincollaborationwiththe

PennsylvaniaHomecareAssociation,UPennsoughttotestevidence-basedpracticeguidelinesfor

homecareagenciesusingtelehealthforchronicdiseasemanagementservicetoolderadultswith

CHFordiabetes.303olderadultsparticipatedinthestudy.UPennconductedanincremental-

interventionanalysis,comparingstandardhomecareservicestohomecarewithphonefollow-upand

tohomecarewithtelehealthfollow-up.

UPennresearcherswenttothevarioushomecareagenciesandtaughtnurseswhen/howtouse

telehealthequipmentaccordingtotheguidelines.Becausetheguidelinesrequired

regularcontactwithparticipant’spractitioners,theresearchersfoundthat

communicationwasamajorimpedimenttosmoothimplementation.Nurses

hadtorelaymessagestophysiciansthroughofficestaff,whichwasoftenavery

inefficientprocess.Thisrevealedjusthowhelpfulanelectronicrecordand

electronictransmissionoftherecordfromhomehealthnursestophysiciansand

visaversawouldbe,ratherthanplayingmedicalphonetag.

Duetothehighlymanagednatureoftheparticipantsselectedforthestudy,researcherswereunable

tofindasignificantreductioninre-hospitalizationratesduetotheuseoftelehealth.Existingre-

hospitalizationratesforthestudygroupwaslow,at17percent.However,inanotherstudyofCHF

patientsservedby10differenthomecareagencies,UPennresearchersfoundsignificantreductionin

re-hospitalizationandanincreaseinconsumerconfidencefromtheuseofbothvideoandnon-video

telehealthservices.

Beginninglatethisyear,UPennwillbepartneringwithNewCourtlandElderServices(see section

5.1.4)onanevaluationofalargetelehealthandtelemonitoringpilotwithupto1000olderadult

participants.Thestudywillbeginwithevaluatingthehealthandqualityoflifebenefitsoftelehealth

biometrictechnology,andpotentiallytoincludetheuseofactivity/wellnessmonitoring.As

discussedabove,theprojectalsowillinvolvephysiciangroupsandislikelytoinvolveinsurance

agencies.

InalargeelectronicheathrecordspilotprojectfundedbyMedicare,UPennwillconductastudyof

theimpactonhealthoutcomesbyusingstandardizedlanguageinelectronicrecordsfor200patients

insuredbyAetnaInsuranceinPennsylvania,200insuredbyBlueCrossinPenn.and300patients

insuredbyKaiserPermanenteinCalifornia.Thepilotwillseektostandardizetheterminologyused

bynursestodescribethecaretheyprovideaswellaspatients’conditions.

Finally,UPenniscurrentlydevelopingresearchontheuseofacommonmass-marketdevice,

theiPhone,togetherwithtelehealthbiometrictoolsforcancerpatientsattheMemorialSloan-

KetteringCancerCenterinNewYorkCity.Onereasonforthepilotistofindabettercare

managementmodeltoavoidunnecessaryandfrustratingappointmentsforpatients.Forexample,

whencancerpatientsgotothehospitalfortheirchemotherapyappointment,sometimesthey


��

CHFordiabetes.303olderadultsparticipatedinthestudy.UPennconductedanincremental-

interventionanalysis,comparingstandardhomecareservicestohomecarewithphonefollow-upand

tohomecarewithtelehealthfollow-up.

UPennresearcherswenttothevarioushomecareagenciesandtaughtnurseswhen/howtouse

telehealthequipmentaccordingtotheguidelines.Becausetheguidelinesrequired

regularcontactwithparticipant’spractitioners,theresearchersfoundthat

communicationwasamajorimpedimenttosmoothimplementation.Nurses

hadtorelaymessagestophysiciansthroughofficestaff,whichwasoftenavery

inefficientprocess.Thisrevealedjusthowhelpfulanelectronicrecordand

electronictransmissionoftherecordfromhomehealthnursestophysiciansand

visaversawouldbe,ratherthanplayingmedicalphonetag.

Duetothehighlymanagednatureoftheparticipantsselectedforthestudy,researcherswereunable

tofindasignificantreductioninre-hospitalizationratesduetotheuseoftelehealth.Existingre-

hospitalizationratesforthestudygroupwaslow,at17percent.However,inanotherstudyofCHF

patientsservedby10differenthomecareagencies,UPennresearchersfoundsignificantreductionin

re-hospitalizationandanincreaseinconsumerconfidencefromtheuseofbothvideoandnon-video

telehealthservices.

Beginninglatethisyear,UPennwillbepartneringwithNewCourtlandElderServices(see section

5.1.4)onanevaluationofalargetelehealthandtelemonitoringpilotwithupto1000olderadult

participants.Thestudywillbeginwithevaluatingthehealthandqualityoflifebenefitsoftelehealth

biometrictechnology,andpotentiallytoincludetheuseofactivity/wellnessmonitoring.As

discussedabove,theprojectalsowillinvolvephysiciangroupsandislikelytoinvolveinsurance

agencies.

InalargeelectronicheathrecordspilotprojectfundedbyMedicare,UPennwillconductastudyof

theimpactonhealthoutcomesbyusingstandardizedlanguageinelectronicrecordsfor200patients

insuredbyAetnaInsuranceinPennsylvania,200insuredbyBlueCrossinPenn.and300patients

insuredbyKaiserPermanenteinCalifornia.Thepilotwillseektostandardizetheterminologyused

bynursestodescribethecaretheyprovideaswellaspatients’conditions.

Finally,UPenniscurrentlydevelopingresearchontheuseofacommonmass-marketdevice,

theiPhone,togetherwithtelehealthbiometrictoolsforcancerpatientsattheMemorialSloan-

KetteringCancerCenterinNewYorkCity.Onereasonforthepilotistofindabettercare

managementmodeltoavoidunnecessaryandfrustratingappointmentsforpatients.Forexample,

whencancerpatientsgotothehospitalfortheirchemotherapyappointment,sometimesthey

Nursemonitoringapatient’sprogressatthecentralstation


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learnthattheyareunabletogoaheadwiththeirtreatmentbecauseofinsufficientbloodcellcounts.

Inthestudy,careproviderswillusetheiPhoneandtelehealthdevicestomonitorpatients’healthat

home.

Overall,asaresultofchangesinthereimbursementstructurefrompervisittoepisodic

reimbursement,UPennresearchersbelievethatthefinancialbenefitsoftelehealthwillcontinueto

ensureitsgrowth,particularlywiththecurrentnursingshortage.Theyalsoseeagreatvalueofthe

technologyisthatbyusingthetelehealthequipment,patientstakemoreresponsibilityfortheircare

andlearntounderstandtheirhealthvitals.Inaddition,nursescanseemorepatientsinaday,some

studiesreportasmanyas20perdayusingtelehomecareversusonlyfour-sixtraditionalin-person

homevisits.Thesavingsinnursetime,travel,andpreventionofhospitalizations;alongwithcloser

monitoring,alladduptoequalorbetteroutcomesatlesscost.

7. agIng servICes TeChnology resourCes In PennsylvanIa

Thefollowingisabriefhighlightofresourcesforproviders,consumersandtechnologycompanies.

7.1 PA Medicaid Waiver TeleCare Program

Asdiscussedaboveinsection4.1.6,thePennsylvaniagovernment-fundedTeleCareprogramis

amongtheonlyandmostthoroughpublicagingservicestechnologyreimbursementprogramsin

thenation.Bypartneringwithhomecareorganizations,technologycompaniesanddurablemedical

equipmentprovidersorbecomingacertifiedhomehealthagencyinPenn.,agingservicesproviders

haveauniqueopportunitytofulfilltheirmissionstoserveallolderadults,includingthosewith

limitedmeans.Bytakingadvantageofthisground-breakingpublicprogram,providerscanofferthe

careenhancementsaffordedbytechnologytopersonswhoarelow-incomeandwithsignificantcare

needsthathaveheretoforebeenlargelyunabletorealizethebenefitsoftechnology.Toparticipate,

providersmustcontacttheirlocalAreaAgencyonAginganddevelopaprovidercontractagreement.

7.2 HUD Financing for Technologies in Affordable Senior Housing

HUDNeighborhoodNetworksfundingisavailableforselectagingservicestechnologiesinaffordable

seniorhousingcommunitiesonacase-by-casebasis.Thisprogram,createdin1995,wasoriginally

focusedonlyoninstallingcomputerlabsincongregateHUDandFederalHousingAdministration

(FHA)-insuredandassistedcommunities.Theprogramhasnowbeguntoreimburseprovidersfor

installationcostsandmonthlyfeesofvideo-interactiontechnology,suchasFamilyVirtualVisits

(FVV)andsimilartechnologies(seesection5.2.2).

www.hud.gov/offices/hsg/mfh/nnw/nnwaboutnn.cfm


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SchwenkfeldManor,anonprofitagingservicesproviderinSoutheasternPenn.,operatesatotal

of225unitsacrossthreeHUD-subsidizedseniorproperties.Itwasthefirstprovidertopioneer

reimbursementforusingtheFVVtechnologythroughtheHUDNeighborhoodNetworksprogram.

HUDbelievesthistypeoftechnologyfitswellwiththeprogram’spurposetopromoteself-sufficiency

andprovidetechnologyaccesstoresidents.Olderresidentscurrentlyusethetechnologytovisitwith

friendsandfamilyaroundtheworld,whichhasbecomeverypopular.

Furthermore,asdiscussedabove,thiskindoftechnologyalsocanbeusedtoprovide“virtualcare

management”orotherservicessuchasseniorlegalservices,mentalhealthservices,andservice

coordnation.Infact,HUDalsowillpairthereimbursementofthetechnologyandmonthyservice

feeswithitsservicecoordinatorprogramreimbursement.Manysmallaffordableseniorhousing

communitiesaretoosmalltobeabletoaffordafull-timesocialservicecoordinator.HUDwill

provideservicecoordinationreimbursementof$15perresidentpermonththatcouldbeprovided

toownersofseveralcommunities.Thisamount,whenpooledtogethercanbeusedtohireaservice

coordinatortoservethecommunitiesvirtuallythroughthevideotechnology.

HUD’sNeighborhoodNetworkswebsitealsolistsmanyprivateorganizationswhohavefunding

availabletohelpcentersdevelopandimproveprogramsandservices.

http://www.hud.gov/offices/hsg/mfh/nnw/fundingopps/midatlantic.cfm

7.3 Economic Development Programs for Aging Services Technology Companies in PA

ThePittsburghLifeSciencesGreenhouse(PLSG)isapublic/privatepartnershipthatinvestsinand

supportsthegrowthofbiosciencescompaniesinwesternPennsylvania.ThePLSGhasinvestment

andbusinessgrowthprogramstargetedatbothlocalstart-upsandrelocatedbusinesses.Sinceits

inceptionin2001,PLSGhasfocusedonbiotechnologytools,diagnostics,healthcareIT,medical

devices,andtherapeutics.Ithasmade$12millionindirectinvestmentsin50companiesinthose

areas,resultinginover$375millionofadditionalfundraising.

PLSGsupportoftheagingservicestechnologysectorincludesaseedgranttoCarnegieMellonand

theUniversityofPittsburghforQualityofLifeTechnologyandsupportoftwostart-upcompanies,

CartesiaDxandSyncrateLLC.Thegreenhouseisincubatingcompanieswithproductsaimedat

chronicdiseasesthataremostprevalentinolderadults,includingParkinson’sandAlzheimer’s.

Pennsylvania’sBenFranklinTechnologyPartners(BFTP)issomewhatanalogoustoPLSG,operating

fourcentersacrosstheCommonwealththatprovideseedcapitalandmanagementsupportservices

totechnology-basedstart-upcompanies.Thoughitalsosupportssomelifesciences,itsportfolio

ispredominantlyelectronics,roboticssoftware,andotherIT.Athirdstate-wideprogramisthe


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TechnologyCollaborative(TTC).BothBFTPandTTCareinvestingincompaniesintheeldercare

space.

www.pittsburghlifesciences.com

www.benfranklin.org

www.techcollaborative.org

7.4 Grants and Financing for Consumers’ Purchase of Aging Services Technologies

The Pennsylvania Assistive Technology Foundation (PATF) isanon-profitorganizationthat

provideslow-interestloansandgrantstopeoplewithdisabilitiesandolderadultssothattheycan

buytheassistivetechnologydevicesandservicestheyneed.Assistivetechnology,or“AT,”isdefined

asanydevicethathelpsapersonwithadisabilityachieveamoreindependentandproductivelife.

Assistive technology servicesarethoseservicesthathelpwiththeselection,acquisitionoruseofan

assistivetechnologydevice.Servicesmayincludeevaluatingtheneedsofanolderadultorperson

withadisability,trainingtouseaparticulardevice,maintainingandrepairingadevice,designing

andbuildingadevice,orprovidingtechnicalassistanceforfamilymembers,personalcareattendants

oremployers.ManypeoplewithdisabilitiesandolderPennsylvaniansneedtomakemodifications

totheirhomesorbuysomeequipment,includingthefullrangeofagingservicestechnologies

(telehealthbiometricandactivity/wellnessmonitoring,cognitivefitness,safelightingtechnologies,

etc.)butcannotaffordit.

PATFprovidespeoplewithlow-interestloans,orinsomecasesgrants,sopeoplecanaffordthesedevices

andservicesthatwillhelpimprovethequalityoftheirlives.PATFhastwoloanprograms,onefor

loanamountsupto$1,000;andasecondforloanamountsgreaterthan$1,000.PATFmaybeable

toofferamini-grantofupto50%oftheloanrequestif theborrowermeetsthegranteligibility

guidelines.Guidelinesincludetherequirementthattheborrowermustexhaustallotherfundingoptions,

andmusthaveahouseholdincomethatisnogreaterthan150%ofthefederalpovertyguidelines.

PerhapsequallyasvaluableastheloanandgrantprogramsistheassistancethatPATFprovides

toindividualstofindanyandallavailablestateandprivateresourcestohelpthemachievethe

technologyneedsandgoalstoremainindependentintheirhomes.Forexample,PATFwillassist

olderadultsinknowingaboutthenewPennsylvaniaTeleCareprogramiftheyareMedicaid

eligible,orworkwithotherstatedepartmentsandprogramstofindapplicableresources.They

alsoarefamiliarwithwhatinsurerswillandwillnotcoverandwillhelpindividualsfindeligible

reimbursements.PATFishappytocollaboratewithagingservicesprovidersaswell,butisdesigned

toprovideassistancedirectlytoconsumers.

www.patf.org


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8. Call for aCTIon

ThestateoftechnologyinagingservicesinPennsylvaniaissignificantlyfurtheradvancedthanin

manystates.Therefore,anappropriatecalltoactionisonethatpetitionsproviderstoseizeaplethora

ofopportunities,encouragesgovernmentto“staythecourse”infleshingoutandrampinguparobust

MedicaidTelecareprogram,challengeslong-termcareinsurerstostepuptoprovidereimbursement

similartowhatthestatehasdone,andurgestechnologycompaniestocontinueseekinginteroperability

ofitstechnologysolutionswithothers.CASTcanserveasafacilitatorandchangeadvocateinthis

processwiththevariouspartiesinvolved.Amongotherefforts,CASTwillsupportPANPHAinholding

anagingservicestechnologydemonstrationinthestatecapitoltoeducatestatepolicymakerson

availabletechnologyandpotentialbenefits.

8.1 Aging Services Providers

Providersarecalledtotakeadvantageofopportunities,bothpublicandprivate,toincorporate

technology-enabledservicesasdemonstratedbyearlyadoptersabove.Othersalreadyhavecharted

thenewestground,nowisthetimetoengageandfullyadoptagingservicestechnologiesintoyour

caremodels.

Providersshouldpursueresourcestoplanandexecuteadditionaloutcome-orientedfieldpilots

andlarge-scaledemonstrationprojects.Thisisparamountinshowinghowtechnologycanimprove

qualityofcare,consumersatisfactionandwellbeing,staffefficiency,etc.,withvariouspopulations

ofolderadultsindifferentcaresettings.Suchfindingscanleadthewayforinsurerstochange

traditionalreimbursementpoliciesandprogramstructurestoachievethesemutualgoals.

Earlyadoptersshouldraiseawarenessamongpolicymakersabout“bestpractices”ofhowproviders

havemadestrategicinvestmentsintechnologytoimprovecareaswellaswhatremainingbarriers

theyfacetoachievesustainedbusinessmodelsandbroaddeploymentofagingservicestechnologies.

Criticaltosuccessistheneedtoaddressorganizationalintegrationandadoptnewwork-flow

strategies,developinnovativebusinessmodelstosustainoperations,andprovidetechnicalsupport

personneltomanagenewprocesses.Privateagingservicesproviderswhoareprimarilyfundedby

private-payconsumersareuniquelypositionedtomodifyoperatingpracticesandservicedelivery

becausetheyarenotdependentupongovernmentorotherpayersources.

Providersalsoshouldcommitexecutivestaffresourcestopursuepossibleopportunitiesand

resourcessuchasthoseoutlinedabove.Forexample,providerscouldseekparticipationinthestate’s

MedicaidTelecareprogramasawayoffulfillingtheirmissionstoserveolderadultsinneed.


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Finally,providersshouldadvocateforandbeproactivecollaboratorstoensurethatlong-term

caresettingsareincludedinHITlegislationandstate-wideprogramsincludingplanningand

implementationgrants,suchasinSB8discussedinSection4.2above.

8.2 Government and Private Payers

TheCommonwealthofPennsylvaniahas“steppedup”totheplateinabigway.CASTcommends

thedepartmentsofAging,PublicWelfareandtheOfficeofLong-termLivingforbeingamongthe

veryfirststatesinthenationtoputforwardathoroughMedicaidreimbursementprogramforaging

servicestechnologiesinitsTeleCareprogram(seesection4.1.2).Ittakesagreatdealofforesightto

beontheleadingedgeofMedicaidpolicy,especiallyinarelativelyunchartedpublic-fundingdomain

suchastelecare.Thestateisencouragedtokeepitscommitmenttomaintaintheindependenceof

olderPennsylvanianstothegreatestextentpossiblewithtechnologyasitrampsuparobustMedicaid

telecareprogram.

Legislatorsareurgedtospecificallyincludelong-termcaresettingsinHITlegislation,including

planningandimplementationgrants,suchasinSB8discussedinSection4.2above.Thecost-

effectivenesspotentialforHITisespeciallyhighfortheolderpopulationduetointeractionwithand

transitionbetweenmultipleprovidersandsettingsinthehealthcarecontinuum,includinglong-term

careproviders.

Privatehealthplansareacriticalparticipantinthiscallforaction.Becauseoftheirabilitytotailora

packageofservicestomeettheneedsofconsumerswithinacertainamountofreimbursement

(e.g.,capitatedpayment),theyareuniquelypositionedtochangetraditionalserviceandpayment

models.GatewayHealthPlanisoneoftheveryfewhealthplansinPennsylvaniathatprovides

reimbursementfortelecareservicestohomecareagenciesforitsparticipantswithchronicheart

failure.Insurancecompanies,includinglong-termcareinsurers,areurgedto“stepup”toprovide

reimbursementsimilartowhatthestatehasdone.

Healthplansalsoshouldseekpartnershipswithagingservicesprovidersandtechnologycompanies

tofurtherquantifythevalueoftechnology-enabledcareanddemonstrateeconomicandnon-

economicbenefitsfortheirplan’sbenefitpopulations.Becausethecareneedsoftheplans’

beneficiariesareoftencomparabletothoseofpublicfee-for-serviceprogramconsumers,thestate’s

experiencethroughtheTeleCareprogramcouldbeespeciallyinformativeforinsurers.

8.3 Technology Companies

Technologycompaniesareurgedtocontinuetoenhancethetechnicalcapabilitiesoftheir

technologiestorealizethetechnology-enabledcarevision.Importantstepsincludeachieving

interconnectivitybetweendifferentanddisparateclinicalinformationtechnologysystems,which


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isneededtoguaranteecompletenessandcontinuityofinformationbetweenthehomeandlong-

termcaresettingsandassuringcontinuityofcare.Technologycompaniesmaywishtocrafta

commonstandardofpracticetoprovideadequatetechnicalsupporttoensurethatemergingtools

aredependableforconsumersandcareprovidersforon-goingserviceoperations.Companiesalso

shouldaddressacceptanceandusabilityoftechnologybyend-users.Thismightbeachievedby

takingasystematicapproachtoresearchanddevelopmentthatinvolvestheparticipationofseniors,

caregiversandprovidersintheproducts’designanddevelopmentcycle.3

9. ConClusIon

ThestateoftechnologyinagingservicesinPennsylvaniaisstrong.Thisstrengthisduetoan

innovativegovernment“TeleCare”reimbursementprogram,theleadershipofhomecareagenciesin

adoptingtelehealthandrelatedtechnologies,robustresearchanddevelopmentworkbyuniversities,

andahostof“earlyadopter”agingservicesorganizationswhoareenthusiasticallytakingadvantageof

technologyineveryaspectofwhattheydo.

Byfocusingonthecommongoalofprovidingeffectiveandefficientcareforolderadults,more

interestscanalign,includingthoseofinsurers.Throughthisprocess,newideaswillemergeand

additionalopportunitiestoharnessthevalueoftechnologycanbefound.Furthersuccesseswillrequire

allpartiesinvolvedtotakeaction.CASTcanbebothacatalystandbridgetohelpbringaboutthis

change.

� Alwan and Nobel, CAST “State of Technology in Aging Services According to Field Experts and Thought Leaders” February, 2008.

25�9 Connecticut Avenue, NWWashington, DC 20008-�520

www.agingtech.org

Phone (202) 508-946�Fax (202) 220-00�2

abouT CasT

TheCenterforAgingServicesTechnologies(CAST)isleadingthechargetoexpeditethedevelopment,

evaluationandadoptionofemergingtechnologiesthatwilltransformtheagingexperience.

CAST four focus areas: 1. Driving a global vision of how technologies can improve the quality of life for seniors

while reducing health care costs; 2. Accelerating technology research and development through pilot evaluations with

seniors; 3. Advocating to remove barriers to the rapid commercialization of proven solutions; and 4. Promoting dialogue about standards to ensure interoperability and widespread access to

aging-services technologies.

CASTisnowaninternationalcoalitionofmorethan400technologycompanies,aging-services

organizations,businesses,researchuniversitiesandgovernmentrepresentativesworkingtogetherunder

theauspicesoftheAmericanAssociationofHomesandServicesfortheAging(www.aahsa.org).The

membersofAAHSAhelpmillionsofindividualsandtheirfamilieseverydaythroughmission-driven,

not-for-profitorganizationsdedicatedtoprovidingtheservicesthatpeopleneed,whentheyneedthem,

intheplacetheycallhome.

ConTaCT CasT

MajdAlwan,Ph.D,Director

(202)508-9463

[email protected]

JoIn CasT

MembersandSponsorsreceiveawidevarietyofbenefits.PleasevisitourWebsite

www.agingtech.org/join.aspxforafulllistingofbenefitsandduesstructure.

Documents

The State of Technology in Aging Services in Pennsylvania · 2016-07-22 · 5.1.3 Keystone Home Health & Hospice ... Pennsylvania homecare providers are regarded as national leaders