Home and Community e-Care Technology - Products, Performance, Policy

1. Home and Community e-Care Technology - Products, Performance, Policy Age and Disability Odyssey DEC Center - Duluth, MN June 17 - 18, 2013

2. Presenters Diane Sprague Director Lifetime Home Project Minneapolis, MN Barb Turner Chief Operating Officer ARRM S. St. Paul, MN

3. Today we’ll review... • Overview of home/community telehealth • Representative examples of existing, emerging technologies for • Seniors • Younger persons with disabilities • Technology’s significance, potential

4. Overview, Technology Examples

5. Materials drawn from... • Metro Aging Eldercare Development Partnership home/community telehealth project • Report on background, developments, cost/benefit, status in other states, policy assessment • Web product database • Presentations

6. Telehealth involves... • Collecting medical/health • Data, images, voice/sound • Via a range of options, e.g., • Peripheral, wearable, ingestible, implantable devices • Medically smart home furnishings/features, portable/structural sensor devices

7. Telehealth involves, con’t. • Typically forwarded to • Stationary computers - mainframes, towers, etc. • Portables • Laptop computers, netbooks, pads • PDAs, smartphones • Transmitted for remote receipt/use by • Wires – phone land line/DSL, fiber optics, cable • Wireless - radio frequency

8. Telehealth involves, con’t. • Revolution in medical use of smart devices • Becoming prime global delivery platform • Modified for direct diagnosis • Mini-peripheral equipment (shown later) • “There’s an app for that...” • 1 million+ apps (2012 - MobileWalla) • 2,000 come to market daily • Healthcare apps - about 40,000 (2012 -MobiHealth News)

9. “The smartphone will see you now...” iExaminer - retina (Welch-Allyn) Smartphone/tablet clip-on 60X zoom microscope lens (Cellphone Shop - $25.00...) iPhone ECG - cardiac (AliveCor)

10. Remotephone - ear exams (otoscope) (Georgia Tech/Emory U) Catra - cataract exams (MIT Media Lab) • uCheck (app for urine checks) • (Biosense Technologies) • Camera IDs test strip (by Seimens, Bayer) color

11. Ultrasound - MobiUS (MobiSante) iStethescope (Oxford U/UK U of Capetown/S. Africa

12. Evolving definitions • Telemedicine - surgery, treatment, therapy, consultation, etc. • Specialty telemedicine, e.g., • Telerehabilitation • Telepharmacy • Telementalhealth • Telehealth – broader term covering the above plus fitness, wellness, etc.

13. Evolving definitions, con’t. • “e-care”, “e-health”/-“wellness” • Beyond original “tele”phone land lines • Beyond original tele“medicine” focus • “m-care,” “m-health” • Mobile - relying on wireless connections • “Biosensing” • Medical/health monitoring via sensors on/in body

14. Technology examples • Many products initially designed • For care settings; now adapting for homes • To perform one function; now incorporating others • By medical companies; other fields now in competition (e.g., security, home automation, communications) • Result - industry expansion is fluid, unpredictable

15. Communications • Upgrades/enhancements for reduced vision, hearing capabilities, e.g., • Land line phones • Cell/smartphones • Text converters • Apps for caregiver, etc., connections • Reader(Intel) • Converts text to speech

16. XL45(Clarity) • High db ring, voice • Remote problem diagnosis • Remote function changes • BioAid(U of Essex, UK) • Free open-source app • Turns iPhone into hearing aid • Amplifies soft, deamplifies loud sounds

17. Jitterbug(Samsung) Services: • GreatConnections • GreatSafety • GreatHealth • GreatLife • mPERS • C-900 (Clarity) • Four large buttons • 20db amplifier • Programmed emergency help button • Hearing aid compatible

18. Caregiver’s Touch - app • (H2Mobile, LLC) • Helps manage, access • loved one’s critical information • In iPhone, Web version • Can gather: • Medication history • Medical/hospital history • Financial/legal • Emergency, insurance • Military, religious • Assets • CareZone - free app • For tracking: • To-dos • Journal • Key contacts • Calendar • Shared notes, instructions • Emergency contacts, etc.

19. Personal Emergency Response Systems (PERS) • Wireless monitoring • Original style - pendant, only short range • Models now can provide • Two-way voice communication • Location tracking - GPS, telemetry • Position monitoring, automatic fall response • Wireless perimeter “fence” wander guard • Coverage outside home in community

20. Personal Emergency Response Systems (PERS), con’t. • Some products- just device, monitoring service • Others - integrated into system with additional e-care devices

21. My Halo • (Halo Monitoring) • Alerts caregivers and emergency responders • Accelerometer fall detection • iPhone-enabled • Personal Assistant • Link (PAL) • (ActiveCare Active One) • CareSpecialist, emergency services • GPS, virtual fence • Accelerometer fall detection

22. Lifecomm - mPERS • (Hughes Telematics, Inc.) • GPS • Auto fall detection • Two-way communication • QMedic • (QMedic) • 24/7 call center • No device charging • Alert given when not worn • Smartphone alert for • abnormal health activity

23. Mobile Care Monitor (AFrame Digital) • Auto fall detection • Care Station alerts to caregivers • Integrates with electronic door locks • Medications logging • Lifeline (Philips) • Medical alert • Auto emergency call • when fall detected • Medication dispenser - add-on

24. Wander monitoring • (Evolving potential overlap with PERS...) • Wireless room/area detection devices - • Sound • Pressure - under mattress, rug, chair cushion, etc. • Contact - cabinets, exterior doors • Wireless wearables, e.g., • Pendants, wristbands • Belt clips, shoe laces • DinoDirect • Door, window contact alarm

25. Wander monitoring, con’t. • Originally - short-range transmission • Newer - GPS, telemetry, Web tracking displays • “Virtual fence” • Comfort Zone • (Alzheimer’s Association ) • GPS/cellular locational monitoring - family • establishes range • 24/7 monitoring center services • Access to emergency health records (MedicAlert)

26. TriLoc Personal Locator • (iLoc Technologies) • Cellular and GPS technology • Fall detection alert • Bi-directional voice capability • SOS check in button • Setup on website or smartphone • Multi-zone geofence • Tell My Geo • (Iconosys) • Android OS • smartphone app • User and caregiver • both carry phones

27. Medication monitoring/management • Self-tracking • Passive adherence tracking • Reminders • Alerts to potential duplicate dosing, etc. • Automatic reorders • Telepharmacy • OnTime RX Software • (Ameila Plex, Inc.) • Sends med reminders • Maintains 911 meds/ • health data

28. GlowCaps (Vitality) • Wireless sound/visual med reminder • Personal/caregiver adherence updates • Pharmacy reorder • Physician adherence reporting Wireless reminder light • GlowPack ( Vitality) • For blister packs, inhalers, injectible solutions, liquid • medicine, skin ointments, etc.

29. Microchipped pills • (ProteusMedical/Novartis) • Just approved by FDA • Date-stamps ingestion • For medication adherence tracking • E-pill (MedSmart) • Organizes, provides reminders, dispenses • Locked unit • Models - stand-alone, adherence reporting to caregivers (MedSmart Plus) • Compliance Dashboard

30. Vital signs monitoring • Peripheral equipment collects/reports on, e.g., • Cardiac • Respiratory • Blood sugar, oxygenation • Body weight • Stationary systems • Peripherals - proprietary or outside vendor/s • Originally - wired; now - wireless • Can serve individual or group (kiosk)

31. Vital signs monitoring, con’t. • Mobile - mini-peripherals for smart devices • Systems may just monitor vital signs, or also perform other functions (e.g., PERS device, sensor monitoring)

32. Connections 365 (Cardiocom) Kiosk • Commander • (Cardiocom - Chanhassen...) • Home monitoring/ • data management system

33. 3100 Wrist Ox (Nonin - Minneapolis...) • Glucose monitor • (iBGStar) • Plugs into iPhone • Test strip inserted, • blood drop applied • Glucose reading • on display, stored Blood pressure monitor/dock (i-Health Lab)

34. Health on the Go • (Healthanywhere) • m-Health for Blackberry • Supports Bluetooth-enabled medical peripherals • For single user, multiple-user kiosk • Indiego - e-thermometer • (Kinsa) • Plugs into ear jack • Uses phone’s batteries • For individual treatment, • also for epidemiology • outreach

35. Asthmapolis • (Asthmapolis) • Inhaler with GPS • Tracks/sends data on • ambient conditions • during attack • For individual treatment, • also epidemiology studies • e-Cane • (Fujitsu prototype) • Bluetooth, GPS, WiFi, cellular radio in handle • Tracks temperature, blood pressure, heart rate readings

36. Sensor monitoring suites • Small sensor devices track activities/safety • Earliest - video, motion tracking, now, e.g., • Motion • Contact (door, drawer, etc.) • Water flow, humidity • Pressure, vibration (e.g., fall management) • Heat (e.g., stove) • Wireless in home, wired or wireless transmission

37. Home monitoring units (Healthsense - for seniors; Sengistix - comparable for persons with disabilities) (Additional devices for assisted living) Motion Contact Bed, chair Toilet flush

38. e-Neighbor activity/ • safety monitoring system • (Healthsense) • Can link with: • “e-Neighbor Vitals,” • “Vitals Kiosk” • systems

39. Iris - home • “sensor kits in a box” • (Lowe’s) • Security monitoring • (including locking) • Video • Controls (e.g., • outdoor lights) • Energy management • Care monitoring

40. Care monitoring • Tracks normal movement/activity - visual confirmation via motion, contact sensors • Alerts for falls or emergency situations - via Iris Senior Pendant or pre-set decision rules • Pre-set decision rules assess if daily routine isn't performed

41. Multi-function systems • Sonamba wellbeing monitor • (pomdevices - pom -“peace of mind”) • 24/7 home monitoring • PERS, auto med reminder • Social communications • Digital photo frame • Remote setup • Daily caregiver updates • Optional room activity sensor

42. Multi-function systems, con’t. • GrandCare • (GrandCare Systems LLC) • Multi-caregiver communications, • ADL, safety, • locational monitoring • Telehealth peripherals • Med management • Smart home monitoring • Socialization/entertainment

43. Biosensing • Can monitor a range of functions, e.g., • Temperature, heart rate, other vital signs; electrolyte balance, gait, incontinence, etc. • Typical products • Shirts, vests, jackets, caps, underwear • Shoes • Bedsheets • Skin patches • SmartSlippers, SmartInsoles • (24Eight) • Gait analysis, • fall detection

44. Biosensing underwear • (U of San Diego research) • Screen-printed sensors • monitor post-hospital • heart rate, blood pressure EKGear sensor shirt - (NanoSonic) heart rate and EKG More evolving definitions... “connected clothes” “biosensing textiles” “medical textiles” “smart fabrics” “wearable computing” “wearable technology” Heart-sensing bra (Numetrex)

45. Health-smart homes • Sensor products integrated into home’s structure • Goal - compatibility and/or coordinating with other wired/wireless home-based systems, e.g., • Automation • Security • Communications, recreation • Can install at construction, retrofit Jane Jetson

46. Health-smart homes, con’t. • Feature examples • Toilet monitoring blood sugar level • Stair landings that light when stepped on • “Talking” medicine cabinet, windows, doors – for cognitive needs • Drapes adjusting to light level • Flooring sensors (e.g., joists, “magic carpets”) analyze gait, fall detection Smart microwave (Gator House, U of FL)

47. Robots Jane, George Jetson, Rosie the Robot... Kompaii (Robosoft/France) Carebot - (Gecko Systems/US)

48. Hector (University of Reading, UK CompanionAble / Holland) Giraff (Giraff/Sweden) VGo “Skype on wheels...” (VGo Communications, -/US)

49. iRobot product examples Roomba floor vaccum Mirra - submersible pool cleaner Mint - floor washer

50. “First Look” (throwable security monitor) iRobot SUGV (Small Unmanned Ground Vehicle) “Seaglider” - research, oil/gas exploration