Special to The Hawai‘i Herald
Imagine having technology in the home that could detect whether your elderly mother who lives alone has fallen down, or has not gotten out of bed at her usual time, or has forgotten to turn off her stove. What about automated phone calls at prescribed times of the day to remind your elderly father to take a particular medication? Or sensors under the carpet that can measure walking patterns and send that information to a health provider if something seems out of the ordinary (e.g., lots of walking during hours when your grandmother is normally sleeping, indicating a behavior change that may need looking into)?
These kinds of devices, and many others, may enable older adults to “age in place” as technologies are built into “smart homes” of the future that are designed to help people live more safely and securely. Although human support and services from health care providers, family members and friends should continue to be a part of an elder’s care management plan as needed, aging-in-place technologies may help direct more health care activities to the home environment for certain individuals, where feasible, and delay or minimize more costly and inconvenient visits to hospitals and clinics.
For well over a decade, Eric Dishman has been thinking about health care reform — not only about how health care is paid for, but also about how health care is delivered and optimized. He believes that the centuries-old model of health care being centralized in hospitals and clinics needs to change.
Dishman has compared the desired shift away from hospitals and clinics to the computer revolution. At one time, computing power was centralized in large, powerful mainframe computers off in the distance somewhere. You had to go to the mainframe computer to access that power. Now, many people have that computing power on their tabletops at home. That’s how Dishman sees the future of health care, as well. The hospital is like the mainframe computer. Personalized health care, by contrast, is like the desktop computer at home: globally networked, ready when you need it and relatively easy to use.
It took the Kupuna Education Center’s Cullen Hayashida about four years to lure Dishman to Hawai‘i from his post at the Intel Corporation’s Portland, Ore., campus for a series of talks in April. But Dishman had good reason for delaying his visit: He had his own personal health care concerns and solutions to consider.
Here’s the back story. A couple of years ago, Dishman, now in his mid-40s, was in urgent need of a new kidney. He had lived with kidney disease since he was an undergraduate in college and was being treated for it with drug therapy and other interventions. But after many years, even those weren’t enough. His kidneys began to fail, and he needed a new one to live.
In September 2012, he received a new kidney from a colleague at Intel whom he had not known prior to her volunteering to be a potential kidney donor for him. After the life-saving transplant procedure was performed, Dishman took some time off to recuperate, which he did successfully. By 2014, he was ready to come to Hawai‘i.
This background is important in knowing who Eric Dishman is and why he was in Hawai‘i this past April. As general manager of Intel’s Health & Life Sciences Group, Dishman is an innovator and visionary in the field of health information technology. Among the many initiatives that fall under this broad category, “personal health technology for the aging population” is something he and his multidisciplinary research team have been studying over the years.
For those not familiar with the company he works for, Intel is not primarily in the health care business. It is a multinational computer chip company based in Santa Clara, Calif. It makes the components that give computers their power. But one part of this corporate giant’s work is to research and develop health information technology, and that’s where Dishman’s special perspective is valuable. As a longtime patient in the U.S. health care system, he has seen and experienced, firsthand, how that system operates — and he thinks it’s long overdue for change. Although he works for a company whose name is associated with computers, it should be noted that Dishman himself is not a computer engineer by education. He is a social scientist, which means he is more interested in human relationships, communication and communities than he is in “gadgets.”
This was a point he made clear during his talks in Hawai‘i. “Technologies and gadgets are important,” Dishman said at the East-West Center on April 10, “but what we’re trying to do is build a social system, a business system, that has a technology system in place that supports it. So we actually need people with different disciplines and expertise [on the research team].”
What Dishman hopes will happen in the future — and, indeed, feels must happen if America’s health care system is to be sustainable — is for health care to become more personalized and based in the home and community. That’s where aging-in-place technology comes into the picture. His research team has been studying how and what kinds of technologies would be appropriate in the home to improve an elder’s quality of life. They put their minds together and came up with what Dishman calls “opportunity maps,” or areas to invest further study and development in order to solve real-life problems with technology.
What are some of those opportunity maps? He summarized: “Solutions that help support cognition. Solutions that help support physical activity. Solutions that help bring health care home. Solutions to get help giving the care. Solutions that enable social interaction.”
These are not just pie-in-the-sky ideas. They are aging-in-place technologies already in existence that are being used or tested in real homes in real communities both in the United States and abroad. They are being used with real people in their everyday lives, not in artificial living environments on college campuses.
Dishman cautioned, however, against thinking of the older adult population as one large, undifferentiated category. There is no one-size-fits-all technology.
“Obviously, older people are not all the same,” he said. There are geographical differences, cultural differences, life stage differences and so forth. “All of those differences have to be taken into account.” But, he said, you have to start somewhere, and a good place would be to start with a segment of the older adult population that is likely to adopt aging-in-place technologies and then seeing if it can “fan out” from there. He said technologies in the home can be relatively simple, such as the movement sensor devices mentioned earlier, or complex and expensive, such genomics, which he said will someday enable scientists to quickly acquire a complete blueprint of an individual’s genetic makeup. This could lead to a much more personalized understanding of an individual’s particular health journey. That technology is currently in development and is expensive.
On a practical level, some on Dishman’s team are looking at how aging-in-place technologies can work as a successful business venture, a topic he addressed in his talk at The Plaza Club in downtown Honolulu. The personalized health care system model may seem like an idea whose time has come, but if it is not financially feasible, it is unlikely that it will be implemented. Dishman compared the building of the 21st century health care model to developments in the space industry, in which the U.S. has been dominant. But he said there’s much more work to do in the U.S. in terms of health care reform.
Of course, Dishman is not opposed to the existence of hospitals. Given his own serious health care issues, he has benefited from good hospital care. But he believes that health care needs to expand outside traditional institutional boundaries. His mantra has become, “Care anywhere. Care networking. Care customization.” In an era of increasing specialization, where physician-specialists treat parts of the body, he sees a need for greater “whole person care,” where health care teams work together to coordinate successful outcomes, almost like a team sport. “And you’d better be on that team,” he said.
Dishman has a special place in his heart for caregivers because he was one himself. At the age of 16, he began helping to care for his grandmother, who was showing signs of Alzheimer’s disease. Even at that young age, he was thinking of how he could design a technology that would alert him and his family whenever his grandmother used the oven. He said his caregiving experience with his grandmother had an impact on him that remains until today. Also, in his 25 years of living with kidney disease, he has come into contact with other patients and their caregivers, many of them older adults in doctors’ waiting rooms. He has seen first-hand the struggles that patients and caregivers go through in trying to manage chronic illness.
Although Dishman’s kidney transplant was a major undertaking for him and his wife, they felt well-prepared for going through the process, including the pre-surgery and recovery period, because of the excellent training he said they received from his health care team. He said his transplant care team “thought through the care model and gave us the support technologies to help us do our job.” The experience taught him how important it was to have a reliable and competent care network in place.
Technologies in the home could include things such as individual health monitors (some of which people already use), home sensor devices that can measure movement or can let others know when one has come home or left the home, easy-to-use touch-screen technology for information and communication, as well as enhanced uses of smart phones or regular telephones that can be used in innovative and creative ways for personal medical care. Technology can also be useful in avoiding medical errors. As patient medical records move online, all members of a patient’s health care team can see what each other has prescribed, hopefully preventing medication errors such as overdoses or harmful interactions.
Some self-monitoring technologies are already widely available. For example, glucose and blood pressure monitoring equipment and defibrillators for cardiac conditions have been consumer health products for some time. In a talk that Dishman gave on the Mainland, he demonstrated a personal hand-held ultrasound device that actually took an image of his new kidney in front of an audience and instantly sent it to his kidney doctor for analysis while they were communicating with each other via a video link over the internet. This device is not available to the mass consumer market, but Dishman used it as an example of what may be available in the future as personalized care moves closer to the home. At that same talk, Dishman said he was scheduled to have a biopsy soon, but joked that he would rather not do that procedure himself.
Moving forward, he encouraged people and organizations in Hawai‘i who are interested in aging and technology issues to work together and coordinate their efforts. Key stakeholders, in addition to the users of the 21st century health care system, would be technology companies, legislators, policymakers, educational institutions, nonprofit organizations and others.
Perhaps not coincidentally, Dishman’s visit was an opportunity to bring together many of these very stakeholders in Hawai‘i, as evidenced by the listed members of the event’s organizing committee. Dishman’s visit was hosted and sponsored by the Assistive Technology Resource Centers of Hawaii, whose executive director is Barbara Fischlowitz-Leong, and a fairly long list of cosponsors and supporters representing both the public and private sectors, education and nonprofit organizations that read like a Who’s Who of gerontological leaders in Hawai‘i.
Can a small state like Hawai‘i really make an impact in the field of aging-in-place technology?
“Smaller states have an advantage here,” Dishman told the Kupuna Power television show in an interview posted on YouTube. “Big states are so big that they can’t get out of their own way to drive innovation. They can’t even get all the stakeholders in one room because they don’t even know who all the stakeholders are.”
A small state like Hawai‘i is different, he said. “In Hawai‘i, you can get the payors (e.g., insurance companies), you can get the government, you can get citizens representatives from every age group that you need, you can get the not-for-profits and you can get the academics together in one room in one day.” These stakeholders, he said, can get together and lay out a plan to be at the forefront of aging-in-place technology.
“I think the way for Hawai‘i to think about this is to say, ‘Can we be a big fish in what’s a small pond right now, but thanks to demographics is going to become a tidal wave?’”
To learn more about assistive technologies, visit the Assistive Technology Resource Centers of Hawaii website at http://www.atrc.org/. The website includes this statement about what it does: “ATRC is a nonprofit whose mission is to link people with technology and empower individuals through its use. ATRC is also the State of Hawai‘i’s designated Assistive Technology Act agency. Our primary role is as an education center for anyone interested in Assistive Technology. We do not sell products. We will recommend vendors if requested.” The organization’s phone number is 808-532-7110.
Kevin Kawamoto is a longtime contributor to The Hawai‘i Herald.