Wearables and remote monitoring technology offer many clear benefits for seniors, their families, and the communities and home health organizations that support their care. But there are many valid concerns to overcome: What if my seniors won’t wear a wearable? How do I keep their data secure? What kind of Wi-Fi is needed to support such an initiative? How do I manage the corresponding data with IoT integration in a way that improves outcomes?
For our latest PeerView, CDW Healthcare’s Ginna Baik tapped the expertise of two senior living providers (one owner/operator and one vice president of IT) who participated in a resident wearables pilot, as well as the president of the analytics platform they’re using, to hear about their communities’ experiences implementing senior wearables and lessons learned. They are:
- Charles Turner, President of LifeWell Senior Living/PinPoint Senior Living
- Moulay Elalamy, Vice President of Information Technology, Benchmark Senior Living
- JP Bewley, Chief Executive Officer and co-founder, Big Cloud Analytics, Inc. (BCA)
CDW: Please tell us a little about your organization and your involvement in a resident wearables pilot.
JP BEWLEY: Big Cloud Analytics’ background and experience is in working with data streams from wearables and other connected health devices and using those to understand patterns in people’s behaviors. This has been an exciting project to be part of, to understand the nuances of how wearables are applied to a senior care population. We’ve learned a tremendous amount both from the data and from the process of getting wearable devices deployed, including the additional considerations. Our role has really been to help make sense of the data and adapt the process to support it.
CHARLES TURNER: If you saw my desk, you would see it’s littered with the carcasses of many dead wearables that have run out of batteries. At LifeWell, we’ve developed 13 communities, and we’re interested in technology, but we put a heavy emphasis on what improves quality of lives. We’re always asking what we can employ now to give us new information. Resident data is fantastic, but most people don’t need a wearable to tell them they didn’t sleep well — what can we learn to help our residents? But also, what is the process? How do we deploy this to 80+ residents? Through deploying BCA’s platform, we learned a lot.
MOULAY ELALAMY: At Benchmark, we have the advantage of being relatively small, so we can try new solutions and be quick in deciding whether to move forward or not. Going into this pilot, we wanted to gather trending information and see if we could glean some intelligence from the data. Our goal is to design and test an end-to-end solution and understand how we could implement it from an IT perspective. The right coverage, the right devices and the right applications — there are a lot of factors we don’t always think about.
These types of projects can become very complex; they must involve legal, sales, risk management and the operational team — not just IT. Everyone is touching it from a different angle. Deploying such a platform always requires a collaborative effort.CDW: Technology is changing the way we look at health and wellness as a whole. For you, what’s the “why” behind this project — the benefits of wearable technology? What were your goals?
MOULAY ELALAMY: Coming from a business intelligence background, I went in looking for actionable data points. For example, it can be hard to discern whether someone is not feeling well or approaching depression, but what if we had access to their sleep data — for example, tossing and turning more than usual — and could combine it with an elevated heart rate, etc.? You can start to better understand or predict. Are they in a depression mode? Is this usual for them? Can we react to it before that person falls or has to be hospitalized? That would be a very powerful and compelling experience.
CHARLES TURNER: We don’t look at a wearable device in isolation. An activity pattern or heart rate, in and of itself, isn’t enough motivation to deploy a rollout. Where it becomes useful for us is when we take this data, plus our exercise program, plus our EHR … all this data formerly in silos now combining together becomes very important, and you can start being proactive instead of reactive. This is just a fraction of what we’ll be able to do.
JP BEWLEY: This combination of wearable data with existing data sets we can overlay is really where we’re starting to get the first hint into the day-to-day quality of resident impact instead of just evaluating acute events. We’re already starting to see some reveals emerge where we can start to approach care differently based on this initial data.
CDW: Can you talk a little bit more about the pilot process? Who was involved? What foundational technology was required to support the program? What big learnings did you uncover?
JP BEWLEY: Because these wearable devices are consumer-oriented, they were developed to function as one-to-one — one wearable device syncing to one tablet. In a community, we had to expand this to be 100 wearables (one wearable for each senior) syncing to 100 tablets. We had to work through that implementation thought process ahead of time. We also had to think through how we would incorporate the adjusted implementation process into workflow. We had to create new software that would automatically wake the tablet up when needed. After going through all this, now we know the base-level process.
Another key learning was how important key associate and resident champions are. One staff member at LifeWell, for example, had a true passion for how this could make an impact on residents’ lives, and we learned from that. Project management, drive and discipline within the process are important, but passion and opportunity for change are contagious.
CHARLES TURNER: It does require a culture change. On the operating side of the business, what Moulay said is true — collaboration across all departments is necessary. Risk management is always concerned about data security, and you need to assess how to find the balance between better care and protecting data. You’re also adding another thing for already over-taxed caregivers to do. There’s a culture change, and we had to hire the right people to champion it in the community. It took us longer than you’d think to get that done.
MOULAY ELALAMY: It does take longer than you think. This project especially lent itself to longer cycles because you’re involving so many groups at the onset — you’re planning, discussing, and in part lobbying that it’s a good idea, and making sure everyone understands the value and how wearables fit into the realm of senior living. It becomes a deeper and more complex conversation really quickly. But this part is important. We spent a lot of time planning for it. We really wanted to understand the legal ramifications — what does this project mean from a HIPAA compliance perspective? Who gets to see what data and when? If you don’t set it up right, you open up to a new level of exposure.
Expect the planning process to take three to four months. Especially if you have to tweak infrastructure. Also identifying your associate champions, assessing compliance — those are important things to consider. Then you can focus on the fun stuff — when you launch, it’s exciting and a bit of a party!
CDW: What data is captured? How do you address wearables that may not be totally accurate? How is data captured or assessed for seniors with mobility aids?
JP BEWLEY: The 75 residents we monitored in one of the pilots generated 8.3 million heartbeats a day, 77 beats a minute. After this project, north of 3 billion heart rates will have been analyzed. Because wearables enable a non-invasive, always-on capability, you can look at a wealth of data sets. Through doing this, you start to talk about accuracy versus precision. I think that’s a good discussion to have. As we assess, we filter through and can start to determine what the norm is for the population, gender and age ranges, and then have a conversation about outliers.
One thing we asked was if we could easily identify those who have a resting heart rate while sleeping above 95 beats per minute — residents who may need some additional attention. And then, is this a one-off, or are those residents consistently there? In this project, we had homogeneity of the wearable, so we could compare. Take those with mobility aids, for example. It’s important to have an apples-to-apples comparison when benchmarking against others with mobility aids; then we can cut by gender and age groups. What’s a normal range for seniors who are 75 to 80 years old, male, and use a rolling walker? Then, how do we understand whether they’re getting enough activity, and how do we quantify that activity?
CHARLES TURNER: You’re looking for directionality. What we came to realize is the law of big numbers — the anomalies in data collection will average themselves out as long as you’re consistent. The more data points you gather, the more meaningful the data you get becomes.
CDW: How can this data be leveraged in assessing and adjusting senior care? What’s the potential future impact?
JP BEWLEY: I think there’s a tremendous opportunity to make an impact in seniors’ lives over time as this continues to evolve. One community saw a senior consistently have an unusual data point — now that resident has a pacemaker. It really causes you to dig deeper.
MOULAY ELALAMY: Short term, I’m most interested in understanding how this data can impact levels of activity and how we’ll adjust our programs accordingly. Longer term, it will be interesting to see if health decisions will be based on, or at least influenced by, this type of health data.
CHARLES TURNER: I see this as a research project versus a pilot. When gathering this information, we didn’t know what data we were going to find. Until we understand the actionable items, we don’t know what value will be created. Secondly, the devices are really more for retail, so how do we make them enterprise? Are there devices that take information from a wearable and marry it to resident monitoring, resident locating, or emergency response? What device are we ultimately going to roll out? There are a few more months of figuring out what the enterprise product is.
Over time we want to get more into the anecdotes. Right now we have correlations, not causations, so we want to understand what we can do from a care standpoint that pushes people up and to the right in quality. You want to start looking at the stories behind this data. That allows us to understand the correlations to direct further research into the causations. The value could be immense, especially if you’re in an incremental care environment.
Want to hear the full conversation between Ginna Baik, Charles Turner, Moulay Elalamy and JP Bewley? Check out their discussion via the webinar recording, Wearable in Senior Care.