m sterling

MaryAnne Sterling

s koss

Shannah Koss

The fast pace of evolving technology has awed most of us over the past two decades. Remember the first iterations of the mobile phone? We chuckle when we think back to these clunky oversized early versions when compared to the smart phones of today. Tech has come a long way. But when it comes to technology accessibility and usability for seniors, we are still in the dark ages. Even worse, we have failed to adapt health information technology to the needs of seniors, who traditionally have more health challenges and would benefit the most from using it.

We discovered many obvious and not-so-obvious examples of this during a recent focus group conducted to elicit feedback on our health information technology pilot project in Maryland. We are working with a residence for low-income seniors and the disabled. A few observations:

1) Some of our most notable realizations had to do with the common assertions about seniors as ‘patients’, particularly individuals with complex healthcare needs and their ability to be engaged.

Not only do they want to be engaged, they are open to the technology-based platform and often have technology access in their homes, in addition to community computers provided by the residence. Our participants highlighted that few, if any, of their healthcare providers ever ask them to be engaged or are willing to engage with them, online or face-to-face, on anything other than the episodic focus of a given visit.

2) Without a human interface to broker, and perhaps soften, the technology interfaces, the benefits of technology will likely fail to support the aging and perhaps most needy populations.

The residents of this facility are similar to other individuals with complex healthcare needs, even with their added economic challenges. They want to be engaged, they will likely need assistance in using tools, but they will value tools that help them understand their own health information, consolidate that information and support them in their day-to-day needs. Technology can be a critical component of community-based support, but only if it also has a human and caring component and recognizes the overwhelming burden that individuals are already managing.

Rapidly changing technology without human support is likely to undermine the value of all technology based resources.

3) Family caregivers are essential interfaces to technology. These critical health partners are often more comfortable with technology and can assist their senior family members as technology coaches.

We found that residents and their family caregivers wanted easy access to their health information but had never been introduced to tools that helped make this happen. This underscores an on-going issue with health information technology – the attitude of “build it and they will come”. We have not taken the time to introduce these tools to seniors or to family caregivers, much less framed them in the proper context.

The tens-of-thousands of health apps available at your favorite app store aren’t making the conversation easier. The interdependent nature of needs for individuals with complex health issues cannot be solved with single apps or a narrow focus on health care distinct from social determinants of health and individual needs and preferences.

What boggles the mind is that consumers, including seniors and family caregivers, are rarely part of the team that designs health IT platforms. It’s as if the industry thinks it can all happen with or without the patient and family.

4) Usability of health information technology is a chronic problem that festers like an open wound.

The physical dynamics of accessing technology can be challenging for seniors and the usefulness of the information they are seeking can be an even greater barrier.

Basic hardware, such as the keyboard, is designed for nimble hands and can be a barrier to using technology. On the software side, tiny fonts, dense text, and too many clicks discourage all but the hardiest users.

Health information is not presented in a format that most people can use. Neither patients nor their family caregivers can act upon information they don’t understand. Access to health information in plain language and language-of-choice is critical to the success of the patient-and-health-information-technology interface. We found that a visual medication list that residents could easily understand, that told them how to take their medications and why they were taking them, was a powerful and life-changing tool.

Finally, providing free technology with no instructions on how to use it, particularly by individuals who are challenged by age and illness, is practically a slap in the face. This theme played out over and over again with our pilot participants as they struggled to simply browse the internet on community computers that were not designed with ease-of-use in mind.

We have a long way to go before the healthcare industry, and the technology vendors serving this industry, really support patients seamlessly accessing their own health information. This is especially true of seniors, who we risk leaving behind because we did not include them in the design process.

All is not lost. There are emerging community-based models that will help rapidly correct many of these challenges if we shift our mind set and current funding mechanisms.

  • Focus on the whole person and the context in which she lives
  • Partner with the organizations that are community based and have staff that can be the human face
  • Reverse the trend of shrinking budgets for aging services, ideally shifting the acute care spending to more community-based and palliative care
  • Eliminate data blocking from individuals and resurrect patient and family engagement in meaningful use stage 2 with flexibility for providers and families on how it is achieved
  • Recognize that the killer “app” will simply add to the plethora of noise in healthcare information without infrastructure and services that readily curate and navigate to what is truly helpful for quality of life


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One Response to “Aging & Technology: A realistic look at the challenges of using health IT”

  1. Linda Radovic Reilly Says:

    This article deftly tackles the challenges facing the elderly and the disconnect between the benefits that informed healthcare technology delivers and what patients are actually accessing. Thank you for giving me a strong strategy for help with my mother’s care.

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