Source: CREATEABILITY CONCEPTS, INC. submitted to NRP
RURAL-HEALTH-MATE: A TELE-MONITORING SYSTEM THAT IMPROVES RURAL SENIOR'S HEALTHCARE VIA MONITORING, COMMUNICATION & STAKEHOLDER INTERACTION
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
Reporting Frequency
Annual
Accession No.
1006886
Grant No.
2015-33610-23783
Cumulative Award Amt.
$499,661.00
Proposal No.
2015-04161
Multistate No.
(N/A)
Project Start Date
Sep 1, 2015
Project End Date
Aug 31, 2017
Grant Year
2015
Program Code
[8.6]- Rural & Community Development
Recipient Organization
CREATEABILITY CONCEPTS, INC.
5610 CRAWFORDSVILLE RD STE 2401
INDIANAPOLIS,IN 462243727
Performing Department
(N/A)
Non Technical Summary
The significant gap in the healthcare services available to rural seniors is well supported by prior research. Frequently, rural seniors must travel long distances regardless of weather conditions to healthcare facilities. The senior's family members often worry about their loved ones and may not get accurate information regarding their health and behaviors, and falls, missed meds, and nutrition issues are often under-reported.Private Duty Nursing companies, Skilled Nursing companies, Outpatient Rehabilitation Providers, occupational therapy agencies and hospitals all struggle with how to serve rural seniors because they are dispersed over large geographies. The typical human-dominant model is costly and struggles to prevent healthcare incidents and readmissions from previous ER visits. This is a global problem, but the aging of America has raised the awareness within our nation.Existing solutions are expensive, do not automatically report what led up to the incident or situation, and are not designed to help prevent situations. Most require high-speed Internet services which is a mismatch given low coverage in most rural areas. Also, the lack of scalability and customization options drives the cost up and requires most seniors to buy more capability or service than they need.Rural-Health-Mate (RHM) is a system that helps rural seniors maintain their independence in their home through the use of unique and cost-effective remote monitoring and tele-health techniques. Unlike other approaches, RHM does not rely on high speed internet or video cameras with remote technicians.Current experimental remote monitoring systems focus on a specific illness or disease such as Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD) or diabetes. Instead, RHM addresses the top three major areas that cause rural seniors to result in extended and expensive hospitalizations: falls, medication non-adherence, and safety violations (such as leaving the stove on unattended, etc.).Also, current "Smart home" technology is focused on a younger audience that wishes to remotely scan their home, or remotely control lights or locks. The intelligence in RHM is focused on the rural senior, and therefore also collects data in the home through an intelligent network of sensors, vital sign appliances, and the senior's activity patterns. RHM uses a distributed intelligence model:- an in-home Control Center that collects sensor data and vital signs, and communicates with the individual on their TV, and- cloud computing that relays notifications and alerts to the proper personnel as well as providing a portal for coordinating care with family members, caregivers and healthcare providers.CreateAbility will build on the success of Phase I and complete the development in Phase II in preparation for full-scale commercialization in Phase III. Phase III will incorporate a nationwide business-to-Business (B2B) model, where CreateAbility's customers are the businesses that serve rural seniors. These include rehab services, skilled nursing, and private duty nursing companies.The basic methods and approaches that will be used to collect and inform the target audiences are:A. Confirm our findings from the Phase I pilot study using a series of focus groups, phone surveys and face-to-face meeting s with rural healthcare providers.Assistive Technology Partners will facilitate the focus groups using the Nominal Group Technique (NGT). The NGT approach guarantees that all members get an equal voice in the outcomes of the group's impression and voting on the importance of new features and functions.Phone surveys will be handled using a scripted tool to minimize variances of the responses. Face-to-face meetings with existing healthcare providers and support personnel to rural seniors will also be scripted, and yet still provide for the additional data that may be unique to each meeting.B. Enhance the Phase I prototype based on this feedbackThe in-home Control Center will be enhanced to support more vital sign monitoring devices, and to function well in the homes of rural seniors.The cloud services will be enhanced to handle a deeper engagement with the senior and their support team.One important benefit of the RHM approach is that the system does not require the senior to learn about technology, or how to use technology. The senior will receive instructions from a sufficiently large tablet that doubles as a digital picture frame of their family or grandkids. Sensors are small and discreet, and are frequently invisible. This approach is fundamental to the adoption process.C. Initiate the Extended EvaluationAfter the emerging prototype is enhanced, it will be replicated. This will enable CreateAbility and it's team to perform an extended evaluation of the emerging prototype by placing the RHM system in the homes of rural seniors and providing a high level of support to them as needed on this new approach.Another fundamental benefit of the RHM development approach is that the extended evaluation is interlaced with the continual development of the system. This requires the extended evaluation to begin within 12 months after the project start to give our development team and researchers sufficient data on what aspects of the system require special attention. As new features and bug fixes are developed and tested, they can be immediately rolled out to the homes of the study participants. The support team will facilitate any training and transition planning required in the smooth adoption of these new features.D. Analyze the Socio-Economic ImpactThe project concludes with 1) a return on investment investigation relative to the current rural healthcare delivery model, and 2) an impact analysis of the RHM approach which includes the socio-economic impact and training and educational components required for a successful roll out of the project in the commercialization phase.The ultimate goals of the RHM project are:1) Complete the research and development of the RHM system to prepare for a successfully transition into the commercialization phase,2) Assist the network of existing rural healthcare providers and services in a smooth roll out of the RHM system approach, and3) Communicate and inform rural seniors and their support network on the benefits of RHM to communities in rural America through coordination with existing outreach programs that have proven success with improving the lives of rural Americans, such as the regional Rural Health Administrations and Rural Hospital Associations.Expected outcomes and societal impacts:In addition to reduced readmissions and the conservation of scarce and expensive healthcare resources, RHM helps rural seniors maximize the amount of time that they can stay at their current residence thereby maintaining their social network and maximizing the choices available to them. Research and healthcare statics support the claim that each move up the healthcare continuum accounts for a 2-5 X cost multiplier. The Phase I results, as well as previous research in this space supports the notions that RHM has implications for policy makers, medical and allied health practitioners. Dissemination of this research is needed for two primary audiences: 1) to policy makers and practitioners to encourage them to promote environments that support and facilitate RHM use by rural seniors as well as their providers of care, and 2) to educators of existing and future rural medical and allied health workforces to the potential of RHM.As the dispersion of technology continues to extend deeper into rural areas, employment opportunities may expand in the areas of technical support into these areas as well. RHM's benefits will become more obvious as healthcare professionals explore creative approaches to addressing the distinctive health obstacles of seniors residing in geographically isolated regions.
Animal Health Component
30%
Research Effort Categories
Basic
20%
Applied
30%
Developmental
50%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
80360992020100%
Goals / Objectives
Goal 1: Prepare the Rural Health Mate system for transition to commercialization phase.This major goal will ensure that the fruit of this effort results in a game-changing methodology that will improve the health outcomes of rural seniors.Building on the success of Phase I, Phase II efforts will include the further design, development, and testing of RHM resulting in a much-needed system to help rural seniors stay healthy, safe and independent. Additional benefits to care providers and caregivers include remote coordination, communication and monitoring of the senior in a respectful way.The overall goal of Phase II is to continue the research and development activities for RHM to provide a fully functioning software system that can be readily commercialized during Phase III. This will be achieved with the following Phase II Technical Objectives:1) Develop Final Requirements for RHM2) Enhance the RHM Design and Prototype based on Phase I feedback3) Perform Extended Field Evaluation4) Develop the Final SoftwareThe sub-tasks for implementing each of these objects are:Objective 1: Develop Final Requirements1.1. Conduct field interviews1.2. Refine user stories and needsObjective 2: Enhance Prototype2.1. Revise design2.2. Develop Caregiver App2.3. Enhance the Cloud Computing2.4. Integrate, build and testObjective 3: Extended Field Evaluation3.1. Subject Selection / Recruitment3.2. Administer Field Evaluation3.3. Analyze ResultsObjective 4: Complete Development4.1. Review design (throughout)4.2. Reduce Build and Install Costs4.3. Enhance Fall Prediction4.4. Develop Install / Usage Material4.5. Final integration, debug and testGoal 2: Perform Socio-Economic Impact Assessment of the Rural Health Mate systemThis goal will be accomplished via the following Objective and sub-tasks:Objective 5: Socio-Economic Impact5.1. Assess Impact5.2. Analyze and Report Results
Project Methods
The Methods that this Rural Health Mate (RHM) project will be conducted include:1) Collection of focus group information using the Nominal Group Technique (NGT), which empowers each focus group participant with a guarantee that their inputs will be recorded and that they will have equal rights when voting on various aspects of the project that are presented, such as the relative importance of features and functions.2) Definition of user stories AKA Use Cases that describe the rural senior's typical current situation, their goals (as well as the goals of their support team and healthcare team), and the resulting gap analysis.3) Further definition of these user stories detailing the ideal typical interaction with the RHM system, broken down by functional assessment or diagnosis (such as COPD, HF, Diabetes, etc.).4) Conversion of these user stores to design specifications, including the formal Design Specification Document (DSD), which is a living document that was started in Phase I and will follow through into production in Phase III.5) Breakdown of the DSD into an implementation plan with assignment of each relative section to the proper team.6) Weekly Team meetings (including all aspects of the project) to review metrics, issues, potential workarounds or fixes, and measurable outcomes to be accomplished by the next week's meeting.7) Interweave the development cycle with the extended evaluation. This is a fundamental departure of the typical process, called waterfall, where a development team works in a vacuum as they convert the functional specifications into a working prototype - and then reveal the final version to the study participants.CreateAbility's process will interlace the extended evaluation of the emerging system with new features and functions as they become available to immediately provide feedback to the design team on how these new capabilities were supportive, helpful, and used.The key milestone events in this project are:Objective 1: Develop Final RequirementsBeg End Tasks1 8 1.1. Conduct field interviews9 12 1.2. Refine user stories and needsObjective 2: Enhance PrototypeBeg End Tasks13 26 2.1. Revise design17 26 2.2. Develop Caregiver App21 26 2.3. Enhance the Cloud Computing31 39 2.4. Integrate, build and testObjective 3: Extended Field EvaluationBeg End Tasks21 26 3.1. Subject Selection / Recruitment27 78 3.2. Administer Field Evaluation40 91 3.3. Analyze ResultsObjective 4: Complete DevelopmentBeg End Tasks40 78 4.1. Review design (throughout)27 39 4.2. Reduce Build and Install Costs40 65 4.3. Enhance Fall Prediction66 91 4.4. Develop Install / Usage Material40 91 4.5. Final integration, debug and testObjective 5: Socio-Economic ImpactBeg End Tasks66 104 5.1. Assess Impact92 104 5.2. Analyze and Report Results

Progress 09/01/15 to 08/31/17

Outputs
Target Audience:Using the analogy of a dart board, rural seniors with dementia are the bulls eye of Rural Health Mate. Rural seniors are fiercely independent, and want to maintain control of where and how they live. Rural Health Mate helps them stay independent, by making sure that they are adherent in their medications, are on track with their vitals, and their fall risk is stable. The system communicates with the rural senior, and lets remote loved ones and care givers know that they are okay, or alerted if not. The other stakeholders involved with the rural senior are: private duty nursing companies, rehab companies involved in post-acute care, and the senior's personal healthcare professionals. From a macro perspective, the various channels to rural seniors include: Regional Health Connectors, Chronic Disease Support Groups, Community Health Workers, Community Health Centers, The Community Health Collaborative,Community Care Alliances, and Coordinated Care Organizations. All these groups can be granted access to the cloud-based data by the senior. The cloud-based system includes a simple way for the care team to stay coordinated on who is doing what and when. This includes an integrated communication portal as well. Changes/Problems:Other than typical debugging and integration issues, the team didn't experience any major technical issues that couldn't be solved. Even with Microsoft cancelling production of the Kinect game appliance (that was used for tracking). Low-cost Eastern knock-offs were found to meet the needs. The problems we encountered were more central to the go-to marketing plan. While we were counseled and coached that the major customers would be County Hospitals and Personal Service Agencies (AKA Private Duty Nursing), our initial success (representing 82% of sales to date) has been with non-paid caregivers and rural healthcare boards. This shift resulted in re-working the marketing plan to increase awareness in these more fragmented groups, including: targeted email marketing, case studies, attending county health board meetings, memberships in statewide rural health administrations. This shift also resulted in a technical shift to the product offering, that relied less on fall detection via machine learning (where a computer discerns falls via analyzing data from Kinect), to an approach that incorporates enhanced intelligence so that spans the entire household to predict and prevent falls using passive sensors in chairs, beds, floor pads in front of the toilet, and walker movement detection. What about Hospitals and PSAs? County Hospitals and Personal Service Agencies (PSA) will continue to be part of the go-to marketing plan, but these two groups are currently dealing with the following issues: County Hospitals are focused on re-defining their place and purpose, as some chronic care and most surgeries have been transitioned to centralized hospital systems in larger cities. This redefinition period will last approximately two more years. Most PSAs are still able to continue their original business model of staffing care directly into the home. The available labor pool is tightening, but not enough to demand a shift in their business model to the emerging model of periodic in-home visits, supplemented with remote monitoring to provide 24/7 oversight. Currently, only geographies that have big box distribution centers (that pay approximately $2.75 more per hour) have made this transition, again driven by labor shortages. What opportunities for training and professional development has the project provided?New Certified Nursing Assistants (CNA)s or new healthcare professionals that are added to the rural senior's care team can more quickly come up to speed on the history and current status of the rural senior, resulting in improved health outcomes for the rural seniors. How have the results been disseminated to communities of interest?The results of Rural Health Mate have been presented to regional and national conferences, including RESNA. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? All of the objectives for this project were accomplished under both Goal 1 and Goal 2. Goal 1: Prepare the Rural Health Mate system for transition to commercialization phase Objectives 1 - 4 support this goal, and are described below: The design requirements were formulated from the data collected in Objective 1 through field interviews, focus groups and nationwide surveys. User stories were created to describe the ideal user experiences for each of the stakeholders addressed by the project. The resulting design specification was used to enhance the initial prototype in Objective 2, to prepare for the extended evaluation in Objective 3. This involved the development of a Caregiver app, now marketed as MeMinder, that interacts seamlessly with CreateAbility's cloud, called BEAM (for Basic Everyday Activity Monitoring). The extended field evaluation in Objective 3 took place over a 13-month period, and included 96 participants. These study participants involved rural seniors, their remote sons and daughters who are concerned with their parents health and function; their remote healthcare professional; Certified Nursing Assistants (CAN) from various Private Duty Nursing companies, and therapists from post-acute rehabilitation organizations. Development continued on Objective 4 in parallel with the Objective 3 field evaluation. This allowed real-time data from study participant feedback to influence the design and implementation of the final version of the system software and NetWare. New developments were updated into the cloud, apps and in-home equipment to give the study participants an enhanced experience. This included fall prediction, easier installation and training, and much smarter and quicker analytics to alert remote others that there may be a problem with the health and function of the rural senior. Finally, the continued development resulted in an overall cost reduction of the components required for the final system. The Socio-Economic Impact study performed in Object 5 met the requirements of Goal 2.

Publications


    Progress 09/01/15 to 08/31/16

    Outputs
    Target Audience:Rural Health Mate (RHM) will appeal to five major target markets: Rural Seniors: There are 59 million rural seniors in the US. While this number is shrinking slightly (by 50 thousand/year), their acceptance of technology is increasing by 10% per year for a net result of a growing market. That said, CCI feels that the best strategy is Business to Business (B2B), and therefore RHM targets three major market segments: B2B Customers, Size and Growth Rate Target market segments (Agency/Provider), Size and Growth Rates Skilled Nursing (AKA Home Healthcare) over 2,500 agencies 12%/year Private Duty Nursing (AKA Home Care) over 20,000 agencies 20%/year Outpatient Rehabilitation Providers over 5,600 organizations 25%/year Brief Profile of Each Market Segment: Skilled nursing (SN) is a type of nursing that offers long or short-term care for people that need rehabilitation or suffer from serious health issues. Seniors are cared by a nurse or team of nurses that provide the day-to-day medical attention that they need. Identified need or gap within skilled nursing and the significant and relevant advantages of RHM: more efficient or effective delivery of care at lower operational costs, and lower overhead. Private duty nursing (PDN) or home care agencies use non-medical caregivers, (cannot dispense medications or puncture the skin). These organizations provide broad range of services from medical and nursing care to personal care services such as companionship, bill paying and transportation services - to help clients remain independent in their current residence. Identified need or gap within PDN and the significant and relevant advantages of RHM: 1) Helping acquire new customers. RHM's care plan introduces the processes and structure that will ease the transition into a PDN coming into the home. 2) Extending the services to existing customers through the use of RHM's automated medication adherence capabilities, and vital sign measurement. 3) Retaining existing customers longer through the use of RHM's automatic fall detection. Outpatient Rehabilitation Providers (ORP) consist of healthcare professionals dedicated to providing a multitude of skilled rehabilitation therapy services to individuals in a variety of settings including inpatient, outpatient, skilled care, assisted living, educational systems, industry / occupational health. There are 3 major categories within this group: 1) Rehabilitation Agencies that provides an integrated, multidisciplinary program designed to upgrade the physical functions of seniors returning from the hospital. 2) Rehab Clinics are facilities established primarily for the provision of outpatient physicians' services. 3) Public Health Agencies are established by a State or local to maintain the health of the population served by providing environmental health services, preventive medical services, and in certain instances, therapeutic services. Identified need or gap within ORP and the significant and relevant advantages of RHM are more efficient or effective delivery of therapy, lower costs, higher performance. This segment is the most flexible in terms of embracing and affecting change in the rehabilitation therapy industry. Benefits to CCI's Customer and End User (by segment): The benefits to the Skilled Nursing Company: Cost savings, higher level of service (continuous monitoring), increased efficiency Smoother transition to long term care. The benefits to their customers (rural seniors): Reduced intrusion, reduced documentation burden, smoother transition into home care PDN. The benefits to the Private Duty Nursing Company: Easier acquisition of new customers (advertisements on freeware), smoother transition into their care plan delivery methods, data to support need (gaps when doing this using volunteers), increased service offerings and better retention of existing clients. The benefits to the rural senior who use PDN companies that incorporate RHM into their service delivery: Drastically reduced intrusion, reduced cost, increased sense of security The benefits to the Outpatient Rehabilitation Providers: Data and documentation, smooth transitions, Increased efficiency, Extra fees for 24/7 coverage. The benefits to their customers (rural seniors): Reduced trips, reduced reporting / data logging, increased flexibility, reduced cost. More detail about the end-consumer - Rural seniors According to the U.S. Census, the rural elderly population was 8.4 million as of the year 2010. This number is expected to increase to 10.6 million by 2020, and 13.8 million by 2030. Rural seniors (people 65 years and over) represent a large portion of the nation's home care recipients. Rural seniors are more likely than their urban counterparts to have complex medical issues requiring health care interventions, including a higher incidence of diabetes and heart disease. Further, rural seniors report a 27% increase in hypertension over urban seniors. Research demonstrates rural seniors in the U.S. have worse health outcomes than their urban counterparts. Rural America presents a unique set of obstacles and conditions that make the delivery of healthcare and related support services, such as aging in place difficult. These conditions include lower insurance coverage; the financial circumstances of rural hospitals; federal rules concerning Medicare reimbursement rates; a scarcity of human service agencies with too few trained professionals and/or too few health care resources that must cover a sparse and scattered population. This is further complicated by difficulties with cultural and social differences, isolation, poverty and transportation issues. There is no data to support that the poverty levels are linked to ethnicity, but there does appear to be a higher incidence of diabetes among seniors with African American decent. A key strength of the RHM plan is to not create innovative training delivery mechanisms, but to build trust through the use of existing training and social events. The distribution of services and education will take place in traditional classrooms and distance learning methods, and hands-on activities at County Fairs and social events. Changes/Problems:Subject recruitment has been difficult, as several subjects who signed up suddenly dropped out during the summer months. To adjust for this, CreateAbility and it's partners are enlisting the assistance of leaders in the local communities who frequently are made up of heathcare professionals. What opportunities for training and professional development has the project provided?Rural communities seeking assistance for ways to manage the gap left by hospitals who are closing chronic care units have received training on CreateAbility's new BEAM Dashboard and in-home sensor-based systems. CreateAbility's developers each improved their skills as they explored new development tools required for the project. How have the results been disseminated to communities of interest?Less than 3 months What do you plan to do during the next reporting period to accomplish the goals?The remaining Objectives in Goal 1 to be accomplshed are: 3) Complete the Extended Field Evaluation 4) Develop the Final Software The sub-tasks for implementing each of these objects are: 3.2. Complete the Administration of the Field Evaluation 3.3. Analyze Results Objective 4: Complete Development 4.1. Review design (throughout) 4.2. Reduce Build and Install Costs 4.3. Enhance Fall Prediction 4.4. Develop Install / Usage Material 4.5. Final integration, debug and test Goal 2: Perform Socio-Economic Impact Assessment of the Rural Health Mate system This goal will be accomplished via the following Objective and sub-tasks: Objective 5: Socio-Economic Impact 5.1. Assess Impact 5.2. Analyze and Report Results

    Impacts
    What was accomplished under these goals? Under Goal 1: Prepare the Rural Health Mate system for transition to commercialization phase. The major objectives accomplished in this first reporting period were: 1) Develop Final Requirements for RHM 2) Enhance the RHM Design and Prototype based on Phase I feedback 3) Perform Extended Field Evaluation (in process) Specifically, this involved the folowing sub-tasks for implementing each of these objects: Objective 1: Develop Final Requirements 1.1. Conduct field interviews 1.2. Refine user stories and needs Objective 2: Enhance Prototype 2.1. Revise design 2.2. Develop Caregiver App 2.3. Enhance the Cloud Computing 2.4. Integrate, build and test Objective 3: Extended Field Evaluation 3.1. Subject Selection / Recruitment 3.2. In the process of Administering the Field Evaluation

    Publications