Empowering Patients Through Technology
Thank you for your kind words. I am privileged to join all of you here today for this, Nikkei-Philips Symposium, on Independent Living and Home Healthcare. This is such an important issue not just for the future of Japan, but for the future of healthcare around the world. At Philips, we believe in a holistic, patient centered approach to healthcare that focuses on the entire care cycle from disease prevention to screening and diagnosis through to treatment, monitoring and health management. Driving our healthcare solutions is a commitment to developing and implementing new technologies that will empower patients and providers. Home health technologies have the potential to revolutionize the delivery of care. So, I am encouraged to see so many dedicated healthcare professionals here today as we discuss the complex challenge of providing quality care to the nearly 7 billion people living on this planet. The Healthcare Puzzle
As patients, providers, clinicians, scientists, and, perhaps most of all, political leaders are learning, meeting that challenge will take innovation, determination, and a willingness to embrace change. As you all know, the capacity to provide quality and cost-effective care is a puzzle with many pieces. New treatments and technologies offer hope for patients and help for those who care for them. But rising healthcare costs and growing shortages of providers are stretching most systems to the limit. Complicating the current healthcare environment is another factor, another piece in this puzzle that will exponentially impact future care. Whether it is a metropolitan hospital or a rural clinic, a doctor’s office or an academic setting, East or West, it is the “graying” of the world’s population that is putting healthcare in the challenging context we find it in today. The Graying Effect
As providers deal with increasingly older populations, health systems are operating in more and more uncharted territory. But what we do know is the size of the problem, and that’s a good way to begin the discussion. We know that the world’s population is aging at a rate never seen before in history. We know that in the year 2000, there were 600 million people over the age of 60. By 2006, that number had topped 700 million. By 2050, we will see it almost triple – reaching a staggering 2 billion people in the 60 plus category. We also know that at the same time the world’s population is getting older, it is also getting sicker. Again, by 2050, half of the developed world is projected to become chronically ill (1). Why are we seeing this change? Because cultures are evolving. People are eating and living differently, and there are consequences both good and bad when societies transform. WiiFit is good. Cheeseburgers, not so good. Family structures which have endured for generations are also changing as young people flood our cities, seeking economic opportunity and as women enter the workforce in large numbers. In societies around the world, the traditional structures that have provided support for parents and grandparents over generations are breaking down. As the population grays, the family structures upon which seniors depend for care are simply disappearing. The Impact of Aging on Women
This has a particular impact for women. We know that women live longer than men, and that won’t change in the years ahead. In 2007, women not only constituted the majority of the world’s population but outnumbered men by 70 million. As the percentage of women in the population becomes larger in higher age brackets, that has important societal implications. Older women are more likely to live alone. They are more likely to suffer economic deprivation and social isolation. These are sobering facts with potentially devastating consequences when put in the context of health care. Japan’s Aging Challenge
Every country in the developed world is experiencing the “graying effect.” But Japan is at the forward edge of this global phenomenon of rising healthcare costs, a shortage of providers and dramatic increases in the number of the elderly. No nation will feel the impact of this aging effect more or sooner than Japan. Between now and 2050, this nation will witness a substantial drop in its population as the number of people over 65 rises to 40 percent. That transformation will bring with it significant economic, cultural and clinical changes. Fortunately, Japan’s healthcare system is one of the best in the world. As its leaders, you have much to be proud of. But the hospital-centered system that has worked well for earlier, younger generations of Japanese is already coming under great pressure to adapt to the demographic and financial realities of the 21st century. Today, the average Japanese sees a physician almost 14 times a year. That is three times the number of patient visits seen in most developed countries. Japan also has twice as many hospitals and three times as many hospital beds than other developed nations while the average length of a hospital stay in Japan is two to three times longer (2). I might point out; most of those other nations are struggling to find ways to pay for their healthcare systems, too. Rising Costs Pressure the System
Like the rest of the world, Japan can no longer afford to accept the status quo if it intends to continue to provide the quality care patients have come to expect. In 2005, the cost of the National Health Insurance plan was 33 trillion yen, 6.6 percent of Japan’s GDP. Economists have predicted that by 2020 that number could reach 62 trillion yen and by 2035, 93 trillion yen or 13.5 percent of GDP. There are four main reasons for that projected increase. According to a McKinsey & Company report, new treatments, procedures and products offer patients longer, healthier lives, but they also account for 40 percent of rising costs. The rest is a combination of increasing demand for more and better healthcare, the aging population, and shifting treatment patterns required by changes in the prevalence of disease. Changing Healthcare Needs of the Elderly
Elderly patients often have multiple and complex care needs. Chronic and terminal care services are more expensive and longer term than acute care services. While Japan has traditionally had a lower prevalence of chronic disease, as lifestyles and diets change, we can expect to see more Japanese living with ongoing health issues. Remember that cheeseburger I mentioned a moment ago? The long term nature of diseases like cardiovascular disease, cancer and diabetes, dictates a shift away from hospital-centered healthcare to more patient-centered care. For some health systems, that may mean moving toward a regionally integrated system that will allow health care facilities to network and share functions within communities. This could save money and time and ensure better patient experiences and outcomes. Building a Bridge Between Hospital and Home
Meeting the needs of an aging population could also mean adopting new technology that can serve as a bridge between the hospital and the home. It is a path that can lead to continued quality care, our first priority. It can also enable longer term independent living for more seniors and create a more cost-effective healthcare system for Japan. Building a strong bridge between hospital and home isn’t going to be easy. It will take a partnership between patients and providers, the private sector and government. Between the innovators and the implementers. It will also take a commitment to change and that’s not easily accomplished either. Most cultures are intrinsically conservative when it comes to change, especially older people comfortable in their traditions and way of life. As we’re seeing in the U.S., healthcare change often generates strong emotions, in part, because it is so personal. It is about how we choose to live and sometimes about how we decide to die. It is about how we take care of our children, and more and more in the years to come, it is going to be about how we take care of our parents and our grandparents. How we as societies determine the quality of life the oldest among us will enjoy. And those seniors will have something to say on the matter as well. They are concerned about their health because they value their independence. Many fear becoming a burden on their families. They have unique health needs, but they also still have much to give younger generations. And they want to contribute to their communities for as long as they are able. Whatever healthcare changes come, these universal attributes must be honored and respected. Empowering Patients to Believe in Themselves
But we’ve learned that the first hurdle is getting older patients to accept the idea that healthcare change can be good… that new technology will empower them, not overwhelm them. That it will make their lives better and healthier. There’s a story about a little town that was given a bear. The town didn’t have a zoo so the bear was placed in a cage while a suitable habitat was constructed. A year later, the bear’s new home was ready, and he was set free to roam in a large park. But the bear continued to walk the narrow confines of the cage that was no longer there because he was trapped by the self-imposed boundaries of his own mind (3). Education is Key
Empowerment is a product of both one’s environment and one’s psyche. Education is the key. When it comes to healthcare, empowered patients are educated patients. I’m not talking about college degrees. I’m talking about people empowered with a knowledgeable awareness and understanding of Japan’s healthcare challenges and the solutions that meaningful innovations based on the care cycle can provide. As good as Japan’s healthcare is, a recent international survey on retirement issues including healthcare had some results you might find surprising. Of the 10 major developed countries surveyed, the Japanese respondents considered themselves the least healthy, a total contradiction of reality. They also had the least confidence in their ability to pay for long term care and said they looked to private insurance and their own savings to pay for their healthcare in retirement, not the government or their family (4). Clearly, Japan’s seniors are concerned about their future health needs. They see themselves as sicker than they probably are which might explain the 14 annual trips to the doctor I spoke of earlier. So, job one in getting people on that bridge to home healthcare is to get them to believe in their own ability to care for themselves. They need to understand that patient-centered care shouldn’t be crisis driven but reflect pro-active, prevention-based approaches supported by technology.
Moreover, they also need to understand that technology puts them in charge of their own lives and their own care. That’s what empowerment is all about. Physicians Can Help Educate
Physicians can play an instrumental role in patients’ healthcare literacy and self-confidence. One important way is to aggressively include patients in the decision-making process. Patients are not clinical peers. We understand that. But informed patients can be effective partners with their doctors if decisions are made jointly in an understandable and transparent way. In this “Age of Empowerment,” this is change clinicians must embrace to reassure and educate patients. Physicians Can Help Reassure
Healthcare changes that affect people so personally can be frightening. In constructing the technology bridge between hospital and home, it is also important to make sure patients don’t feel abandoned by the system. Home health technology can provide many services to patients, more easily and at less cost. But most patients also want to know that the traditional safety net provided in the hospital setting will still be there if they need it. This sense of security is also important to help prevent psychological dislocation. Many elderly people face a number of life-changing events as they move further into old age. The loss of a spouse or friends. A child moving away. A changing neighborhood. Shrinking income. These are difficult to manage emotionally. Family Support is Vital
As people age into their 70’s and 80’s, the loss of mobility can be a problem. Home healthcare can be of real benefit to seniors if they are empowered with the ability to use it. Here, a patient’s family can play an important role. I’d like to stop for just a moment to ask you a couple of questions. How many of you have elderly parents or grandparents? I see a lot of hands go up. Now, how many of you worry about their long term ability to care for themselves? If I asked that question to any group anywhere in the world, my guess is the response would be the same. At a certain age, most of us will have to make some tough decisions regarding the care of elderly members of our family. I faced that moment when my father’s health required him to move to a nursing home. “Could my mother live independently and safely?” was the question that worried me every day. Empowering the Family
One solution to empowering older patients is to also empower their family. These informal caregivers need education to help them understand what technology is available and then training on the equipment to be able to provide assistance to their family member. This supportive process is also part of building a strong bridge between the hospital and the home. Home health technology can be also a tremendous stress reducer for family members who must juggle family and career with informal care-giving duties. Educating patients about the benefits of home health technology is our first responsibility, but bringing family members into the process can make a huge difference in patient acceptance. So can clinicians. For many healthcare providers, keeping up with the rapid pace of innovation is a challenge in and of itself. Empowering Physicians
Empowering doctors and nurses with knowledge of new medical innovations gives them tools to lessen workloads and increase productivity but most important, to ensure the best possible patient outcome. If they spend less time doing routine tasks that new technology can do, for example, they can spend more time focusing on providing personal, quality care. Education is often a key driver of broad cultural transformation. Healthcare change is no different, and along with patients, caregivers and clinicians, political leaders and government officials who will guide healthcare transformation must also be empowered with knowledge. Embracing the Home Care Paradigm
The 20th century paradigm of hospital-based care must be reformed to reflect economic and demographic realities. The healthcare systems of the future must focus more on prevention, screening and early diagnosis rather than the last stages of the care cycle. Hospital care will continue to be the setting for addressing serious clinical situations that require medical diagnosis and intervention. But using hospitals to deliver routine care such as ongoing health monitoring is no longer necessary, cost-effective or even preferable for patients. Innovative home health solutions are a better answer for patients, clinicians and the bottom line. Yet, many of these new technologies are not covered by insurance. This is true here in Japan and in other countries like the U.S. Yesterday’s healthcare regulatory framework hasn’t caught up with today’s remarkable technology. Empowering Policy Makers
That has to quickly change if Japan and other developed nations are going to meet their healthcare obligations in the future. Again, empowerment through education is the answer. Policy makers need to understand home health technologies, how they work and the economic and medical benefits they provide. Most important, they must embrace a longer term healthcare horizon to understand that investment in home health technology now will ensure a more cost-effective, patient-centered healthcare system tomorrow. So far, I’ve talked about the technology bridge between hospital and home. I’d like to take a few minutes to talk about a few of these new home health technologies that can empower patients and clinicians, family and policy makers. Building the Bridge through Innovation
Perhaps the best place to start is by defining technology. One dictionary says technology is “the application of knowledge for practical purposes.” When it comes to home healthcare innovations, I like to say, if it isn’t practical, it isn’t part of the solution. But there are many technology solutions out there today that can help people regain independence after a medical situation, maintain that independence and protect it against potential threats in the future. Some devices help patients apply what they’ve learned in the hospital or in rehabilitation to their lives back home. For example, remote heart monitoring gives patients feedback to tell them how they’re doing especially when exercising. That’s empowerment. Stroke rehabilitation exercisers let physiotherapists assess a patient’s training routine through wireless sensors and recommend changes to improve performance. That’s empowerment, too. The list of new technologies is a long one, but I’d like to highlight two of Philips innovations that illustrate the benefits that home health technology is already providing.
Building the Bridge: Lifeline
The first is the very essence of simplicity and safety. It’s called Lifeline. It’s an easy to use medical alert service that can connect an elderly person in distress with immediate help, call medical assistance and contact a neighbor or family as well. Getting assistance is no more complicated than pushing a button on a wristband or pendant. Within seconds, a trained responder answers the call, determines the patient’s needs and makes the appropriate calls for help. If there is any one device that can make a significant difference in the ability of older people to remain independent and in their own homes at a relatively low cost, this is it. And for family members who worry about mom or dad living alone, Lifeline provides welcome reassurance that help is literally a touch of a button away. Building the Bridge: TeleHealth
Lifeline is designed to address crisis situations. Philips’ Home Telehealth is a pro-active technology that empowers patients to prevent crisis situations. It also illustrates how home telemonitoring technology can improve patient outcomes and be cost effective as well. It’s a win-win situation for both patients and clinicians. Through this innovative device, care providers remotely monitor patient vital signs on a daily basis with an easy-to-use wireless device. This allows them to make timely care decisions and help prevent unnecessary hospitalizations and emergency department visits. It can also lessen the need for home nurse visits. For patients, it means fewer trips to the doctor and a greater sense of well-being at home thanks to regular interaction with monitoring nurses. Home TeleHealth has proven to be a cost-effective program that produces favorable patient outcomes, but numbers speak louder than words. In a study of heart failure patients done by Tufts Medical Center in the U.S., researchers found a 72% reduction in hospital heart failure readmissions with telemonitoring and 63% fewer cardiac readmissions (5). Another study, done in three European settings, was equally positively showing a 29% improvement in the survival rate of heart patients using telemonitoring. While those numbers are persuasive to us in this room as medical practitioners, for patients, the ease of use is also crucial to their willingness to accept this new technology (6). I want to take a moment to show you just how easy self-monitoring systems like TeleHealth are to use. What I’m going to show you is a patient demonstration film developed by Philips for several home monitoring devices that check weight, blood pressure, heart rate and heart rhythm and forward the information to care providers in a remote clinical setting. (patient training video) Building the Bridge through Innovation
As you can see, these devices are designed to make monitoring as easy as possible for patients. That is especially important for the elderly who have had less experience interacting with digital technologies. That’s changing as we see more and more older people using the Internet and the computer technology that lie at the heart of telemonitoring. This morning, I’ve shown just two effective home health care technologies that are changing the delivery of care to the elderly. Many more are on the market or in the research and development pipeline that will empower generations of elderly people in the years ahead. We’re going to need these technologies and many more to meet the health needs of a graying world.
Japan Can Lead the Way
That takes me to the final point I’d like to make today. It is really more of a challenge to you, the leaders of Japan’s healthcare community. As the most rapidly aging country in the word, Japan will be the first to feel the impact of the aging effect on healthcare. You can also be the first to find solutions. I believe Japan is uniquely positioned to lead on this issue because you are a nation of values with a history of innovation. In Japan, you say, “Old people are everybody’s treasures.” These words are a reflection of the strong tradition which has always underpinned Japanese society and family. What better country to seek the healthcare solutions this graying world desperately needs than one which so values its oldest citizens? But as much as you value tradition, you are also a nation that loves innovation. Japan: An Innovation Pioneer For decades, Japan has been a pioneer, creating innovative technologies that have changed the world. You gave us Yoshiro Nakamatsu, the Thomas Edison of Japan, who gave us the floppy disk and hundreds of other inventions. Another Japanese scientist invented the blue LED which formed the basis for all high-capacity optical media. Japan created the original transistor radio way back when and has been keeping our kids entertained with interactive video games for more than two decades. And I can tell you the parents of the world are grateful to you. Then, of course, there are your robots. Nobody builds “bots” better than Japan. You’ve got robots that throw baseballs and play the violin. Robots that cook and model wedding gowns. You’ve got robotic baby seals that are actually used in nursing homes where they provide a calming effect on patients. And just last month, Japanese researchers unveiled a new hi-tech robotic wheelchair that looks like a motorcycle with a joystick. Amazing! At Philips, we learned firsthand just how good Japanese technology is when we acquired Fuji Respironics last year. It shouldn’t be a surprise to anyone that Japan is a global technology leader. In 2006, Japan filed for more patents than any other country in the world – more than half a million according to the World Intellectual Property Association (7). Like your reverence for the elderly, I’ve come to understand that innovation is a core value here in Japan. I’m beginning to think its part of your DNA. It’s also why, I believe that Japan, as it faces the challenges of its own aging population, can also help find innovative solutions that will impact patient care and quality of life globally. We’re going to need the values and innovation Japan will employ to meet this first wave of generational change. I’ve challenged you to lead the world through meaningful innovation to find healthcare solutions that put patients first. Building a Healthcare Bridge to the Future
All of us have a stake in building a healthcare bridge to the future by empowering patients and clinicians with the technology of change. By educating family members to provide needed support and getting policy leaders to make the right decisions. Today’s home health technology gives us one piece of our 21st Century healthcare puzzle. Future innovation will help put the last pieces in place. I believe Japan can lead the way. Thank you very much. --------------------------------------------------------------------- References:
1. UN Report, “World Population Ageing, 2007,” Department of Economic and Social Affairs, Population Division
2. McKinsey& Company Report “Improving Japan’s Health Care System,” by Nicolaus Henke, Sonosuke Kadonaga, and Ludwig Kanzler
3. “Empowering Older People: An International Approach,” Chapter 2, Brigid Donelan
4. “International Retirement Security Survey, 2005” AARP Global Aging Program, done with Harris Interactive.
5. Tufts-New England Medical Center SPAN-CHF II study announced by Dr. Weintraub at AHA Nov 2005
6. TEN-HMS Study – published in JACC on May 17, 2005, Dr. John GF Cleland, primary clinical investigator
7. Statistics on World Wide Patent Activity, 2007, World Intellectual Property Organization
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