What did it take to get us here

We started with the belief that moving the needle on improving the quality of life for older adults and caregivers required a disruption of the traditional business model of fee-for-service sick care delivery and that a comprehensive care system needed to address social determinants of health external to today’s health care delivery systems.

“We created linkAges to address a very real problem,” said Dr. Paul Tang, VP and Chief Innovation and Technology Officer, Palo Alto Medical Foundation, who leads the Innovation Center. “Quality of life and social health are key determinants of health. The next-generation health system must reinvent itself as a community health partner, not just a sick-care delivery system. linkAges is PAMF’s iteration of that vital reinvention.”

The Innovation Center team spent the initial part of its effort conducting extensive ethnographic research with older adults and caregivers in the community. The goal was to develop a deep understanding of the needs, barriers and constraints that people encounter related to managing their personal health and wellness, from their perspective. We then leveraged what we had learnt to help us design an integrated system that would address the themes that we heard repeatedly. Older adults expressed that they were dealing with feeling isolated, disconnected from the community, lonely, not valued and were increasingly losing opportunities to pursue their interests and passions. Caregivers reflected on experiencing stress, guilt, isolation and coping with multiple demands.

The linkAges system was designed as a responsive community-based network that would address these themes and both enhance and support aging in place for older adults and their caregivers.

Once our conceptual framework for the linkAges system was in place we focused on identifying how we would pilot and deploy linkAges in the community. Once more, we took a comprehensive approach: we wanted to develop a program model that was sustainable and scalable; and would have the capability to support an entire community and its efforts to support aging in place. Therefore it was important to us that linkAges engaged a broader community and supported three key aspects: 1) Quality of life for individuals and family caregivers; 2) Organizational capacity for organizations working in diverse ways to support older adults and caregivers and 3) Policy and Advocacy efforts. We also wanted to ensure that linkAges was accessible to older adults with limited technology skills or limited or no access to technology, people who spoke diverse languages and people who were homebound.

Creating a network of partners

We identified Mountain View as a pilot community because of its diversity, close-knit communities, network of social sector organizations supporting older adults and caregivers, and strong city priorities to support aging in place. We then framed a partnership approach that would sustain linkAges through key supports: implementation partners, advocacy/policy partners and philanthropic partners. From August 2012 through now we reached out to the social sector, city, Chamber of Commerce, Senior Center, Senior Advisory Committee, faith-based groups, advocacy groups, neighborhood associations, public organizations and businesses – and have launched linkAges with 15 founding partners!

As Chair of the Mountain View Senior Advisory Committee, Pamela Conlon-Sandhu, RN, is one of the advocates for Mountain View’s role in this pilot program. “The linkAges program strives to support seniors in our community by utilizing creative new technology approaches. I am looking forward to utilizing this new program to help our senior community,” said Conlon-Sandhu.

Moving towards the future

Over the next years, our partnerships and participants will continue to grow: older adults, community members and caregivers participating as users of the linkAges system and the linkAgesTimeBank will be the pioneers of a community-based effort that we hope will be transformative in its impact to support aging in place.

We will continue to develop and deploy the other components of the linkAges system and reach out to leadership and content experts in the field of aging and innovation and will let our community and participants guide us so that we learn continually as we grow. We will evaluate rigorously and course-correct as needed to meet our goal of creating an integrated toolkit with the linkAges platform, evaluation findings and community deployment model that will be available for scalable deployment.

Our vision is to offer the larger community – older adults, individuals and families, public and social sector organizations, and corporations – a tool that they can adapt and use to advance their own efforts at building community and supporting older adults and caregivers.

“It takes a village to successfully nurture healthy aging in place. linkAges is designed as a deployable, replicable and scalable network. We anticipate that its impact in supporting aging in place will begin in Mountain View and will eventually expand to many more diverse communities,” said Dr. Tang.

It will take a community. We hope that you will join us.

The Palo Alto Medical Foundation’s (PAMF) David Druker Center for Health Systems Innovation is hosting the linkAges™ Developer Challenge and Accelerator Project, and through this initiative is inviting the technical community to partner with it to develop new ways to help seniors age successfully.

Barriers to Successful Aging

Health care for seniors is characterized by fragmented services, high cost, and suboptimal outcomes. It ignores critical aspects of quality of life that significantly impact health, particularly social and behavioral determinants. Each day for the next 18 years over 10,000 Baby Boomers in the U.S. turn 65 every single day. For instance, In 1990, 1 in 8 residents of Santa Clara County was over age 60. By 2010, that grew to 1 in 6. By 2030 it will be over 1 in 4. A vast majority of rapidly growing senior population expresses the desire to age independently in place in their homes and communities.

Problem to Solve

PAMF has committed to tackling one of the most significant issues of our time, “Changing the Aging Experience” for seniors.

Today, the vast majority of the rapidly growing senior population in the U.S. expresses the desire to age independently in place in their homes and communities.  But many face an array of challenges to doing so, including increasingly complex health issues, social isolation, and difficulty accessing resources that support their ability to age in place.  In addition, care for seniors is characterized by fragmented services, high cost, and suboptimal outcomes. It ignores critical aspects of quality of life that significantly impact health, including social and behavioral determinants.

Key Innovation – linkAges™ System for Successful Aging

PAMF’s innovative solution is to create a highly functional, coordinated “Ecosystem” that supports successful aging; aging in place with high quality of life.  This ecosystem, called linkAges™, seeks to tightly connect and integrate social services and caregiver support already in the community, partnerships with professional healthcare teams, and tools that empower seniors and caregivers to gain access to resources specific to their personal context, goals and preferences.

The linkAges ecosystem will be markedly different from today’s world and will create a network of interconnectedness among seniors and their caregivers overlaid by the delivery of an array of services specifically tailored to helping seniors age successfully – not just live longer, but extend the time for independent living with high quality of life.  This will be achieved through the following system capabilities:

• Understand and help realize the senior’s quality-of-life goals, taking into account personal context, needs, preferences and risks
• Leverage personalized knowledge of the senior to preempt situations leading to adverse, acute life events
• Tailor a community safety net for each senior comprising interconnected individuals, resources, and activities
• Create a rich environment that facilitates a senior’s ability to stay socially engaged and maintain a sense of purpose and value

Developer Challenge – Innovative Solutions for Signal Detection

The developer challenge is focused on one of the key components of the  linkAges ecosystem, “signal detection,” tracking and interpreting data that will forewarn of impending events with the potential for significant negative consequences.

The PAMF Innovation Team is asking developers to explore Signal Detection, the creative detection and use of signals of physical and social health of our seniors to proactively improve health outcomes and quality of life.

The PAMF is looking for expansive, outside-the-box thinking, so this is a place for BOLD ideas, from developer teams who are aligned with the Successful Aging mission and share a passion for disruptively innovative solutions.

Further background information was presented in a recent Webinar. Click here for more details.

Challenge Deliverables

Challengers are required to deliver a working prototype of their proposed solution.

Of particular interest are community-based signals that are not currently captured and leveraged within the traditional clinical care setting:

• Select signals they believe are important and relevant to senior health and quality of life
• Prototype creative systems in which those signals could be detected, analyzed and meaningfully visualized by appropriate parties
• Show what actions would be taken as a result
• Demonstrate how the proposed approach would improve the health of a population of seniors in the community.

Indicative Evaluation Criteria

• Addresses a significant problem fundamental to senior health and well-being (30%)
• Potential to impact identified problem (25%)
• Implementability and fit with linkAges system design (15%)
• Innovation and creativity (15%)
• Cost-effective, affordable, sustainable, & scalable (15%)

Timeline

The Developer Challenge will have three stages: kick-off challenge, developer challenge, and accelerator challenge, each stage building on the previous one while raising the bar on the required deliverables and opportunities.

• Developer Kick-off Event: April 14th and 15th
• Developer Challenge Registration Opens: April 30th
• Developer Challenge Webinar Briefing and Kick-Off: May 5th
• Developer Challenge Closes: July 30th
• Developer Challenge Judging: August 13th
• Winner Announced: October 1st
• Winner Commences Accelerator (6 month Program): October 1st

Winner to Join PAMF’s Innovation Center Accelerator

Prizes will be awarded at each stage, but the ultimate winner of the developer challenge will have the opportunity to work in the PAMF Innovation Center Accelerator, further refining their solution, interfacing it with PAMF’s linkAges successful aging system, and implementing it in the real world with real people.

PAMF’s intent in offering the winner of the challenge the opportunity to work in the Accelerator for 6 months is to make this solution a key part of the linkAges system build.

Further Information

Further details on the Developer Challenge can be found on the Health 2.0 website.

In the 12 months prior to the kick-off of the pilot, the EMPOWER-H team undertook preparatory work in developing tools to drive sustained behavior change. Through alpha and beta phases of the study, team members tested processes and technologies and conducted ethnography to evaluate how patients handle hypertension in their day-to-day lives. Using knowledge acquired from both phases, the team was able to significantly improve its approach.

The refined program was then moved into the pilot phase, in which 151 patients were recruited and each equipped with a blood pressure monitor with cuff, a pedometer, a scale, an iPhone, and a Bluetooth device for transmitting blood pressure readings. All from the comfort of their homes, patients use an EMPOWER-H iPhone app to upload their blood pressure, daily number of steps, and weight to their interactive Personal Health Record. Their data is tracked by a designated nurse care manager who provides advice, often through MyHealthOnline. Nurse care managers and a dietician also partner with patients in formulating personalized Action Plans, with goals such as increasing the number of steps taken per day, changing their diet, or reducing the number of cigarettes smoked per week.

By giving patients the tools to measure and monitor their blood pressure, steps, and weight but more importantly, also showing them how they can interpret and use their data to improve their health management, EMPOWER-H seeks to cultivate more proactive, engaged patients. Because patients are receiving real-time feedback as well as continuing education and support from their care team without having to make frequent doctor’s visits, they are better equipped to more effectively self-manage their condition. A patient may observe trend data and see that, for example, a certain medication is helping to lower their blood pressure. This may give them confidence that their actions can positively impact their blood pressure and consequently motivate them to take other steps such as exercising more frequently or changing their diet.

Also developed as part of EMPOWER-H is an Epic-integrated population dashboard for exception-based care management. The system automatically triages patients into high, medium, or low risk categories based on their most recently transmitted blood pressure readings and their “behavioral activation risk,” a value based on whether patients have completed necessary steps in their Action Plans. The dashboard gives physicians and nurses a clear, organized look at their patients, allowing them to quickly spot and intervene with individuals at higher risk.

What sets EMPOWER-H apart from other studies of hypertensive patients? Numerous key features, but amongst the most important are ethnography and rapid cycle development.  The EMPOWER-H team is using ethnography to understand not only a patient’s view of hypertension and the barriers that need to be overcome to achieve higher levels of engagement, but also how to modify the program to increase the ability of the care team to support behavior changes in patients.  Rapid cycle development allows for learnings in one phase to be quickly processed, then implemented and tested in the next phase, giving the team the ability to make rapid and real-time beneficial advancements to the intervention.

The study is expected to wrap up in mid-December, but subject to the demonstration of positive results, the Innovation Center hopes to advance toward a new phase—deployment of the program on a limited scale in day-to-day care in the clinic. Together, experience in home monitoring and driving patient engagement and developing processes for managing larger populations of patients are all relevant to the wider objectives of the Innovation Center: health improvement, disease management, and successful aging.

The Palo Alto Medical Foundation’s (PAMF) David Druker Center for Health Systems Innovation launched its linkAges™ Successful Aging Program with a community education and developer event on April 14 and 15, 2012. PAMF’s linkAges initiative is pioneering new ways to support seniors in the community to live a meaningful life and to age in place. When the Innovation Center invited the community to share its ideas on developing new ways to help seniors age successfully, the response was overwhelmingly positive. The event had a waiting list within days of the announcement, and more than 300 members and leaders in the community, high tech, government and developers attended the free event, which was hosted by PAMF and Health 2.0 at Silicon Valley’s Computer History Museum. The event was also carried live on Twitter via the #linkAges hashtag, with people participating virtually throughout the United States.

The three nationally recognized keynote speakers at the event were:

• Todd Park, U.S. Chief Technology Officer
• Eric Dishman, Intel Fellow and Chief Healthcare Strategist
• Paul Tang, PAMF Chief Innovation and Technology Officer

View videos of the three keynote speakers here.

Dr. Paul Tang, PAMF’s chief innovation and technology officer, welcomed the group with an overview of the two–day event and an enthusiastic invitation for attendees to work together to “join the community in transforming senior health and well-being through disruptive innovation – be a part of it.” Next, he presented to the group on PAMF’s groundbreaking linkAges program, and he also gave an overview of the Innovation Center’s Successful Aging Developer Challenge.

Following Dr. Tang’s talk, U.S. Chief Technology Officer Todd Park took to the stage with an energetic discussion on unleashing the power of open data and innovation to improve health.

Eric Dishman, Intel Fellow and Chief Health Care Strategist, spoke on “Inventing Independence.” During his presentation, Dishman provided insight from Intel’s 20-year journey to find aging-in-place solutions. He also shared his personal health and caregiving story with the group.

“We were extremely gratified by the public’s response,” said Dr. Tang. “So many people talked to me about their stories and how the ideas behind our linkAges system resonate with them. For a team that wakes up every day trying to re-invent what we do to help make our communities better, healthier places to live, this was music to our ears. We look forward to partnering with the community to bring the ideas to fruition.”

What Happened at the Developer Event?

Energized by a morning of stimulating talks, over 70 developers responded to the Innovation Center’s challenge: select an important problem to solve that is a barrier to successful aging, and demonstrate how indicative signals could be detected and acted upon to mitigate risks to a senior’s health and well-being and assist in maintaining a high quality of life.

At the end of the weekend, twenty teams pitched their creative solutions, covering the full spectrum of activity-based, physiologic and participatory (human) signals and sensors. Teams were highly multidisciplinary, running the gamut of user interaction and systems engineering developers, designers, gerontologists and businesspeople. As each team presented, a graphic facilitator rendered a real-time interpretation of their solution, providing immediate feedback on the idea and creating quite a buzz in the process.

Read about the winning teams and their solutions on the Innovation Center website.

What’s Next?

The weekend’s kickoff challenge prepared developers for the PAMF Innovation Center’s three-month linkAges Developer Challenge, sponsored in partnership with Health 2.0, and launching April 30. The winner of the three-month Developer Challenge will be invited to join the PAMF Innovation Center Accelerator, a six-month incubator designed to refine and integrate the winning solution into the linkAges ecosystem for rapid implementation within the PAMF community. To provide additional background and help developers prepare for the challenge, a briefing webinar is also planned for May 3.

The Developer Challenge will be an unprecedented opportunity for the winning team to demonstrate proof-of-concept of their solution in partnership with a nationally recognized health care provider, giving them a critical leg up on the path to potential commercialization.

For more information, please visit the Developer Challenge website, which will be updated with additional information throughout the Challenge.

Participants of the May 8th event  included residents from The Sequoias, a  LifeCare Community located in Portola  Valley, several members of the  Mountain View Co‐housing  Community (MVCC), and community  leaders from Peninsula Circle of Care  and San Mateo County Health System.

During the event, attendees  participated in a fun service exchange  activity where each participant listed 3  services that they would be interested  in offering to other individuals in the  community through the linkAges  TimeBank. Participants were  encouraged to think of services that  they would enjoy providing (vs.  services that they would be ’willing’ to  provide) and to consider services that  reflected their unique skills or  expertise or personal interests and  hobbies.

Participants were then asked to list 3  services they would like to receive  from other members. Participants  were encouraged to identify service  requests related to their personal  interests or goals (e.g. learning a new  language) as well as things in their  everyday lives that they would be  more likely to tackle or enjoy more if  they could do those things with other  people (e.g. gardening, cleaning out a  garage, sorting through photos, etc.)

By the end of the activity, participants  had generated more than 40 service  offers and nearly an equal number of  service requests. Service offers were  diverse, ranging from personal  bargain hunting, reviewing legal  documents and fine jewelry repair, to  care planning, lawn mowing and post‐  party cleanup. Service requests were  equally diverse, ranging from help  with photo organizing, garden work  and  recycling runs, to learning  Sudoku, receiving short lessons in  European history, and learning  calligraphy.

Service offers and requests generated  by attendees at the May 8 Community  Planning Event have been catalogued  in the linkAges Bay Area TimeBank’s  online database in preparation for  official Go Live of the linkAges  TimeBank website in early August.

Once the linkAges TimeBank website  goes live, any TimeBank members  who has attended an orientation session and successfully completed  the linkAges TimeBank membership  process will be able to access the site  to post service ads, respond to service  requests, and record service  exchanges with other members.

How TimeBanking works 

TimeBanking is a service exchange  network where members provide and  receive services from other members  in exchange for time (see How does  TimeBanking work?). In a TimeBank,  members earn time dollars (TD$)  when they provide services to other  members, and use TD$ to ‘buy’  services from other members.  Every  hour of service equals one (1) TD$  regardless of the service, and everyone’s time is valued equally.

Learn More 

Are you part of a neighborhood,  community group or local business that  would be interested in learning more  about how TimeBanking works? Are you  interested in participating in a  grassroots movement to rebuild  community in Silicon Valley and the  greater Bay Area where people know  each other, help each other, and watch  out for each other? If so, TimeBanking  may be just the thing for you! Email  linkagestimebank@gmail.com, or call  (650) 691‐6267 to learn more and to  schedule a local TimeBank orientation  session for your neighborhood,  community group or business.

An important component of EMPOWER-H is educating patients to make improvements to their diet in collaboration with a registered dietician and nurse care manager.  In addition to receiving appropriate dietary counsel, patients are given the opportunity to bring that counsel to life through a guided visit to Whole Foods of Los Altos. “We want to show the relevance and usefulness of our advice to the patient,” explains Shauna Hyde, Registered Dietician for the EMPOWER-H program. “To state that patients should choose low-sodium foods is one thing, but for patients to stroll down the canned foods aisle and compare low-sodium chicken broth to regular chicken broth is another.”
The on-site event begins with a tour of Whole Foods given by store staff where participants learn, for example, about lean meats in the poultry and meat section, inexpensive options for whole grains and dried beans in the bulk foods aisle and where to find instructions on how to prepare them, and Whole Foods’ Aggregate Nutrient Density Index (ANDI), a food-scoring guide that helps people choose produce with greater nutritional “bang for the buck.”  Afterwards, participants head to the Whole Foods kitchen, where Chef Amy Fothergill teaches them how to prepare a menu of healthy, simple, and tasty dishes.  At a recent session, EMPOWER-H study participants learned to make 5 dishes, ranging from a lentil, quinoa, and garbanzo bean salad to a simple pan-grilled fish.  After cooking, participants share a meal together, sampling the fruits of their labor.

Participants receive copies of the recipes for the dishes they’ve just made, along with data on its nutritional content.  In addition, Whole Foods provides another entirely new menu with a week’s worth of healthy dishes, and packs a complimentary bag of groceries that contains all the ingredients needed to make those dishes for participants to take home with them.

The first event was held on June 25, with two more sessions upcoming.

Click here for more information on the EMPOWER-H pilot study.

The PAMF Innovation Center, which formally unveiled its linkAges Successful Aging System on April 14, is partnering with members of the CoC Community Task Force to identify ways in which Community Task Force member organizations can leverage various components of the linkAges Successful Aging System, such as the linkAges Bay Area TimeBank, toward building and sustaining a community-based safety net for older adults and family caregivers.

For more information on the Peninsula Circle of Care program, click here.

For more information on the linkAges Bay Area TimeBank, click here.

Twenty teams pitched their creative solutions, covering the full spectrum of activity-based, physiologic and participatory (human) signals and sensors. Teams were highly multidisciplinary, running the gamut of back and front end developers, designers, gerontologists and businesspeople.

After much debate, the judging panel—comprised of Jeff Gerard, regional president of Sutter Health, Jean-Luc Neptune, senior vice president at Health 2.0, and several senior members of the Innovation Center team—ultimately selected two first place winners: Meter Made and SunHatPig. Finishing strongly in third place was Team JEDi.

The Winning Teams and Their Solutions

Meter Made team members are Robert Sloan, Eric Aker and Kenneth Ng. They took a technical approach to activity monitoring in a senior’s home as a means of latent “okayness” checking. They proposed to leverage existing sensor technology to monitor utilities data from a smart meter. Showing actual data collected from a team member’s home, they described the properties of an analytics engine that could be used to monitor deviations from base-lined normal utilities usage.

Real time interpretation of Meter Made’s solution
rendered by graphic facilitator Tom Benthin (click photo to expand)

Team SunHatPig, comprised of Janet Campbell, Shelly Ni, Benjamin Olmsted and David Parpart, chose to focus on human signals and sensors. They developed a concept for an application that would allow caregivers to express and have their caregiving needs met by a community of caregivers in their area. Requests would be geo-localized to support discovery by nearby caregivers, and the resultant community would be able to further support one another in caregiving by contributing to a “worry score,” a digested rating of how those who interacted with a given senior perceive his or her physical and social health status.

Finally, Team JEDi, which includes Jesse Martinez, Ed Martinez and Don Chin, proposed a means of being able to latently monitor the health and quality of life status of a senior living alone. Acting through volunteer organizations like Meals on Wheels or transportation services that interact with seniors in their home, volunteers would be able to log their observations about micro-changes in a senior’s activities. This might include things like missing meals, moving slower than usual, or even being less socially engaged. Aggregate data could be analyzed and used to prompt appropriate interventions.

What’s Next?

The weekend’s kickoff challenge prepared developers for the PAMF Innovation Center’s three-month linkAges Developer Challenge, sponsored in partnership with Health 2.0, and launching April 30. Winners of the three-month Developer Challenge will be invited to join the PAMF Innovation Center Accelerator, a six-month incubator designed to refine and integrate the winning solution into the linkAges ecosystem for rapid implementation within the PAMF community.

It will be an unprecedented opportunity for the winning team to demonstrate proof-of-concept of their solution in partnership with a nationally recognized health care provider, giving them a critical leg up on the path to potential commercialization.

For more information, please visit the Developer Challenge website, which will be updated with additional information throughout the Challenge.

“Successful aging is about much more than health care,” Dr. Tang said. “It requires a supportive ecosystem of social connections and resources to assist in a variety of daily-living activities. We call this community ecosystem linkAges – linking across generations. We believe it takes a village – a combination of caregivers and community social services working together with professional healthcare teams to create a partnership that supports a vibrant and fulfilling senior community.” P

AMF’s Innovation Center is launching linkAges with a kickoff community education and technology developer event April 14-15. Hosted by PAMF and Health 2.0 at the Computer History Museum in Mountain View, the event will consist of two sessions:

• A morning community education event, Saturday, April 14, 8:30 a.m. – 1 p.m.
• A developer kick-off event, afternoon of April 14, and all day Sunday, April 15

Members of the general public are invited to attend the community education workshop. Developers are invited to attend both events.

About the Community Education Event (open to the public and developers)

The morning community education event will feature three nationally recognized dynamic speakers:

• Todd Park, U.S. Chief Technology Officer
• Eric Dishman, Intel Fellow and Director of Health Innovation at Intel
• Dr. Paul Tang, Chief Innovation and Technology Officer of the Palo Alto Medical Foundation

Both Park and Dishman will discuss the social and health challenges of aging and the tremendous opportunities to apply technology in disruptive, innovative ways to help seniors live vibrant and fulfilling lives – aging successfully. Dr. Tang will describe PAMF’s linkAges successful aging initiative and PAMF’s role as a community health partner.

About the Developer Kick-off Event (open to developers only) April 14, 1 pm – 6 pm, and April 15, 8 am – 5:30 pm

Following the morning keynotes, developer teams from around the country will engage in ideation sessions (the afternoon of April 14 and all day on April 15), focusing on innovative solutions to address the challenges heard in the public symposium. Top ideas will be awarded monetary prizes.

The Developer Kick-off Event will also lead into a related three-month developer challenge, where the top prize will include an opportunity to participate in an accelerator program with the PAMF Innovation Center. Participants in the developer kick-off event will benefit from additional education and feedback that may facilitate their successful participation in the developer challenge.

April 14, 2012
Computer History Museum, Mountain View, CA