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Services move to technology, team care

By Kristen Consillio

LAST UPDATED: 3:30 p.m. HST, Nov 18, 2010

Lorna Ota, a retired Straub Clinic & Hospital radiology transcriptionist, goes online to communicate with her doctor, refill prescriptions and check her laboratory results to make sure she isn't taking in too much salt.

Ota, who is in her 70s, is among a growing number of seniors who have become accustomed to using technology to monitor their health and visit the doctor without actually seeing the doctor.

"I can be more responsible instead of depending on a doctor or dietitian or health worker," Ota said. "I don't know what I'd do without it because it saves me so much time and headache."

More seniors are expected to depend on technology to help them improve their health as tech-savvy baby boomers enter their golden years.

Hawaii Pacific Health, which launched the online service in January 2009, expects the number of users to reach 50,000 during the next few years, up from nearly 11,500 this year. About 45 percent, or 5,105 of all users, are age 55 or older.

Hawaii's health care industry is preparing for a major overhaul with advances in technology, as well as an older population with more chronic conditions associated with aging.

In the next decade, baby boomers will see a significant shift in the way health care is delivered whether via the Internet or at the doctor's office.

With an anticipated shortage of doctors -- geriatricians, in particular -- seniors will not only have to be more active in their own health, but depend on professionals such as public health workers, physician assistants and nurses' aides for their medical care.

"You won't be able to see a geriatrician," said Aida Wen, co-principal investigator for the Pacific Islands Geriatric Education Center.

The industry is prepping for these changes by training a variety of medical professionals in geriatric issues as an integrated team.

Redesigning the health care delivery system is a national movement based on a concept known as "patient centered medical home," which refers to a team-based model led by a personal physician who coordinates the care to improve results and reduce costs.

Those efforts include the use of electronic medical records, patient outreach and education to ensure follow-up visits, vaccinations and appropriate medications, as well as other preventative care. Depending on a patient's needs, the team can include nutritionists, psychologists, pharmacists and physical therapists, among other health professionals.

"Better care outside of the hospital can keep (patients) from being admitted and better care is less of an expense over time," said Virginia Pressler, Hawaii Pacific Health executive vice president and chief strategic officer.

The University of Hawaii has a pilot project under way at the Hawaii Island Family Health Center on the Big Island, training pharmacists, nurses and doctors to care for patients in this coordinated team approach.

There is limited -- or no communication -- between primary care doctors, specialists and other medical professionals, which is why continuity of care is a challenge.

"It's going to be real different," said Tina Shelton, spokeswoman for the University of Hawaii John A. Burns School of Medicine. "Multidisciplinary training is at the forefront of health care now."

In recent years, it has become mandatory that UH medical school students be trained in geriatric problems so health professionals across the board will be able to identify age-related illnesses.

"The pediatrician is going to recognize dementia in the grandmother who's the caregiver, the pharmacist can be aware of potential medical interactions or problems because of dementia or Parkinson's or some other aging issue," Wen said. "No matter what specialty you're in, you're going to need geriatric expertise."

Health care today is designed for a more youthful population with acute care conditions such as a broken leg or the flu, which is how insurance payments are calculated. The elderly have chronic, and often multiple, conditions that are ongoing such as hypertension, arthritis and diabetes, which can essentially be a drain on the system.

"So when you talk about preparing the health care system for an aging population you're talking about a shift from addressing acute conditions to chronic conditions, which requires far better communication and coordination from the medical community than we currently have," said David Baxter, senior vice president of Age Wave, a California-based consulting firm that studies the aging population. "When someone has multiple chronic conditions they need a medical team that needs to be coordinated."

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