Betting on the future of eldercare tech

Long interested in robotics and the use of technology to improve society and reduce health care costs, Alwan, whose mother, at age 84, lives in Damascus, Syria, was appointed director of the Center for Aging Services Technologies (CAST) in May.

Washington, D.C.-based CAST, which is part of the American Association of Homes and Services for the Aging, is a coalition of technology companies, eldercare providers and universities that collaborate to develop new technologies to make health care better for elderly people.

Alwan, who received his Ph.D. in intelligent assistive robotics in 1997 from the Imperial College of Science, Technology and Medicine at the University of London, will moderate a panel Monday afternoon during the fourth annual Healthcare Unbound conference in San Francisco. Titled "The Future of Aging Services--Provider Business Models," the panel is part of a newly launched "Aging Services Track" at the conference, which focuses on the convergence of consumer and health care technologies.

CNET News.com spoke with Alwan recently about CAST, the future of eldercare technologies and what it will take to make them pervasive in society.

Q: What is the purpose of CAST?
Alwan: The end game is to prove that technologies would allow seniors to have a better aging experience in a place they call home. For example, the technologies would allow them to age in a place of choice, whether it's their home or an apartment within a continued retirement community or an assisted-living facility. We have to acknowledge that transition to some form of long-term care setting may, at the end of the day, be inevitable. Technology can play a role in all of these settings, but the end goal is the aging experience. And at the other end, the reduction of cost to whoever is going to bear the cost.

You left the University of Virgina's Medical Automation Research Center and joined CAST as its new director in May. Was it due to the exposure you received to CAST, as the Medical Automation Research Center's volunteer representative to that group?
Alwan: They were looking for a director and I had always been actively involved in CAST. I had some ideas to take CAST to the next level and found that this position might be a good fit, not only for my interest (in biomedical applications and robotics), but also for my aspirations for CAST.

What are your goals for CAST, and how would you describe your role there?
Alwan: CAST plays the role of bringing the stakeholders--tech companies, eldercare providers and university researchers--together at the same table to look at the same issue from different perspectives, and to partner on designing and evaluating technologies in the field and in living laboratories.

So far, CAST has played this role somewhat passively. CAST has not been actively involved in matchmaking, in connecting a specific company to a specific eldercare provider based on the need of each party, and has not played an active role in designing the pilot evaluation studies or in helping to design the pilot evaluation studies to ensure that the field evaluations provide results that can be used to advance the goals of CAST and, eventually, drive policy changes that would remove the barriers that could be in the way of the fast adoption and proliferation of the technology--and show the public, seniors, and public officials that these technologies not only work, but they also deliver a value proposition.

They also can actually improve the quality of life of the seniors who are using them, can actually reduce the caregivers' burdens, reduce caregiver strain for informal caregivers and improve professional caregivers' efficiencies.

Given the matchmaking you hope to do with your members, do you have enough tech companies to go around?
Alwan: There are a sufficient number of technology companies, and the offer to assist in these field evaluations is primarily targeted at the eldercare providers. It is necessary to require their engagement in the first place.

We do not limit our assistance to products of companies who are members of CAST. So, an eldercare provider could be thinking of adopting a product of a small company that is not yet a member of CAST, and we are open to that. We are not limiting that engagement to only the tech companies who are members of CAST.

What kind of tech companies do you count as your members? Largely hardware companies?
Alwan: There are small system integrators who can help you integrate a piece of hardware from company A with a piece of software from company B. There are software companies primarily looking at electronic medical records and financial software companies, and software for tracking elder care, and so on and so forth.

When you look at the tech industry overall, what percentage do you think are involved in eldercare technologies?
Alwan: I would say more than 10 percent. Probably 20 to 25 percent of the tech companies have their eyes on the medical application, medical field and the eldercare field. Whether they are actually actively involved in publicizing their work and their interests is a different matter. Probably out of this 20 to 25 percent, again about 15 percent are looking at the eldercare segments, but, unfortunately, not all of them are part of CAST.

When you look at this group of 15 percent that may be involved in elder care, how would you describe their maturity level? Is this segment still in its infancy, or is it a mature group?
Alwan: I would say that we're in the phase of scoping out the landscape, probably initiating feasibility studies of product concepts, but not quite yet at the phase of launching product development.

What role is CAST playing in helping companies determine whether a market exists for their members' products and assisting them in determining the best way to reach that market?
Alwan: There are two sides to your question. The first side, as I understand, is what pertains to actual needs assessment of seniors and doing or getting involved in market research. CAST has already played a role and conducted a study in 2005. It published a white paper on the CAST Web site on seniors' needs. Again, the study was based on focus groups conducted in five different cities nationwide and it presented a 10,000-foot view of the baby boomers and the current seniors' needs in terms of technology. If they build it, would they buy it, for example. Are they willing to pay for technology and so on and so forth.

This is something that CAST has been involved in and also this is something that is of interest to me personally as a researcher.

Regarding the other side of my question. Will you help companies determine the best marketing approach for their products, or does CAST plan to let the companies figure that out themselves?
Alwan: This is a very, very good question. CAST, in the past, has conducted studies on the state of aging-services technology by scanning what's available in terms of product, who these products are targeted at, what features do they have, what advantages do they have, what unintended disadvantages do they have, and we are in the process of updating this research. We expect to deliver an updated version of this paper by the end of this year or by the beginning of 2008. In that paper, we will also not only provide a definition and vision and categorization and description of these technologies, but also we're going to discuss some of the barriers to the proliferation of these technologies and also what are the potential accelerator models that would accelerate the adoption of these technologies.

Is it by selling directly to the seniors? Or is it by selling directly to the adult child caregiver, the informal caregiver or any promising care models out there that would play a significant role, especially in the initial rollout phase of these products on the large scale?

Who's going to pay for these technologies and how much of a barrier is that?
Alwan: I think it's going to be a fairly substantial barrier. But then again, people sometimes expect the government to pay for everything, and we need to acknowledge that if we want these technologies to be adopted and proliferated we cannot wait for the government to change the policies to make these technologies reimbursable.

We need to look at pioneers, pioneering eldercare providers, pioneering companies who would embark on demonstrating the efficacy and the effectiveness of these technologies. And if these technologies have proven cost-effective and the proof is scientifically sound--for example, the studies are done on a fairly rigorous scientific basis--you can take the evidence and present it to policy makers and present it to insurance companies, who, based on this evidence, would make changes into the payment systems.

Another perspective is showing value. If this technology is going to reduce out-of-pocket payments for an adult child caregiver under the current reimbursement system, and it doesn't cost much, or if the return on the adult child's investment in this technology is a few months of out-of-pocket payments, the adult child would be willing to pay for the technology and adopt it.

Do you ever think we'll get to the point of being like the futuristic cartoon The Jetsons, where robots will be providing daily living assistance?
Alwan: No. What I aspire to see is technologies that are better integrated, that pieces of hardware will talk to each other, even if they were not from the same provider. This pertains to one of CAST's focus areas--primarily, creating standards for information exchange and integrating the information into personal health records and electronic health records that are accessible, secure and available all the time.

Technologies that are acceptable and context-aware do not require significant interaction or correction from a user, whether it's a nurse or a senior. The main things are a fully integrated spectrum of services and linking information to all the parties that need to have access to the information anytime.