High technology coming to a nursing home near you.

The care of the older person has classically been a high-touch person-centered endeavor, but times are a-changin’.1 New technologies are developing rapidly, and although uptake has been slow, they are starting to be incorporated into nursing homes. Nurses and doctors have been slow to embrace these technologies, citing difficulties in using them and lack of relevance to residents as major reasons for lack of enthusiasm.2 Original uptake of technology in nursing homes was for billing purposes and recording the minimum data set (MDS). Table 1 provides a list of the technological advances that will likely invade the nursing home over the next few years. The simplest is the use of the electronic medical record for physicians to record the resident history, examination, plan, and to directly order medications.3 In an ideal world this will be integrated with the nursing home record where nurses are already recording vital signs and behaviors and charting wounds on a body shape. Integrationwith the MDS 3.0 to allow the physician to include scores for delirium, cognitive dysfunction, depression, and so forth, will further increase the value of the electronic record.4e6 Improved prescribing will occur as there is integration of pharmacy records with recognition of potentially dangerous anticholinergic burden and the use of tools such as the Geriatric Risk Assessment Med Guide to reduce medicationinduced delirium and falls.7e14 The computerized medical record should greatly improve communication between nursing homes and hospitals at the time of transitions of care.13,15e22 Telemedicinehas certainlyarrived in remoteareasand forhomecare, but clearly it can be used in assisted living and nursing homes, particularly for night calls.23,24 The availability of telemonitoring, including rhythm strips, makes this an excellent approach for patients with heart failure.25 Advanced-practice nurses working with dermatologists have used this to allow the dermatologist to see the skin rash.26,27 A major need in nursing home care is to improve quality of life by reducing the intrusiveness of nursing presence.28e31 The development of “smart homes” will play an important role in providing technology that will allow more seniors to “age in place” or provide enhanced privacy in institutions.32 A classical example of this technology is “Tiger Place,” associated with the University of Missouri in Columbia, Missouri. At Tiger Place, technology has been developed to do remote monitoring in senior housing to detect potential problems.33 For frail elders,34e43 a series of monitoring technologies has been developed, such as functional ambulation and declining activity