Tuesday, 13 July 2010

The increase in telecare

With the release of the UK government’s “Equity and excellence: Liberating the NHS” document the emphasis for health promotion falls on GPs as they will be getting the vast amount of money from the dissolution of the PCTs (Primary Care Trusts). This really interests me. When I worked for social services in North London, I found that GPs were by and large a very difficult group of people to interest in telecare. Actually finding access to their forum was hard and harder still to get any enthusiasm for the potentials of this new technology.

It seems that with the release of this document and the fact that the commissioning of services will be undertaken predominantly by GPs in the future that they are going to need a crash course in telecare, telehealth, mHealth and eHealth.

So how is this going to happen?

Who is going to do this?

The only way that this can be done is for telecare to be included in the documentation that the government produce but it is nowhere to be seen.

If we are to follow the preventative agenda, then surely telecare must be the spearhead of changing the way we consider health and care. Ideally as a result of the proposed changes and the distinct lack of money in the UK it behoves all GPs to get tele-trained pretty quickly.

I can see that this should also not be something that comes from the manufacturers as this could bread suspicion in GPs rather I can see a role in this for the TSA (Telecare Services Association) as well as the government to bring this information to the desktops of the General Practitioner of tomorrow. But before this can happen, how are can the profile of telecare be raised to such an extent that GPs will actually begin to take a message on board that they have resisted for the last five years?

Any answers gratefully received!

Friday, 29 January 2010

The Language of Telecare

"When I use a word," Humpty Dumpty said in a rather a scornful tone, “it means just what I choose it to mean --- neither more nor less."
"The question is," said Alice,"whether you can make words mean so many different things."
"The question is," said Humpty Dumpty, "which is to be master--- that's all."
Lewis Carroll – Through the Looking Glass.

I am not sure about you, but I think it is time to resurrect the debate about terminology. I have recently been to a number of conferences and at these events people use the words Telecare, Telehealth, Telemedicine and Assistive Technology interchangeably. The speakers seem to appear confused because they are using the words Telemedicine when they are talking about Telehealth and Assistive Technology to mean anything and everything. The term assistive technology (AT) seems to have become an umbrella term for Telecare, Telehealth and Telemedicine which is a little strange as AT is so much more than these small bits. It denigrates the words Assistive Technology. AT after all comprises of environmental control systems, speech helpers any form of technology that can enable an impaired person (http://en.wikipedia.org/wiki/Assistive_technology).

I am not sure that Telehealth enables people in the same way that Telecare does or even qualifies to fit under the banner of Assistive Technology. If you look to the right hand bar I have the definitions of Telecare and AT as: Telecare is the continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living (http://www.telecareaware.com/index.php/what-is-telecare.html).

I would argue that Telehealth monitors patients' health and alerts professionals of possible emergency situations but in a very different mode from Telecare. Telecare produces alarms; it sends real time alerts through to a call centre 24 hours a day; 7 days a week. Telehealth produces less frequent monitoring intervals and the information is sent to staff who are only working when they are at work (often 37½ hours a week). I would also argue that Telehealth does not manage risks associated with independent living, rather it manages peoples' health conditions and possible health deterioration. Therefore, Telecare and Telehealth are significantly different.

On the other hand Assistive Technology (AT) is any product or service designed to enable independence for disabled and older people. (King's Fund, 2001). So Telecare is a small subset of assistive technology. It is not the whole spectrum of assistive technology. Hence, when referring to Telecare, one should use the words Telecare not assistive technology. "the smoke detector is a vital part of assistive technology" is more accurate as "the smoke detector is a vital part of the Telecare repertoire". "Johnathan was helped through the use of assistive technology, the use of augmentative and alternative communication software enables him to communicate for the first time in class". If, for example, I worked with Assistive Technology, I would expect to have some medically training, to have a qualification in engineering and have undertaken the training associated with all people who work in this field. These are very highly skilled people who have years of experience and expertise to offer.

Keren Down from FAST (www.fastuk.org) puts the explanation beautifully “The confusion seems to arise due to the fact that assistive technology is not a term fitted for day-to-day use and that it has been used in very specific (service defined) contexts. It is a term well fitted for strategic planning. An analogy is the term ‘transport’. On the whole people don’t say ‘I’m going to go and take a transport up to the Elephant and Castle’” (http://www.telecareaware.com/index.php/telecare-telehealth-terminology.html).

I would also argue that Telehealth does not fit with the AT definition. Telehealth does not per se actually “enable independence for disabled and older people”. Telehealth supports older and disabled people’s health conditions. I would agree that by these conditions being stabilised the person might be more likely to be independent but this is a by-product of Telehealth not a given. There will be many very sick people who will have their conditions monitored by Telehealth devices in the future but who will not be enabled to be independent as they are too ill.

To me, Telehealth is like a heart monitor people wear at the gym, it is there to monitor fitness where as AT is the machines that people use to get fit. No matter how much you wear a heart monitor it will not make you fit but using the exercise machine will. The gym on the other hand could be considered to be assistive Technology comprising of lots of different component parts.

I think that it is really important that we all understand the basics, and all speak in the same language. If we assume people understand the terms we use then we are making an Ass out of U and Me!

You may not feel that terminology is something we should get het up about, we all 'sort of' know what the person is meaning, but I would argue it is critical! If I am talking to someone about Telecare and they think I am talking about patients in hospitals not people at home, then we start from completely different places. Anything we say after that is interpreted in terms of the initial impression. When I go abroad or talk to people from other countries it often takes a long time to ensure we are both talking about the same thing and understand the words in the same way. If we fail to do this then a conversation can be futile or even dangerous depending on what the other party takes away with them.

So instead of being Humpty Dumpty who states “When I use a word…it means just what I choose it to mean --- neither more nor less” let us use a word to mean what it means, nothing more, nothing less. Moreover, let us ensure that we put pressure on the powers that be to reach clear definitions of the words we need to use… Assistive Technology, Smart Home, Telecare, Telehealth, Telemedicine, e-Health, e-Medicine, mHealth etc. If we don’t decide what they mean soon it will be too late. It is time we master our language within this field.