Wednesday, 15 February 2012

Reopening the hornets’ nest - the terminology of telecare – the ongoing debate...



It has been some time since I wrote about terminology (http://thetelecareblog.blogspot.com/2010/01/language-of-telecare.html) but it’s funny that in the time since that piece was written things have moved on and new services have developed. I do not intend to repeat that blog entry but I think we need to have some common sense when it comes to the terms and their usage.  Maybe the discussion on terminology is old hat and not of great worth at this time.  Maybe the time is right to open the chest and peek inside....

I have already pointed out (in various papers) that the term ‘assistive technology’ has a range of meanings depending on where you live in the world.  In the USA, assistive technology is focused on the technologies that can be used to assist children in schools and with their education in general.  The UK meaning is very different.  Similarly, telecare in the USA is known as ‘Personal Emergency Response System’ (PERS) or ‘medical alerts’, whereas the actual term ‘telecare’ refers to a range of technologies relating to medical/health at a distance (which in the UK is defined as telemedicine and telehealth).

Telecare seems to be a catchall term. Breaking the word down, there is tele (distant) and care (the act of caring, providing care, providing a caring service, providing care for a person, caring for a person, showing you care). This can be contrasted with the word ecare, which has the same second half but the ‘e’ stands for electronic.  To contrast these two words, telecare and ecare we need to see the differences as one is care at a distance and the other is care provided through electronic means. Similarly, ehealth and mhealth differ by health being provided electronically (e) or via mobile services (m).

A key feature of telecare is remote monitoring, this involves people and technology (i.e. people who monitor the alerts and call the person generating the alert).  I consider a simple automated telephone service that has a set of predetermined responses is not telecare; this is ecare. Strictly speaking, it should not even count as ecare, but emonitoring as much of telecare and ecare is concerned with monitoring. 

The public need to be assured that what they are purchasing provides value for money and does what they expect. In ecare systems there are potentially no human interventions, whereas in telecare systems there are. Does the system have call centres where people speak to the person who has triggered the alert?  Do the call centres operatives also make decision on the best course of action (response unit, friends, family, emergency services, doctor, etc)?  The way that a service is described needs to be clear for the customer as their purchases result in a long-term commitments and cash outlays.

Current regulations do not cover the differing types of service and legislation fails to differentiate between the differing aspects of monitoring available.

I can see the benefits of all the differing types of monitoring on the market and strongly believe they each have a place and a level of merit.  What I am concerned about is that the language that is used does not allow for the differentiation that there is between these services.

Personally, I am not bothered what category a service fits under rather I am more concerned about the service they provide. Where I do get concerned is when services are portrayed as belonging to something they do not belong to, as this is a misrepresentation to the public.  The people purchasing a telecare service are expecting care at a distance, whereas when people are  purchasing ecare they should be aware it is all electronic.

I understand why the name telecare was derived, but I also think that this name should be changed to emonitoring or telemonitoring.   This way it says what it does on the packet.  I can also accept that if a telecare service has a full response unit that will be attending people in their home as part of the package then it might deserve the term telecare, but many services currently fail to even offer this basic service.

As a potential purchaser of telecare, for my mother, I suspect that when I look for the company that will be providing the monitoring and technology, one of the first questions I will be asking is does the services do what it says on the packet?  Is this a real telecare service?

I know the currently the UK Government is endorsing telecare through the Whole Systems Demonstrators and the 3millionlives initiative has spent considerably large amounts of money on developing and deploying telecare in the UK and there are now over 1 million people with the service, I suspect that if we redefined telecare to make it more realistic we will find the figures are very different. 


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