Monday, 5 November 2012

Taking technology to the people





For those who do not or have not read Telecare Aware (http://www.telecareaware.com/), I would recommend it for all the latest in news on telecare and telehealth, mhealth etc.  

A recent soapbox on telecare aware struck a chord with me. In this soapbox (http://www.telecareaware.com/index.php/telehealth-soapbox-when-the-elephant-in-the-room-has-no-smartphone.html) Carolyn Thomas, whose blog Heart Sisters (http://myheartsisters.org/2012/10/10/no-smartphone/)  proposes that evidence suggests older and disabled people are the least likely to engage with or use mobile technologies such as smartphones. My own experience of working with people over the age of seventy also bears this out. For many smartphones are too complex to understand, have too poor screens with too small fonts and do not have ringers that they can hear. In fact, it was precisely this reason why I wrote a book on mobile phones specifically designed for seniors (http://www.amazon.co.uk/GUIDE-BUYING-MOBILE-PHONE-ebook/dp/B007U5VG0G), which features easy to use phones by emporia and Doro among others manufacturers. 



The emporia Elegance easy to use phone

Easy to use mobile phones have large fonts, loud ringers and are as they say on the box, easy t use. For many people who are venturing in to the mobile phone market an easy to use mobile is the best introduction to a no-nonsense phone.

Returning to what Carolyn Thomas was saying in her soapbox for Telecare Aware her main thrust was that the UK, and in fact many other countries as well, current health policy relies on the introduction of health apps or widgets to enable the person to monitor their own health and control their own health.  The soapbox suggests that if the people to be targeted and of most need are the older and disabled then these are precisely the people who will miss out as a result.  Older and disabled people do not, by and large, use smartphone or tablets and therefore do not use apps/widgets.

I appreciate the argument that in due course, the older population will be from our age group who are a little more tech savvy but I think this is a little short sighted as an argument. I am all for mhealth and the use of apps/widgets but only as applied appropriately to ensure that each app/widget meets the needs (be they health or whatever).  This made me think of the DTA tool (Dependability Telecare Assessment) and how this can be applied to this form of technology.


DTA

If the DTA tool is used to consider health related apps/widgets for older and disabled people then this app/widget would most likely fail the first box of Fitness for Purpose. Health apps or widgets cannot meet the broad needs of and older or disabled person unless said person has a platform to run the app on which they are confident to use.

I would suggest that many apps/widgets that I have tried actually fail the second category or Trustworthiness as many offer generic platitudes rather than bespoke advice or information. For example If I look up Multiple Sclerosis on many health apps/widgets, I get a lovely article on the origins of the condition and often some rather worrying lists of possible symptoms and how it is diagnosed etc, but there is little written on having MS and fatigue.  For this, you tend to get referred to the fatigue section that talks generically about fatigue. Now, for anyone who experiences fatigue, I am certain that most will recognise that there is a spectrum of fatigue from the “I am tired” stage through to the “so exhausted I cannot press a button”.  Within this spectrum there is a possible infinite number other forms of fatigue.  Some are a direct result of the MS possibly, whereas others are might be as a result of the medication that a person is taking.  I have not seen an app/widget that asks for your full medical history and can compute the possibilities of having multiple conditions and how they interrelate to each other.



Health apps and health widgets

A further problem with many apps/widgets I have tested is that they often over egg the pudding, by which I mean they can make simple conditions into mammoth issues for the person, by instructing them to seek medical assistance immediately.  For many people this is very distressing and can make the use of such apps/widgets less likely in the future, but for people who already have conditions which are debilitating this can be the last thing they need to hear.  Moreover, for the doctor/health professional who actually sees the person as a result of the app/widget this is extra avoidable work that could and should have been avoided. So we have stressed out the patient and the doctor... not a great start.  This means that many apps/widgets are less than 100% reliable and could be classified possibly as dangerous as they will raise the blood pressure when a false positive is received.

Moving to the third column of DTA I would also argue that many of the apps/widgets are unacceptable and not very usable for older or disabled people, so we have some serious flaws in the over reliance on mHealth for this client group.  In fact I would suggest that this might increase risks of premature fatality if rolled out to older and disabled people on mass without a proper trial of each app/widget.

David Shaywitz seems on the right track in a recent article he asserts:

“The danger is that if we don't find a way to recognize, express, and capture the value of the human connection in medicine, we are unlikely to preserve it, and it will become engineered out of healthcare - at least until an entrepreneurial, humanistic developer appreciates just how important and valued such connection can be.”

http://www.theatlantic.com/health/archive/2012/10/humanism-in-digital-health-do-we-have-to-sacrifice-personal-connections-as-we-improve-efficiency/264325/

  
I must admit I personally do believe the only way forward with health is through the appropriate adoption of telehealth and mhealth, but I stress the word appropriate. In the same way that telecare should be personalised to the individual’s needs and wants; mhealth should take this same baseline.  I am a techie person; I own a smartphone, a tablet, a laptop, MP3 player etc, but I want technology to support me to achieve the best from my life, not dictate to me my life.  I want apps and widgets that are bespoke to me and my personal situation/condition, not some generic half baked app/widget that fails to diagnose.

We need to stop focussing on what technology can do and start thinking how technology can be of use to us in supporting and promoting our lives without us modifying how we live to any great extent.


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