Friday, 8 February 2013

Telecare - the interoperability issue revisited


At a recent Athene meeting I discussed the idea of interoperability and in so doing thought it might be wise to share these thoughts more formally.

When telecare was conceived, it appears to have been considered as a reactive, rather than proactive technology that generates alerts after something bad has happened. It does not stop falls, or stop anything, but can generate rather vague alerts which can go through to a call centre or a family member. That said it can also produce false positives which can and often are very annoying for family members.

It, therefore, seemed appropriate that one of the key concerns of telecare is that it should be interoperable, by which I mean I can take any piece of telecare and it will connect to any other piece of telecare irrelevant of who made it, in a sort of plug and play way.  This is also a legacy of the smart home/home automation KNX association which provided the world’s only open standard an interoperability standard for smart buildings which are compliant to EN 50090, EN 13321-1, and ISO/IEC 14543. Interconnectivity would do away with the need for connecting boxes, extra wire and potentially making less dependable systems.

Continua Health Alliance  and many other organisations and groups (see have been set up to explore the relative merits or interoperability, but as companies might say how much they are in agreement with this idea, it is not is their business interest to allow their own devices to connect to someone else’s. If they did allow this then certain monopolies would potentially come crashing down. Instead, we are left with a faint nod to interoperability whilst ensuring that the top players in telecare and telehealth retain their throne through not allowing other devices to connect easily.

If we look to the emerging mobile market, there are currently three main players, Apple, Google and Microsoft, with their iOS, Android and Windows mobile operating systems. These systems allow companies to make apps for these devices, and apps which are written in C++ and HTML5 are often easier to cross platform. What is interesting about this is that one app, can be cross-platformed to a range of mobile devices and even have standard computer based versions as well. A good example of this is the game ‘Angry Birds’ which can be played in the browser (Chrome) as well as through Facebook, as well as on most mobile devices.

If we consider what we actually want from telecare in the future, it might not be the reactive containment model that currently exists, instead we might want a more flexible proactive technology that can predict and prevent falls, or unexpected difficulties etc. This, I am sure will come through the mobile platforms, in the near future, with people having mobile devices which have sensors monitoring actions and activities in the home as well as outside the home. We will hopefully dispense with anything we need to wear, such as the pendant, and have unobtrusive sensors built into everyday artefacts and clothing. We will hopefully develop systems in which the data is more usable to the person with health conditions so they can sensibly make their own rationale decision on their health state, as well as alert the correct people if someone is in crisis without direct intervention.

I also see the rise in robots as interesting, but wonder if this is the actual way we want things or whether the building of robots is actually a step in making technologies more intelligent and more honed to our future needs and wishes. 

There are always utopia's and dystopia's, and the reality will possibly somewhere in the middle, but I can see that mobile platforms provide a valuable reference to build and new telecare world in which the person is not a passive recipient of care. This change in the way of seeing telecare does require a large change in the way we see telecare and consider its merits, but I think that it is evident that we need to take things to a new level.

So what is the next step? 

I hope that someone from one of the big companies, be that Microsoft, Apple, Google, IBM, Philips, Bosch, Samsung, Nokia, HTC, Backberry etc read this and like some of the vision and start to run with it.  I, of course, would be happy to add some assistance fin this venture. 

So we need to move away from interoperability thinking and instead consider cross platform mobile devices which are proactive and reactive.  We need to have devices that are what people want and will use that produce real information that helps the person as well as the health professional.  We need a cultural shift in the thinking of telecare and telehealth to embrace this new thinking, and we need the big IT/mobile companies to take up the health and social care challenge today so we can start to experience it before it is too late.

What do you think?


Wayne said...

You mentioned the Smart House market as having similar interoperability issues, and I couldn't agree more. It's been a fledgling market for over 40 years and still has not become mainstream, largely due to the lack of interoperability. Hopefully mHealth & TeleHealth will due better as smartphones embrace Bluetooth 4.0, the lower-power version. But still some fitness and medical devices use other wireless "standards" such as ANY+ and Z-Wave.

I've written about interoperability on my own blog, including an article on the different video conferencing solutions. See

Alex Evans said...

Interesting point about Telecare systems being reactive currently and not proactive. I'm a co founder for a startup working to develop a web based proactive monitoring system that allows health workers, carers and families to make better sense of the sensor data. It needs to be predictive to identify early opportunities for interventions. Your input on this would be really useful

Alex Evans said...

Interesting comment on telecare systems being reactive. I am a co founder of a startup developing a web based telecare system that evaluates sensor data to predict when interventions need to occur, this has got to be the future of telecare, allowing carers and healthworkers to make sense of the data and put it to good use.

Always looking for input....

Guy Dewsbury said...

Always happy to help Alex, drop me an email and we can set up a chat.