(Google) ‘Now’ there is something new for people with dementia

For many younger people, after a long drinking session on a Friday or Saturday, if they find that they are lost or unsure how to get home what do they do?  Most will turn to their Smartphone to call for help or to find out where they are.

For people with reduced capacity there has always been a push to develop reminder and location aware devices to reorientate them. These have included some great telecare devices such as Buddi (http://goo.gl/vXZ3E) and services such as Telecare Technology (http://goo.gl/XtK25) who provide a range of reminder services.  The services and devices if use correctly could help a person remember their medication or important dates/times or assist a lost or confused person.

Google Now on my Nexus 4

What is exciting is the development of a completely new free system from an old system. Google Now (http://goo.gl/Uxz4c) is just such a system. Google Now is the new Google search feature designed for Android mobile Smartphones but also available for iPhone and iPad.

Google Now is more than just an entree to the world’s number one search engine, it uses the data already collected by your Smartphone to determine your location and can synch with your Google calendar and other Google apps to assist you through your day.  

One feature that stands out is the constant monitoring of the phone’s location.  For a burglar this might not be ideal for Google to monitor your location 24/7 and for people paranoid about privacy this might also seem a little zealous, but the advantage is that when you go somewhere, Google Now will tell you how long it takes to get how and how far it is.  It can also link in with your recent searches and suggest places locally you might have searched for or it considers you might want to know about.  To illustrate this, I was shopping last weekend in an area I rarely visit, and had previously been searching for a DIY store as I needed something from it. Whilst shopping I looked at my phone and it told me that I has thirty miles from home and that a branch of the DIY store I had previously searched for, before I left the house, was only a minute away.  Thus I killed two birds with one stone and went to the DIY store after I finished shopping.

Google Now integrates with other Google apps and services

This got me thinking about the other applications of Google Now and the most obvious one was for people with dementia. Google Now maps your routines and places you go and integrates with other Google apps such as email, maps, calendar, tasks etc.  This therefore presents an opportunity to build in simple reminders to a dairy to take medication which can be done in the calendar.  Google Maps, for those that use it for directions and navigation will already know that this has the ability to be programmed to where you live and take you home.  If Google know where you live then it can reorientate people who get lost.  It provides turn by turn navigation for walkers which I have used in many large cities when I have been for a meeting.

For a person with dementia Google Now provides a non patronising way or providing location based services and reminders both of a daily routine and medication. It would not be difficult to add in alerts to call friends and family to the system so that if a person was “out of zone” or potentially lost the family could be notified by SMS or even Google Hangout and open up an online face to face conversation with the person.

Google Now purportedly learns from you.  It logs where you go and what you do on your phone and links in with other apps to find your likes and dislikes.  In time and with use, it should be a very good source of help. It is not too difficult to see that even though Google Now is relatively new, and I would suggest in its infancy, there is a real opportunity to develop this service for people who in the future who will get dementia or some other health issue. Most importantly it has the potential to put the person in control of what is monitored and the correct response.

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.

Why don't we have interoperability of telecare devices... yet?

One of the old chestnuts within the telecare arena is the idea of interoperability.  Interoperability simply means that technologies can work together, thus a product by one manufacturer can be used with another manufacturers kit. A simple analogy would be that a Microsoft Word document could be edited on on a PC as well as a Mac computer.

In telecare terms this would mean that I could buy a fall detector from one manufacturer and it should still be configurable with another manufacturer's alarm system. In reality, this can usually be simply done through the purchase of a bridging device, but interoperability should mean that this device is no longer required.

I am mindful of the recent courtroom battle between Apple and Samsung which upheld Apple in the US but nowhere else in the world as the designers of the iPhone and iPad appearance and software. It is interesting to me as I am writing this on a netbook with Windows XP installed, whilst having an Apple device flash emails arriving to me.  I also have an Android smartphone and and Android tablet on this same desk providing further alerts and noises.  I know I will never miss any critical information with all this technology, but the time spent sifting through the rubbish to find the golden nugget is considerable. It is questionable whether this venture  is actually worth the effort.

I stray to illustrate that today we have a range of technological options open to us and we have to decide how we progress down the technological route.  For computers to write type on  I prefer Microsoft products but I also have a  keyboard for the tablet computer  and occasionally use that to edit things on.  The tablet has its own excellent touchpad keyboard as does the smartphone so I can actually edit documents and other things without the need for an external keyboard.

I use the cloud providers of free storage to store current active documents so they can be accessed anywhere on any of my wireless device. I also use the cloud to share documents with other people I work with, so they can edit them or review them. Thus if I am in McDonald's I can still access my email and edit a paper whilst sipping my Coke.

So what does this say about interoperability? Well it is interesting, to me, that although the devices are not per se interoperable, certain things on them are.

One source of interoperability is Bluetooth, which enables all my devices to link together or link to portable devices such as keyboards, mice etc.

A second interoperable source is the cloud providers allowing access to all my stored files on any device, as long as the operating system is compatible with the cloud software.

I have similar software on all my devices and Skype is a great example of a cross platform software that operates on almost all platforms.

So I am thinking to myself, I have a mobile phone that can communicate with everything else, I have an Apple product that does this as well and a netbook that also does this, and a Nokia Symbian smartphone that also does this, that I no longer use,so why can simple telecare devices not make use of the advances in technology to allow proper interoperability?

I am fully aware of the Continua group and think what they are doing is great, but it is no longer rocket science.  Devices can communicate through Bluetooth or Zigbee, or infra red or wirelessly. Software can be made to be cross platform so each operating system can use it, so why can I not use the fall detector I think is best with the dispersed alarm unit I think is best and add the best peripherals to this?  Why are we still faced with no choice? we are committed to buying a system from one manufacturer and then we must purchase on their peripherals with the limitations that they have.

The customer is left with little or no choice.

I am staggered that the mobile product market is rapidly expanding but the telecare marketplace appears stagnating in comparison.

How can we reverse this state of affairs?


How can we make telecare interoperable and usable?