Proactive telehealth apps

The use of mobile devices to encourage people to become fitter and healthier is nothing new.  The more recent development is the use of apps which connect to Smartwatches. As a Smartwatch wearer, I have found that there are some apps which have limited or no use to me, but I do like the apps that sit in the background and measure my inactivity. As an Independent research Consultant I spend  considerable hours every day sat in front of computer screens. As a single dad, I am also active as kids keep you active, well so I thought. The truth of my inactivity was brought home to me when I started wearing my Smartwatch and receiving daily updates on my activity.  When I receive the activity update such as the one in the picture above, I know that I need to be more a to bring the numbers up. 

This nudge is perfect for me. It does not imply that by not doing exercise something bad will happen to me, and on days when it is impossible to exercise at all I might feel bad but, over all, I feel in control of my own health.

The key design features I love about this is that it is non judgemental, it is up to me to exercise, it is my body and my life and I can decide I want to be a couch potato if I want to.  The is no one encouraging me to do anything, but at the end of the week I can see how little or how much I have exercised.

A current failure of this app, like many of its ilk, is its inability to actually detect exercise.  For example, I could do 154 sit ups,  squats  or push ups but the app would not see that as exercise as I am stationary and it requires movement to register activity.  This is a small issue and one that can be countered by manually adding any activity that I do which is not detected.

For people with long term health conditions and people who are couch potatoes this app and smartwatch could be a cost effective method of motivating people to take up activity.  If the NHS supplemented the purchase of Smartwatches of activity bands but also obtained the results from them, this would mean that people who do not exercise could be made to pay back the supplemented part.  For those that do use the watch I can see the benefits being  very high for the NHS in the long term.

(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.

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?

Choosing a telecare mobile phone

The telephone is a simple device that has been with us for many years in various forms. In recent years it has undergone some considerable revolutions allowing hands-free communication, number identification and a range of other features to enhance the experience. For older people, big button phones appeared which were ideal for the visually impaired and phones with loop settings aided the hearing impaired.

The mobile phone is a new development for many. Although most people have a mobile phone, their potential is often not realised. Just as Microsoft Office can do amazing things most people use it for typing things and generally use only a fraction of what it can do.

It seemed to be a good idea to think about phones. Phones make and an ideal gift for parents who are less than tech savvy. The mobile phone has changed so much and continues to evolve with new models three to four times a year. As Steve Jobs understood, the traditional computer is less likely to be developed as handheld mobile devices are likely to proliferate the market. This could happen if the experience of the person using the mobile is equal to their expectations.

I have a confession, I love mobile phones and am passionate about the variety available and which is the best. When it came to my upgrade, I spent months working through exactly the specifications that I needed from my new phone before making the decision.

The mobile market is interesting as it currently has four main operating systems: Windows mobile, Apple IOS, Android (from Google) and Blackberry which are available on the mass market.There are other operating systems out there but these are the big four.

Each operating system has its own usability issues and positive and negative features. The phone manufacturer can also add the the features as can your phone operator by limiting some functions and expanding others, so already you can see that the choice of phone is very difficult.

The mobile phone makes a potentially excellent telecare device. The difficulty is matching the phone to the person. There are a range of simple display phones available. There are also phones with clear well defined keys to enable dialling. There are large displays phones which enable people with visual difficulties to see what they are dialling or writing and loop phones for the hearing impaired, but are these telecare phones? There are a number of mobiles that provide dedicated digits or an extra button which can be dedicated to sending a call through to a pre-specified recipient. These can be useful as long as the person using the phone has the capacity to operate it when required and will operate it.

Mobile phones have a range of other things that might be worth considering. Applications, or apps that can be downloaded from the operating system provider and can be very useful for making a phone into a medical device or reminder system, ideal for people with medical conditions or memory problems. Each operating system has its own apps and it is worth considering the apps available before buying a phone, similarly the ease of downloading them and the reliability are key things to think about. Viruses and malware are problems with smart phones where you can download apps to and the operating systems way that they deal with malware and viruses is also something to consider prior to purchase.

Location, location, location... Many phones have simple location devices built in and most smart phones have a range of locating software built in to the phone which can be used to locate a lost older person and provide a map home (if maps are built in and preprogrammed). Having maps and location properties on a mobile is only the beginning as the actual software that comes with the maps might be too difficult for the user to use so actually playing with the location software is very important in the decision process.

Gyroscopes and accelerometers can be built into phones which can be set to alert a friend or family when someone falls. These are a great idea and well worth exploring but always test the functionality of them before purchase. Do they trigger false alerts? Do they not work when someone actually falls? These conditions can easily be replicated in a shop. It is also important to consider the alert call that could be produced and who is to respond. There is no point in living a long way away and being the first call number, ideally a neighbour or a call centre would be be better, as speed of getting to the person who has fallen is most important, but read the blog entry on fall detectors before considering purchasing this on a phone.

The downside to location services and fall detection is the additional battery usage. As phones have become smarter, more applications run undetected, in the background, constantly working things out, such as where the phone is and at what angle is. All this background data analysis consumes battery life and timely changing of a mobile phone is a critical feature for modern smartphones. Although the battery life that the manufacturers provides are accurate, they are before any applications are downloaded and location and other services are activated. If you want a phone with ‘bells and whistles’ you pay with battery life, so expect to charge the phone daily. This can be a difficulty for some people so the capacity to do this is essential.

Sound quality, network coverage and ability to use the phone are actually the most important aspects to consider in a phone when purchasing it for someone else. A good phone should enable a the person to make calls easily, be able to hear the person they call and have a call go through from where they live without needing to go outside.

Finally, don't forget about the cost of calls and network coverage, the smarter the phone and the more things it does the more likely it will use more bandwidth even if no calls are made as there will be a lot of things sending and receiving data on the phone so ensure the package is one that enables the person to use the phone as they would like.

In sum, a mobile phone is potentially a very good telecare device providing the ability to alert others when a difficulty arises, but just because a phone sounds good does not mean it will be the correct phone for the person. Hopefully, issues already addressed in this blog will help in the decision process and this entry has highlighted the main things to think about.