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 http://projecthydra.info/wp-content/uploads/2012/07/Standards_Project_Hydra.pdf) 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?

The world's most digital health service - the NHS?

There has been a recent spate of articles alluding to the NHS becoming the most digital health service (see http://www.telecareaware.com/index.php/the-nhs-to-become-the-worlds-most-digital-health-service-uk.html).  For over ten years I have been listening to people telling me that the NHS is to become paperless.  To some degree I think it will and it has, but I am always alarmed by the notion of a paperless office or paperless business.

I do as much as I can on line, this is not because I do not keep paper records, because I do, rather it is because there is insurance from storing things online and completing things digitally, which is the digital footprint.  When I pay a bill online, I leave a digital footprint behind, and I receive online confirmation as well as, in most cases, an email confirmation that the bill is paid.  For me, this is a double insurance policy that I have two forms of proof of payment. This is traceability.

The addition of cloud services have allowed me to use online storage space to keep track of important data which I might require wherever I am. This storage means I can access my data wherever I am located as long as I have an internet connection.

This same principle is used in the new NHS. People can stay at home whilst their medical information is in virtual space.  This allows health practitioners to undertake virtual consultations, and telehealth some products to function appropriately. 

I fully embrace the digital health record and the ability for my health data to be shared between practitioners at a touch of a button.  All this is brilliant.

What I am concerned about is what happens when electronic data is corrupted or lost - when there is a critical failure.  The necessity for paper backup data is even more important if we are to use paperless working practices.

When I worked for a local authority, as well as when I worked for universities, and even now when I work from home as a writer and consultant, I require data to be available 24/7 and in a range of forms. In the event of a power failure, I have back up power from the batteries in the devices, this is limited but does allow me to continue working. I have things stored offline as well as online so I can refer to the most important data whether power is on or not. Similarly as the Internet is prone to being hacked or ISPs crashing off line printed data is critical to maintaining my working practices.

There are so many difficulties with relying solely on the use of online data and online data storage that it does not require me to even start to describe them, but it is important to realise that although online data is preferable in many cases the limitations within the health arena are many.  A good illustration of this is the use of Xrays or MRIs which provide images to the Dr’s desktop within minutes.  This allows the Dr to make a speedy diagnosis.  If this were changed to pictures of moles looking for cancerous indications, this will depend on the quality of the camera image and the screen image to make diagnosis a possibility.

As we increasingly rely on health technology, such as telecare, telehealth and mHealth systems to be used to support and ameliorate care in the community it is critical that the powers that be understand the areas where critical failures are likely to occur and take steps to prevent this causing a system that could work well from crashing.

So digital future is good as long as the paper is available to keep it from failing.