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.

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?

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.

Taking Telecare to a new level

With the beginning of a new year, after considerable thought I have decided to take telecare activities to the next level. Having spent three years as a Telecare Coordinator for a London Borough and obtained excellent CQC reports for the service whilst in charge, and having worked as an academic for over ten years working in the field of telecare, assistive technology, smart homes, telehealth, ambient technologies, ubiquitous technologies, eHealth, mHealth, mobile technologies in addittion to my other interests in architecture and building design, health in general and of course people with long term conditions and disabled people, I now feel that the time is right for something new.

The Whole Systems Demonstrators (WSD) by the UK’s Dpeartment of Health (DH) has recently reported on its headline findings which clearly indicate a positive use of technology can save lives and save resources. There is little doubt that these findings will be scrutinised fully once the full reports are available, and at this point the headlines might not reveal the whole picture, but they are very encouraging.

We can now be confident that technology can save lives and resources, but we also need to ensure that the technology meets the needs and expectations of the people requiring it. It is important that as a result of using technology the person is not expected to become a machine, operating in unreasonable and predictive manners.

If you have a long term condition, your life is punctuated by regular events, such as taking medication, medical appointments, all the way through to the more chronic who might require assistance in all activities of daily living. What I consider unacceptable, is that technology designed to assist becomes the problem. This could be through making assumptions about people’s lifestyles and expecting unreasonable interactions such as checking-in every hour, or pressing a button regularly to stop an alert. This could also be through false alerts or just the technology not meeting operational expectations.

We are in a era which is really exciting. Technology is evolving faster than ever before and we should be able to harness this technology to enhance people’s live by removing barriers of distance, by producing virtual communities, and bringing virtual services through the cloud to people anywhere in the world.

My current concern is that although some electronic devices benefit from the advances in modern technologies, (eg mobile phones, tablets etc) other more mundane technologies, such as pendant alarm based systems or wandering sensors are failing to think beyond the standard.

We are entering a new year, 2012, and we have the chance to begin to create the world we want. A world where distance is not an issue, where access to products and services is far easier through modern technology. My hope for this new year is that we can get together and design products that will last, which have relevance and meaning to those we design for. This year could and should be the year of personalisation and innovation.

We need to stop waiting for tomorrow to create what is needed to today. We need to act now!

We need to change the way we think about products.

We need to change the way we think about services and service provision.

We need to change the way we think about technology and we need to change the way we think about people.

We need to step away from the tick box solution.

Let’s make Person-Centred Design truly person-centred!

It is with these messages in mind that I have started a new business called gdewsbury which is a Freelance Specialist Technology Writing Service and Consultancy (gdewsbury.com) with which I wish to work with the cutting edge businesses to assist in the build and design or truly exeptional products and help small or new businesses become great through expert input.

This is the year to take telecare to a new level.

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.

The increase in telecare

With the release of the UK government’s “Equity and excellence: Liberating the NHS” document the emphasis for health promotion falls on GPs as they will be getting the vast amount of money from the dissolution of the PCTs (Primary Care Trusts). This really interests me. When I worked for social services in North London, I found that GPs were by and large a very difficult group of people to interest in telecare. Actually finding access to their forum was hard and harder still to get any enthusiasm for the potentials of this new technology.

It seems that with the release of this document and the fact that the commissioning of services will be undertaken predominantly by GPs in the future that they are going to need a crash course in telecare, telehealth, mHealth and eHealth.

So how is this going to happen?

Who is going to do this?

The only way that this can be done is for telecare to be included in the documentation that the government produce but it is nowhere to be seen.

If we are to follow the preventative agenda, then surely telecare must be the spearhead of changing the way we consider health and care. Ideally as a result of the proposed changes and the distinct lack of money in the UK it behoves all GPs to get tele-trained pretty quickly.

I can see that this should also not be something that comes from the manufacturers as this could bread suspicion in GPs rather I can see a role in this for the TSA (Telecare Services Association) as well as the government to bring this information to the desktops of the General Practitioner of tomorrow. But before this can happen, how are can the profile of telecare be raised to such an extent that GPs will actually begin to take a message on board that they have resisted for the last five years?

Any answers gratefully received!