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.
Sunday, 27 November 2011
Sunday, 6 November 2011
Telecare Efficiencies
One of the main reasons for the use and uptake of telecare is the potential efficiencies it brings. Efficiencies is a euphemism for cuts or savings not the alternative meaning of improving something. This does not mean that by making cuts something could not be improved, simply, this is not the main agenda.
This blog is testament to how efficiencies can be made whilst ensuring the quality of service and care are not reduced.
Telecare can save money, there is considerable evidence to back this up, but it can also waste money. Wastage is most clear when a predetermined set of telecare devices are used as a standard response to a specific condition. This can often mean redundant and disabling devices. Person specific telecare should ensure mean no redundant devices, thereby saving unwanted devices and their potential running costs.
The personalisation of telecare should enable efficiencies through enabling people and promoting healthier behaviours. For example, a woman who had fallen badly several times and been lying on her floor for many hours before being discovered by her daughter. As a result of this fall she sat in a chair all day too scared to move in case she fell again. The provision of a simple telecare pendant meant she no longer felt she had to remain seated. Moving around was now permitted as she could call for assistance in the event of a fall. This is constitutes efficiency and true enablement. Efficiency as all that was required was a pendant alarm. Enablement was through the woman not spending her remaining years sat in a chair. For this woman telecare meant independence. Clearly the hidden savings are in other health related spending as a result of sitting all day and not moving. Over the forthcoming years that could be a seriously large amount of money for this one person.
The most effective efficiencies are derived through assessing people correctly for telecare and ensuring that team that provides the telecare works well. This means the processes and protocols are in a coherent workable form. It also follows that they need to be easy to implement and follow just as audit trails are required to be evidenceable at any time.
The telecare service provision is most likely to be riddled with policies and procedures that either do not exist or outdated and this directly causes inefficiencies. Inefficiencies equate to throwing away money and poor customer service. These inefficiencies can be riddled throughout the whole service including response services and the sales teams.
This blog is testament to how efficiencies can be made whilst ensuring the quality of service and care are not reduced.
Telecare can save money, there is considerable evidence to back this up, but it can also waste money. Wastage is most clear when a predetermined set of telecare devices are used as a standard response to a specific condition. This can often mean redundant and disabling devices. Person specific telecare should ensure mean no redundant devices, thereby saving unwanted devices and their potential running costs.
The personalisation of telecare should enable efficiencies through enabling people and promoting healthier behaviours. For example, a woman who had fallen badly several times and been lying on her floor for many hours before being discovered by her daughter. As a result of this fall she sat in a chair all day too scared to move in case she fell again. The provision of a simple telecare pendant meant she no longer felt she had to remain seated. Moving around was now permitted as she could call for assistance in the event of a fall. This is constitutes efficiency and true enablement. Efficiency as all that was required was a pendant alarm. Enablement was through the woman not spending her remaining years sat in a chair. For this woman telecare meant independence. Clearly the hidden savings are in other health related spending as a result of sitting all day and not moving. Over the forthcoming years that could be a seriously large amount of money for this one person.
The most effective efficiencies are derived through assessing people correctly for telecare and ensuring that team that provides the telecare works well. This means the processes and protocols are in a coherent workable form. It also follows that they need to be easy to implement and follow just as audit trails are required to be evidenceable at any time.
The telecare service provision is most likely to be riddled with policies and procedures that either do not exist or outdated and this directly causes inefficiencies. Inefficiencies equate to throwing away money and poor customer service. These inefficiencies can be riddled throughout the whole service including response services and the sales teams.
Tuesday, 13 July 2010
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!
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!
Friday, 29 January 2010
The Language of Telecare
"When I use a word," Humpty Dumpty said in a rather a scornful tone, “it means just what I choose it to mean --- neither more nor less."
"The question is," said Alice,"whether you can make words mean so many different things."
"The question is," said Humpty Dumpty, "which is to be master--- that's all."
Lewis Carroll – Through the Looking Glass.
I am not sure about you, but I think it is time to resurrect the debate about terminology. I have recently been to a number of conferences and at these events people use the words Telecare, Telehealth, Telemedicine and Assistive Technology interchangeably. The speakers seem to appear confused because they are using the words Telemedicine when they are talking about Telehealth and Assistive Technology to mean anything and everything. The term assistive technology (AT) seems to have become an umbrella term for Telecare, Telehealth and Telemedicine which is a little strange as AT is so much more than these small bits. It denigrates the words Assistive Technology. AT after all comprises of environmental control systems, speech helpers any form of technology that can enable an impaired person (http://en.wikipedia.org/wiki/Assistive_technology).
I am not sure that Telehealth enables people in the same way that Telecare does or even qualifies to fit under the banner of Assistive Technology. If you look to the right hand bar I have the definitions of Telecare and AT as: Telecare is the continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living (http://www.telecareaware.com/index.php/what-is-telecare.html).
I would argue that Telehealth monitors patients' health and alerts professionals of possible emergency situations but in a very different mode from Telecare. Telecare produces alarms; it sends real time alerts through to a call centre 24 hours a day; 7 days a week. Telehealth produces less frequent monitoring intervals and the information is sent to staff who are only working when they are at work (often 37½ hours a week). I would also argue that Telehealth does not manage risks associated with independent living, rather it manages peoples' health conditions and possible health deterioration. Therefore, Telecare and Telehealth are significantly different.
On the other hand Assistive Technology (AT) is any product or service designed to enable independence for disabled and older people. (King's Fund, 2001). So Telecare is a small subset of assistive technology. It is not the whole spectrum of assistive technology. Hence, when referring to Telecare, one should use the words Telecare not assistive technology. "the smoke detector is a vital part of assistive technology" is more accurate as "the smoke detector is a vital part of the Telecare repertoire". "Johnathan was helped through the use of assistive technology, the use of augmentative and alternative communication software enables him to communicate for the first time in class". If, for example, I worked with Assistive Technology, I would expect to have some medically training, to have a qualification in engineering and have undertaken the training associated with all people who work in this field. These are very highly skilled people who have years of experience and expertise to offer.
Keren Down from FAST (www.fastuk.org) puts the explanation beautifully “The confusion seems to arise due to the fact that assistive technology is not a term fitted for day-to-day use and that it has been used in very specific (service defined) contexts. It is a term well fitted for strategic planning. An analogy is the term ‘transport’. On the whole people don’t say ‘I’m going to go and take a transport up to the Elephant and Castle’” (http://www.telecareaware.com/index.php/telecare-telehealth-terminology.html).
I would also argue that Telehealth does not fit with the AT definition. Telehealth does not per se actually “enable independence for disabled and older people”. Telehealth supports older and disabled people’s health conditions. I would agree that by these conditions being stabilised the person might be more likely to be independent but this is a by-product of Telehealth not a given. There will be many very sick people who will have their conditions monitored by Telehealth devices in the future but who will not be enabled to be independent as they are too ill.
To me, Telehealth is like a heart monitor people wear at the gym, it is there to monitor fitness where as AT is the machines that people use to get fit. No matter how much you wear a heart monitor it will not make you fit but using the exercise machine will. The gym on the other hand could be considered to be assistive Technology comprising of lots of different component parts.
I think that it is really important that we all understand the basics, and all speak in the same language. If we assume people understand the terms we use then we are making an Ass out of U and Me!
You may not feel that terminology is something we should get het up about, we all 'sort of' know what the person is meaning, but I would argue it is critical! If I am talking to someone about Telecare and they think I am talking about patients in hospitals not people at home, then we start from completely different places. Anything we say after that is interpreted in terms of the initial impression. When I go abroad or talk to people from other countries it often takes a long time to ensure we are both talking about the same thing and understand the words in the same way. If we fail to do this then a conversation can be futile or even dangerous depending on what the other party takes away with them.
So instead of being Humpty Dumpty who states “When I use a word…it means just what I choose it to mean --- neither more nor less” let us use a word to mean what it means, nothing more, nothing less. Moreover, let us ensure that we put pressure on the powers that be to reach clear definitions of the words we need to use… Assistive Technology, Smart Home, Telecare, Telehealth, Telemedicine, e-Health, e-Medicine, mHealth etc. If we don’t decide what they mean soon it will be too late. It is time we master our language within this field.
"The question is," said Alice,"whether you can make words mean so many different things."
"The question is," said Humpty Dumpty, "which is to be master--- that's all."
Lewis Carroll – Through the Looking Glass.
I am not sure about you, but I think it is time to resurrect the debate about terminology. I have recently been to a number of conferences and at these events people use the words Telecare, Telehealth, Telemedicine and Assistive Technology interchangeably. The speakers seem to appear confused because they are using the words Telemedicine when they are talking about Telehealth and Assistive Technology to mean anything and everything. The term assistive technology (AT) seems to have become an umbrella term for Telecare, Telehealth and Telemedicine which is a little strange as AT is so much more than these small bits. It denigrates the words Assistive Technology. AT after all comprises of environmental control systems, speech helpers any form of technology that can enable an impaired person (http://en.wikipedia.org/wiki/Assistive_technology).
I am not sure that Telehealth enables people in the same way that Telecare does or even qualifies to fit under the banner of Assistive Technology. If you look to the right hand bar I have the definitions of Telecare and AT as: Telecare is the continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living (http://www.telecareaware.com/index.php/what-is-telecare.html).
I would argue that Telehealth monitors patients' health and alerts professionals of possible emergency situations but in a very different mode from Telecare. Telecare produces alarms; it sends real time alerts through to a call centre 24 hours a day; 7 days a week. Telehealth produces less frequent monitoring intervals and the information is sent to staff who are only working when they are at work (often 37½ hours a week). I would also argue that Telehealth does not manage risks associated with independent living, rather it manages peoples' health conditions and possible health deterioration. Therefore, Telecare and Telehealth are significantly different.
On the other hand Assistive Technology (AT) is any product or service designed to enable independence for disabled and older people. (King's Fund, 2001). So Telecare is a small subset of assistive technology. It is not the whole spectrum of assistive technology. Hence, when referring to Telecare, one should use the words Telecare not assistive technology. "the smoke detector is a vital part of assistive technology" is more accurate as "the smoke detector is a vital part of the Telecare repertoire". "Johnathan was helped through the use of assistive technology, the use of augmentative and alternative communication software enables him to communicate for the first time in class". If, for example, I worked with Assistive Technology, I would expect to have some medically training, to have a qualification in engineering and have undertaken the training associated with all people who work in this field. These are very highly skilled people who have years of experience and expertise to offer.
Keren Down from FAST (www.fastuk.org) puts the explanation beautifully “The confusion seems to arise due to the fact that assistive technology is not a term fitted for day-to-day use and that it has been used in very specific (service defined) contexts. It is a term well fitted for strategic planning. An analogy is the term ‘transport’. On the whole people don’t say ‘I’m going to go and take a transport up to the Elephant and Castle’” (http://www.telecareaware.com/index.php/telecare-telehealth-terminology.html).
I would also argue that Telehealth does not fit with the AT definition. Telehealth does not per se actually “enable independence for disabled and older people”. Telehealth supports older and disabled people’s health conditions. I would agree that by these conditions being stabilised the person might be more likely to be independent but this is a by-product of Telehealth not a given. There will be many very sick people who will have their conditions monitored by Telehealth devices in the future but who will not be enabled to be independent as they are too ill.
To me, Telehealth is like a heart monitor people wear at the gym, it is there to monitor fitness where as AT is the machines that people use to get fit. No matter how much you wear a heart monitor it will not make you fit but using the exercise machine will. The gym on the other hand could be considered to be assistive Technology comprising of lots of different component parts.
I think that it is really important that we all understand the basics, and all speak in the same language. If we assume people understand the terms we use then we are making an Ass out of U and Me!
You may not feel that terminology is something we should get het up about, we all 'sort of' know what the person is meaning, but I would argue it is critical! If I am talking to someone about Telecare and they think I am talking about patients in hospitals not people at home, then we start from completely different places. Anything we say after that is interpreted in terms of the initial impression. When I go abroad or talk to people from other countries it often takes a long time to ensure we are both talking about the same thing and understand the words in the same way. If we fail to do this then a conversation can be futile or even dangerous depending on what the other party takes away with them.
So instead of being Humpty Dumpty who states “When I use a word…it means just what I choose it to mean --- neither more nor less” let us use a word to mean what it means, nothing more, nothing less. Moreover, let us ensure that we put pressure on the powers that be to reach clear definitions of the words we need to use… Assistive Technology, Smart Home, Telecare, Telehealth, Telemedicine, e-Health, e-Medicine, mHealth etc. If we don’t decide what they mean soon it will be too late. It is time we master our language within this field.
Thursday, 19 November 2009
The TSA Conference 2009 report of exhibitors
The Telecare Services Association Conference 2009, Hilton London Metropole Hotel - Report of Exhibitors
Although there were loads of excellent people presenting their wares at the Conference certain ones were found by the author to warrant considerable attention.
The NEAT dispersed alarm supplied by Possum
First up is the NEAT dispersed alarm that Possum had on their stall. Apart from the size and design quality/looks there are a number of excellent features that make this something to watch. Firstly the dispersed alarm unit is small and thin with three buttons which are clear. The unit has a voice unit which can pick up on someone calling for help and trigger an alert to the call centre (the round item in the middle of the picture with the red button on it). The other thing that I really like is the fact that the unit and each device provide a handshake. The handshake means that each device can communicate with the other devices in a smarter fashion as information can go bi-directionally. This opens many possibilities. The main possibility demonstrated to me was the fact that if a device fails by using a simple pendant you can easily find the failing device as the handshake will not occur, as demonstrated by a light on a pendant.
Another thing that I really liked was the fact that each device works in its own state. In this way the system can be a standalone system that can send an alert to the pager in the bottom right of the picture alerting the carer that the person is in difficulties. Any device can be set to do this without the need for the dispersed alarm. Furthermore the pager can be set to have a range of functions such as pass the alert to another pager or accept the alert. The most obvious benefit I can see for this is in supported living services where care staff might require extra help or the person themselves can start to use technology to enable a more independent lifestyle.
The other most important thing the NEAT system can do is to act as a wayfinding device to assist the user in maintaining independence. This can split the house into various zones and these zones can be defined by the practitioner or family or person. If you go out of zone then it is up to the practitioners or family to determine the best course of action. This is just the beginning of what this system can do so keep your eyes open for news on the NEAT system.
The Halliday James Stand
The Halliday James Ltd stall where Bernard Wignall demonstrated the excellent range of technologies that they have developed to support wayfinding. These include mobile phones, simple pendants with GPS and GSM capabilities as well as handheld units that have maps and so forth on them. What impressed me with this is the way in which the person using the technology was always at the forefront of all the design ideas and decisions. The two best products demonstrated were the HTC smartphone in the top of the table that can provide a decision support system for people with memory problems. This is very similar to the things I saw in the
The other standout item from Halliday James Ltd was the standard looking watch below the mapping device in the picture. This is a normal watch and could be the person’s own watch but the strap has a GPS/GSM unit built into the base – out of sight. Therefore the unit looks like normal watch but is actually as wayfinding device. Simple good design shining through again.
The third company stall that had something standout to show was Chubb Community Care who finally produced two things I have been looking forward to, and they have been promising, for some time. The first is the new fall detector which as the picture shows is a wrist worn device. It looks like many other wrist worn devices and has a black emergency call button on it. In actual fact it looks just like a standard pendant on a wrist strap but actually is a fall detector that will detect ‘out of ordinary bumps’. “When a fall alarm is raised, the technology will vibrate immediately, during this period if the user does not want to send out the signal of the alarm, they just have to move their arm which will cancel the alarm. If this is not done then a call will be sent through the IntelliLink carephone or to the Carer Alert so the appropriate response can be sent”. Its not rocket science to see that this is fraught with potential possibilities for falls to be canceled as the person is crawling along the floor or some such activity that mimics the cancellation mode. But to their credit it is a well designed and well thought out piece of kit. If the person does decide to wave their arms in the air after a true fall and cancel the signal it can still be reactivated by pressing the black button. So a fail-safe is in place. I am looking forward to testing these out.
The Chubb Flexible Bed Occupancy sensor
Another thing by Chubb that I have been waiting for is the blue flexible mat that acts as a bed occupancy sensor (BOS). This is currently not to be found by me on their website. This is the mat shown above the standard BOS mat. The reason for this mat being exciting is that it can be used on pressure relieving mattresses which inflate and deflate. I am also pleased to see it connected to the new Chubb Bed Occupancy Monitor which enables personalised timing features so that these devices can finally be timed to meet the needs of the person.
This proves to be a valuable conference for many reasons. Not only is it the place to meet and touch base with the Telecare Gurus, but it is also the place to find out what the future direction for Telecare is to be. But for me, the best thing is to see how some manufacturers are still churning out the same things whilst others are beginning to see the true potential of listening to the people who use their devices.
Thursday, 18 June 2009
ALIP
The Digital Access Project which is part of the Assisted Living Innovation platform ALIP have produced released the first of the demonstrations from a venture I worked on. It is available here. Currently only two videos are available but the scenarios are hopefully useful.
Wednesday, 10 June 2009
Some web publicity
I have recently featured in two ventures I am pleased to be part of one working with the UK consumer affairs magazine Which? and the other an interview with Hometoys Emagazine which is the smart home site. Versions of these are available on line:
The Which? article can be found at http://tinyurl.com/nqmhbv
The Hometoys piece can be found at http://tinyurl.com/l5aqs8 - Amended link sorry for the previous error.
The Which? article can be found at http://tinyurl.com/nqmhbv
The Hometoys piece can be found at http://tinyurl.com/l5aqs8 - Amended link sorry for the previous error.
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