What is Telecare?

The question 'What is Telecare?' has several answers

Telecare defined

For some years the readers of this site have been working with the following definition of telecare: '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.'

This definition firmly associates it with 'social' or 'lifestyle' monitoring. However, there is an emerging case to use the term 'telecare' also as an overarching term for all types of care, including health care, delivered at a distance.

The above definition has appeared in a number of publications but its original source is unclear. To elaborate its meaning, devices range from those where the user presses a button that raises an alert at a control centre, such as a pendant alarm or medical alert/personal emergency response service (UK and US terminology respectively), to systems that monitor the person's well-being, environment, or both, and which trigger - without, if necessary, the person's conscious involvement - a warning that the well-being has deteriorated or that an untoward event has occurred. There is a rapidly growing interest in using mobile phone (cell phone) technology to enable such monitoring to take place outside the home.

Some systems give the person immediate feedback so that memory problems in particular can be accommodated and the person’s dignity and independence maintained.

In all cases except the latter, procedures for delivering an appropriate response from an external person (carer, neighbour or statutory service, etc.) are vital to the whole system. In the UK, telecare alarms are mediated by routing through dedicated call centres, whereas in the USA it is possible to purchase devices that communicate directly with emergency response srevices.

Examples of telecare systems and devices

The following short video, produced a few years ago for the UK's Department of Health, gives a good overview of telecare as it is seen in the UK, and its connections to social alarm systems - what, in the US, are called medical alerts, PERS, etc.

In essence there are three types of systems, parts of which may be used together:

1) Systens that help predict problems: These systems depend on software that takes signals from sensors and analyses the frequency and severity of monitored events, such as minor falls and alert carers to visit the person to find out what has changed.

2) Systems that reduce the chance of problems occuring: For example, a bed sensor can help prevent falls by activating a light when someone gets out of bed. This helps because the person does not need to reach for the light switch or move around in the dark.

3) Systems that mitigate harm: These devices, such as pendant alarms, heat sensors, smoke detectors or bed sensors - again - send alerts a call centre after a pre-determined event so that help can arrive quickly. The bed sensor, for example, can raise an alarm if the person does not return to bed within a predetermined time. An alternative approach is contained in the Alertacall Safety Confirmation system where, if a person fails to press a button by a certain time each day to confirm that they are OK, then an alert is raised. By getting help quickly, problems do not escalate.

Clearly, some of the above shade into the health arena and the trend for telecare and telehealth (as in 'remote patient monitoring') systems to merge continues, and will continue with increasing speed as they serve the same people and share the same technological infrastructures.

To see what examples of the devices that connect to these systems look like, explore the interactive 'telecare house' on the website of UK device manufacturer, Tynetec.

Benefits of telecare

An excellent example of telecare devices arranged to help a person who had a stroke and fell often can be read by following that link. (DTA in the article = the Dependability Telecare Assessment tool, by the way.)

Telemedicine

Telemedicine as a term has been in use for some time and is therefore better defined. The following, by the World Health Organisation, is simple and clear.

'Telemedicine is the practice of medical care using interactive audio visual and data communications. This includes the delivery of medical care, diagnosis, consultation and treatment, as well as health education and the transfer of medical data.’

Telemedicine is therefore essentially doctor-to-doctor, with the patient somewhere in the system, and typically involves consultations with specialists at a distance. There are also other branches of medical ‘tele-s’ such as teleradiology and telepathology.

Telehealth, e-health, m-health etc.

You can see from the heading that the terminology usage in this area is even more varied. For the purpose of this page we are focusing on telehealth as remote patient monitioring. Do be aware, however, that when you read 'telehealth' in other places, the authors may be talking about all sorts of thing, including health advice phone systems and websites.

Let's press on...

The following definition of telehealth monitoring from 2003 is one of the best, although it now needs extending from being home-based to include people on the move being monitored by mobile phone technology. It is from Telecare: Using Information and Communication Technology to Support Independent Living by Older, Disabled and Vulnerable People July 2003 Curry RG, Trejo Tinoco M, Wardle D.

'Telehealth monitoring is the remote exchange of physiological data between a patient at home and medical staff at hospital to assist in diagnosis and monitoring (this could include support for people with lung function problems, diabetes, etc.) It includes (amongst other things) a home unit to measure and monitor temperature, blood pressure and other vital signs for clinical review at a remote location (for example, a hospital site) using phone lines or wireless technology.'

Examples of telehealth devices are:
Blood pressure monitoring
Blood glucose monitoring
Cardiac arrhythmia monitoring
Asthma monitoring
Medication reminder systems. It will be a pity if, as telehealth technology gains a firmer foothold, the term ‘telecare’ becomes further confused by its continued application in the telehealth arena.

What's the future direction?

Although it is easy to predict that telecare and telehealth technologies will merge, and although the clients and patients they benefit are often one and the same individuals, we believe that it is still useful — at this stage of technological and linguistic evolution — to maintain a difference between the terms 'telecare' and 'telehealth'.

However, just as people want entertainment, not necessarily a TV, some people also need a service that helps them to stay independent, with dignity. The technology should only be one means to that end.

For a more in-depth consideration of these matters, look into the 'Terminology Campaign' section of the site and/or read this briefing paper which includes comments on the definition in the UK Government's Department of Health document Building Telecare in England, and some examples of the use of the terminology in the United States.