Telecare Aware

Devon County Council and the South Western Ambulance Service NHS Trust (SWAST) has launched a dedicated service to respond to community alarm calls. Historically, SWAST’s clinicians have been called to non-medical situations where an elderly person may have fallen but fortunately not sustained an injury. Consequently, any attending resources - clinicians, vehicles and equipment - which were allocated to these calls were prevented from attending life threatening emergencies. Many people are also reluctant to contact the ambulance service for incidents that do not appear to them to be an emergency, and have put themselves at risk by not calling for assistance. The new partnership provides a 24-hour service specifically for non-injured clients and those with other identified health and social care needs. News report.

Adam Vincent, Caitlin M Cusack, Eric Pan, Julie M. Hook, David C. Kaelber and Blackford Middleton from Partners Healthcare System and Harvard Medical School produced a one-page conference poster for the AMIA 2007 Symposium suggesting a taxonomy for telehealth. This is an interesting and useful contribution to the debate about terminology. View/download ‘A New Taxonomy for Telehealth Technologies‘.

They suggest that four factors need to be taken into account and that they will “allow for the inclusion of future telehealth endeavors”. They are (and I have paraphrased for simplicity here): Type of Interaction; Location of Controlling Medical Authority; Real-time care, and whether the data is used in ’store and forward’ mode.

This would be fine if it were not for the medico-centric nature of the model. (Mind you, I quite like the Larsonesque idea of some of the doctors being on the ‘far side’.) The world is changing and, as this WSDAN article by Nick Goodwin points out, patients will start to take more control. I think that will be especially true when Google Health and Microsoft Health Vault take hold and home-based telehealth monitoring becomes as ubiquitous as mobile phones.

Thanks to Frank Wartena of Philips Research Europe for pointing out the poster.

In an imaginative marketing move, Assistive Technology Services, the US company that trades by trumpeting its Christian-faith based credentials, says it wants to give away 1000 alarm systems in 2009. But only if other people donate towards the cost of doing so! Press release.

Frankly, I’m not sure what to make of this story. The introduction reads:

“The University System of Ohio is soon to be a global hub for online medical education and videoconferencing following a decision to fund the creation of a resource center in Columbus. The Ohio Telehealth Video Resource Center will establish Ohio as a center of excellence worldwide in videoconferencing technologies and, at the same time, contribute to the improved health and well-being of countless people throughout world,” said Ohio Governor Ted Strickland.

If it its true that this Center can become what it says it will, great. A new star is born. But why does my gut instinct tell me that the reality will be different? Perhaps it is because I have observed that when doctors, academics and politicians get together it is hype, not a star, that is born. Or perhaps it is because the world is a bigger place than people tend to imagine? Read the story and then, if you know the telemed scene, leave a comment to tell me whether my gut feeling is accurate or not.

Croydon has been using the Combined Predictive Model in its virtual wards project (see Telecare Aware item) whereby people identified by the model as having a very high risk of future hospitalisation are put on a ‘virtual ward’. They are provided with preventive care in their own homes by a multi-disciplinary team who use the systems, timetable and staffing of a hospital ward but without the physical building.

Admission to the virtual ward is determined solely by the output of the Combined Predictive Model. Patients’ risk scores are monitored over time and can be used to prompt the virtual ward staff to discharge patients when appropriate – and offer admission to a patient at higher risk.

Item from the Kings Fund site where you can download a Croydon case study.

Hats off to Margaret McArthur, Senior Associate at the Health Services Management Centre, University of Birmingham for her newly-published report on automatic medicine dispensers. (Readers from June may recall her request for information.) Although working with limited data she has woven the material into a readable and informative 59 page report. It picks up all the important matters around the use of such dispensers, including their issues for pharmacists and the implications of the UK’s shameful health-social care ‘divide’ when it comes to provision.

Download the pdf from the West Midlands CSIP site: Essential reading for anyone involved in commissioning or planning telecare and telehealth services.

The item most people had been waiting for, the headline news on the analysis of the CSCI performance data from social care authorities on their use of the Preventative Technology Grant (PTG) is predictably disappointing. Not because the figures look bad but because they are so hedged around with caveats that it is clear that any conclusions you might be temped to draw would be shaky indeed. At least the author had the integrity to resist spinning them. It will be interesting to see how the regional and individual authority data is presented in November.

Other items include:

• a report of the recent visit by the Deputy Minister from Taiwan’s Department of Health, Mr Chen Tzay-jinn, who led a delegation to look at the implementation of telecare and telehealth in England (Item 3)
• some detail on the successful bids for the Assisted Living Innovation Platform (ALIP) programme. This is actually the most interesting item in the newsletter. It shows not only the range of projects and companies involved but some ingenious project name acronyms (Item 4)

Download the pdf version of the September Telecare eNewsletter.

Tynetec will lead an innovative research project to evaluate the potential benefits of proactive preventative telecare and telehealth systems in partnership with Aid Call and three regional care providers: Darlington Borough Council, Intrahealth Ltd and Your Homes Newcastle. The University of Newcastle will collate and analyse the project data. It is one of the Assisted Living Innovation Platform (ALIP) programme projects referred to in the CSIP newsletter. Details in this Tynetec press release.

Results of a clinical study of EarlySense’s EverOn system conducted at the Sourasky Medical Center in Tel Aviv were presented at the European Respiratory Society in Berlin on October 6. EverOn is “a continuous, contact-free, patient supervision system that measures patient parameters and alerts upon patient change in clinical condition.” Press release.

Read this press release reproduced in Wireless Healthcare and you will think that the eNeighbor is a wonderful system, presented at a wonderful conference. But the press release strikingly lacks any information about the nature of the system or what it does! However, track down their website and it turns out to be a comprehensive, but fairly standard community alarm-based offering.

Here is a link to a summary review of Technology and Aging (Mihailidis, A. et al. (2008)) in the Louis de la Parte Florida Mental Health Institute Research Library. Interesting to note the comment that “AT can hardly be regarded really as a specific discipline any longer”. See why, here.

Someone ‘gets’ it. Interesting that it is someone in the telecoms and not the telecare industry:

The ‘business case’ for Fibre-to-the-Home networks is no longer based solely on the commercial returns from Internet access and other communication services. Important services that depend on high quality broadband infrastructure include telehealth, tele-education, e-business, digital media, e-government, smart utility meter reading, etc. These are all key reasons why developed nations need Next Generation Networks.

Read full article by Paul Budde in his Australian BuddeBlog.

For UK suppliers and call centres, a reminder [see also] from the Telecare Services Association that the new BS 8521 has been published as a draft. After a period of public consultation it will become a standard later this year, in time for it to be available in equipment purchased next year and before the BT21CN [new network] national roll out begins.

The draft document can be downloaded from http://drafts.bsigroup.com/?i=179 and all interested parties are encouraged to read it and submit their comments to BSI during the consultation period which will remain open until early September.

Angel Telecare has recently been founded by a couple in Florida. It is similar in principle to the UK’s Alertacall ’safety confirmation service’ in that non-interaction with the phone starts an alert sequence. However, Angel Telecare has automated dialling out to participants, like the volunteer-run, often community-based phone services that have been operating for years in the States. So the focus of responsibility is on the service to make contact whereas with Alertacall the focus of responsibility is with the individual to make the contact before the predetermined time each day.

It is interesting to speculate on whether the differences are rooted in the countries’ cultures, or in the pricing structure of the phone systems.

Story of Angel Telecare founders. Angel Telecare website. Alertacall website.

“The [Hallmark Health VNA and Hospice] agency recently completed a year-long study on the effectiveness of telemonitoring in reducing re-hospitalizations of patients. It found that patients using the home telemonitoring system had an 18 percent re-hospitalization rate as compared with the general population, which has a 36 percent hospitalization rate.”

A patient-focused local news report.