Just flagging up this story in the terminology category, although as the ‘Telecare Crisis Line‘ began in 1989, it has a prior claim to the term.

Drat! I was going to set up a ‘telecare crisis line’ for telecare services running into problems.

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.

Not telecare, but a terminology issue as it refers to the target client group for telecare/telehealth companies. When I read about ‘the elderly’ or worse, the near-meaningless, ‘the vulnerable’, I imagine that the writer is probably hardly out of their twenties or thirties, or still has that mindset. If you want to alienate your potential clients, this is the language to use.

A brief read, with an American perspective, but with interesting survey results. Baby boomers? Older people? Senior citizens? Elders? What would you like to be called in your middle and later years? by Rita R. Robison.

In this item you will find links to two new important (and free) reports published by the Califonia Health Care Foundation. But start with the blog item by one of the authors, which puts them into context.

Start here: Anytime, anywhere health: 2 new reports from CHCF by Jane Sarasohn-Kahn

The first of the reports takes a look back at developments in the field and the second, commissioned from Forrester Consulting (their reports are usually too expensive for individuals to purchase) focuses on the state of things in the USA.

CHCF reports here: Right Here Right Now: Ten Telehealth Pioneers Make It Work and Delivering Care Anytime, Anywhere: Telehealth Alters the Medical Ecosystem

I’m flagging up these reports in the Telecare Aware ‘terminology’ category because the definition of ‘telehealth’ is wider than usually applied – in the UK, at least. It is:

The use of telecommunications and information technologies in any area of health care, including medical intervention, prevention, care management, education, administrative tasks, and even health advocacy….It is a broader term than ‘telemedicine.’

That said, it helpfully defines four sub-categories of telehealth:

• Live videoconferencing
• Store-and-forward systems
• Remote patient monitoring
• E-visits/e-consults

However, for a cautious assessment of the potential for telehealth technologies, read this item by David E Williams of the Health Business Blog who lists ’some of the mundane problems that have slowed the field down’.

These items are for the ‘terminology’ category: pointing up that the terms ‘telehealth’ and ‘telecare’ are used in a variety of ways.

Native Telehealth Outreach and Technical Assistance Program

TeleCare Exceptional Customer Service Over the Phone

The full title of this item is A Second Life for eHealth: Prospects for the Use of 3-D Virtual Worlds in Clinical Psychology. (If you are not up to speed with what Second Life is, read this Wikipedia entry.)

The article (Gorini A, Gaggioli A, Vigna C, Riva G A Second Life for eHealth: Prospects for the Use of 3-D Virtual Worlds in Clinical Psychology J Med Internet Res 2008;10(3):e21) concludes that, owing to the anonymity such encounters offer people seeking help “…3-D virtual worlds, used as an adjunct to face-to-face settings, may represent a valid opportunity for the future developments in eHealth. Our hope is that the present paper will stimulate a discussion within the research community about the potential, the limitations, and the risks that this emerging medium offers for cybertherapy applications.”

Just because the consultation between client/patient and the health professional is entirely mediated by technology, I’m not at all sure whether it is appropriate to construe this as telecare, even in its broadest sense: hence the ‘terminology’ category tag.

This is one for when you have time to read and ponder.

Tunstall press releases back from a two month break. Like the press releases that claimed that Nottingham, Walsall and Hull are mainstreaming telehealth using Tunstall equipment, they still don’t tell us how they define ‘mainstreaming’. Is that every single patient in the area who meets certain criteria? A couple of thousand? A couple of hundred? Thirty?

I did the Swindon PCT search for you. It’s not very revealing, either. The PCT Board paper dated October 2006, which apparently kicked off the project, mentions a quarter of a million pounds to be spent on implementing telehealth monitoring for 56 users for a 6 month project. (Yes, that’s £4,464 per person.) The Telehealth page, updated 20 August 2008 doesn’t mention numbers but says that “Telehealth became active across the borough on Tuesday 3rd July 2007″ So what’s changed to make the project newsworthy now?

This is a complex story even if you understand the medical system in the US and have been following what has been happening in terms of disease management (DM) and physician payment regimes controlled by the Centers for Medicare & Medicaid Services (CMS) (previously known as the Health Care Financing Administration (HCFA)).

Fortunately, the strands are expertly picked apart by consultant Vince Kuraitis of Better Health Technologies in his blog e-CareManagement. The upshot is that telehealth should be getting a serious boost from a large scale project called the ‘Medicare Medical Home Demonstration Project’ (MMHD):

“The number of physician practices that will participate in the demonstration is estimated at 400; we estimate this will result in approximately 2,000 individual physicians participating. Each practice is estimated to serve 200 beneficiaries resulting in about 400,000 beneficiaries that could participate over the course of the demonstration.”

Before plunging into Vince’s posting, you might want to take a crash course in the context. If so, read the item headed Chronic Disease Management Megatrends which you will find down the left hand column on his site.

I’m also flagging this item as being in the ‘terminology’ category in view of the advancing use of the term ‘medical home’ which, due to this project, will only grow in currency. Why Americans have to medicalise everything is a bit of a mystery. It must be a cultural thing. Once upon a time they only medicalised people then, of course, along came ‘auto clinics’ for the diagnosis and cure of cars, then were ‘money doctors’ to care for your… er, money, and on and on. Now, just when you thought it was safe to stay at home, they medicalise, sorry, medicalize, that!

An interesting story on the use of information on MP3 players for people with asthma to listen to when an attack threatens. However, is calling it ‘Telecare for Asthma’ stretching the definition of telecare too far? Do leave a comment on the terminology.

Tunstall starts to stake a claim to the terminology ‘highground’ with the promotion of the term ‘telehealthcare’ to indicate the interconnectedness of telehealth and telecare. Tunstall press release reproduced by eHealth Insider.

Will it catch on? Or does it add confusion rather than clarity? What do you think? Read the item then participate in this poll. After you vote you will be able to see whether other people agree with you.

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Apart from the intrinsic interest of the content, this article clearly raises a terminology issue for people who refer to telecare-enabled accommodation as a ’smart home’. (See also this Telecare Soapbox item.)

What better to put the two stories above into perspective than this interview with Dr. Martin Denz, President of the European Health Telematics Association. “A major thing that EHTEL is also trying to do is to bridge the gap between policy makers, IT providers and health professionals who all understand health and health care differently.”

The item also has some terminology implications. Read it here.

These Home Telehealth Clinical Guidelines were adopted by the American Telemedicine Association in 2002. I thought I’d re-publicise them in the light of the Telecare Aware Terminology Campaign. Can you spot the difference between 1.1 Home Telehealth and 1.3 Telemonitoring? The latter is more detailed but they seem to be saying the same thing. ATA Home Telehealth Clinical Guidelines.

Here’s a case that justifies the above post. Wirral Council does itself no favours by asking me (or other editors, presumably) to publish material from such a scrappy press release as this. As far as I can find, a proper version isn’t even posted on the council’s website.

Not only that, you have to read to the fourth paragraph before you realise that they are restricting the use of the term ‘assistive technology’ to mean ‘telecare’ – one of the reasons I started the terminology campaign.

Download the press release: Project to help people live independently shortlisted for a prestigious national award.

Janet Brown, for the American Speech Language Hearing Association made this comment about its policy on ‘telehealth’, posted on Google Video. It’s good to see that she shows a sensitivity to the uncertainties of the terminology.

What a great way to make policy announcements!