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.

Telecare system provider Mediagrids has confirmed to Telecare Aware that it is subject of a winding up order from Inland Revenue. This is despite cost-cutting measures, including redundancies, during the past year. So, despite the UK Government’s policies of encouraging telecare and supporting businesses through the recession, a Government agency is pulling the plug on the only broadly-based, broadband, video conferencing telecare system with potential to link users with not just telecare and telehealth monitoring but with online services, family and other users with shared interests.

The provider of a similar system, Netherlands-based Impact Valley, also went bust in the summer of 2007 and, like Mediagrids, lack of cash was the immediate cause. However, the root cause seems to be that commissioners and service operators are reluctant to dip a toe into innovative waters, which is a huge shame.

A Mediagrids spokesperson said “I think we were 4-5 years ahead of the market. Selling to the public sector and NHS is a nightmare and, whilst they all loved what we showed them, nobody was prepared to take the slightest risk to commit to trying it or spend any money with us…[they] have no need or desire to save money by adopting innovative software.”

Sadly, this will ring a bell with many UK equipment and service providers. It is a very common experience that it takes two years for initial local interest to evolve into a trial order. If anyone can throw any light on the reasons for this ultra-conservative mindset, please leave a comment.

In a statement to Telecare Aware, a spokesperson for Philips in the US denied rumours that the replacement of equipment to Health Watch customers earlier in the year was a recall related to the FDA’s warning letter in February about insufficiently robust quality processes in the Health Watch facility in Boca Raton, which it had acquired the year before.

Andre Manning of the Philips Healthcare communications team said: “In April of last year, we announced the acquisition of Health Watch. Over the next 18 months, Philips Lifeline worked with Health Watch’s existing customer base to update the Health Watch units in their homes with new equipment from Philips Lifeline. The change in the equipment was done at no cost to the customer nor did it interrupt the monitoring service. For optimal operational support and monitoring service, it was necessary to have all customers using the Lifeline units. There was no “recall” of units produced by Health Watch. It was a swap of equipment so that we could best service each of our customers. There is no connection whatsoever between the FDA audit in the Boca Raton facility and the swap out.”

Interestingly, the Health Watch website is still live. On the page that announced its partnership with Tunstall in pre-Philips sale days, it says

Health Watch has continually pioneered advanced technologies and innovative services in Personal Response Monitoring…Working with Tunstall Group, Health Watch has initiated the most dynamic research and development effort in the industry, giving Subscribers and Providers open access to the world’s newest Telecare solutions. Our next generation monitoring technologies help to assure independent living and personal security for more people than ever before.

Hmm… is this a case of “Beware, your hype will always find you out”?

Update: 5 December 15:30

Richard Farrell Smith, Product Communications Manager, Tunstall Group sent the following comment for clarification:

I read with interest your article on HealthWatch however I am concerned that it implies a connection between the FDA letter and products supplied by Tunstall. The FDA letter does in fact refer to alarm units (HW3000 and HW6000) that were manufactured by HealthWatch prior to its relationship with Tunstall. These units are easily confused with the units that Tunstall did supply to HealthWatch (HW3000T and HW 6000T). Although the FDA letter does cover more than just the manufacturing of the units, I would appreciate it if you could clarify that none of the issues relate to Tunstall and the manufacturing issues relate specifically to units manufactured by HealthWatch.

Richard - Thanks for the further clarification. There have been a number of rumours going round about this which I’m pleased to lay to rest. Steve

Regular readers will recall that in May it was announced that Northern Ireland ’s Department of Health and Social Services was to issue a tender worth £46 million for the supply of telehealth services (the Remote Telemonitoring Northern Ireland (RTNI) Service) to cover 5,000 people by 2011. (Telecare Aware item)

Browsing, as one does, the website of Belfast’s European Centre for Connected Health, I was struck by the companies now long listed for this substantial, high-profile project. Count how many have real-world experience of delivering on-the-ground telehealth services. The mystery is, how did most of these companies get onto the long list?

Here’s the list:

• Bayer Healthcare LLC Diabetes Care (Viterion Telehealthcare)
• British Telecommunications plc (BT)
• Fujitsu Services Limited
• Hewlett Packard Limited
• Humana Europe Limited
• iSoft plc
• Philips Healthcare Company
• Robert Bosch GmbH
• Steria Limited
• Tunstall/Fold/S3 (TF3)

European Centre for Connected Health site.