home care and telemonitoring artur serrano nst 2012 01-16

Home care and telemonitoring- Redefining Participatory Design -

© 2012 NST Artur Serrano

Artur Serrano

Leader Research GroupHOPE - HOme care and PErsonalised health

NST - Norwegian Centre for Integrated Care and Telemedicine

HOPEHOPE •HOme care & PErsonalized health•15 members•Social Science•Health Care•IT

Norwegian Centre for Integrated Care andTelemedicine•100+ people•Research Dep.•Consulting Dep .

UNN•University Hospital in Tromsø•Regional (North Norway)•4 hospitals•Patients treated (total) 350K

© 2012 NST Artur Serrano

Tromsø• Source: http://www.timeanddate.com

• 350 km north of the Arctic Circle

• Tromsø – Oslo: 1155 km• Oslo – London: 1155 km

© 2012 NST Artur Serrano

The long night in WINTER

The midnight sun in SUMMER

© 2012 NST Artur Serrano

In this talk

1. Home care and telemonitoring

2. What we are doing?

3. Where are we going?

© 2012 NST Artur Serrano

1. Home care and telemonitoring

• Elderly/chronic care– Ageing population, increased price of hospital

treatment – chronic care and re-hospitalization

• Home care – care at home and Care Homes• Telemonitoring and telemedicine• Social care• Primary care• IT for health care -> electronic health• ...

© 2012 NST Artur Serrano

Care services

eHealth

Telemedicine

Home Care

Telehealth

Telecare

Healthcare Social Care

Telecare – service user to responder: environmental monitoring such as fire, flood, fit and falls in order to ensure appropriate responses

Telehealth – patient to clinician: vital signs and general condition monitoring such as blood pressure, weight, mental & physical state as an aid to treatment of congestive heart failure

Telemedicine* – clinician to clinician: seeking expert advice such as a GP consulting a dermatologist

eHealth – all the above* I include in this Telehealth as defined before

In the following are my graphical understanding of the concepts involved in Care Services, and also the Dep. of Health's definitions of the various terms used in this topic area (RSM web site):

© 2012 NST Artur Serrano

Before

• Branko G Celler et al. (1999)– “Very few studies to evaluate the cost effectiveness of

home telecare have been published”– “Large-scale trials to compare quality of life and

healthcare outcomes of a matched cohort of elderly subjects … are required to provide evidence”

– “Implementation of home telecare will require fundamental changes in every sector of the healthcare services” … “and driven by patient demands for a greater role in shared decision making”.

© 2012 NST Artur Serrano

Today

• Latest systematic literature reviews in telehealth: – “Although home telemonitoring appears to be a promising

approach (…) future studies should consider ways to make this technology more effective” Paré et al. (2010)

– “limited number of high quality studies with suitable reference standards” Martin-Khan et al. (2010)

– “There is a need for more detailed, better-quality studies and for studies on the use of telerehabilitation in routine care” Hailey et al. (2011)

– “All included studies suffered from methodological weaknesses” Anna Davies, Stanton Newman (2011)

© 2012 NST Artur Serrano

2. What we are doing

• Medical practice and Business opportunity– Better care?– Evidence on health outcomes– The big guys – Who is paying the bills?

© 2012 NST Artur Serrano

Interfaces between levels of careProcesses, processes, ...

© 2012 NST Artur Serrano

Technology that works?• Technology that works

– Video conference? Panic button?• Technology that does not (yet) work

– Fall detection, speech recognition, Integrated Care Services Platforms

• Users motivation– Are we forcing the elderly to cross the

street?

© 2012 NST Artur Serrano

Challenges• 6 important challenges in the research field of

“home care for the frail elderly”– Who are the users? A complex triangulation between

professional carers, informal carers and the care recipients– Tackling inherent complexity of the elderly health

conditions (e.g. comorbidity )– Inappropriateness of methods for controlled trials– Lack of immersion of IT specialists in the actual care

settings– Incapacity of creating feasible business cases– Technology (solution or challenge ?) Addressing specific

needs of the elderly target group relating to technology usability

© 2012 NST Artur Serrano

Possibilities for cruising safely to a new Home care reality

CRUISE• C aring scenario

– Who are the users? A fuzzy triangulation of professional carers, informal carers and the care recipients

• R elate– Complex health conditions of elderly - e.g. long term, comorbidity

• U nique-User Trial– New methods for controlled trials

• I mmersion– Lack of immersion of IT specialists in the actual care settings

• S preading– Addressing the incapacity to create feasible business cases

• E ndogenous– Addressing specific needs of the elderly relating to technology usability

© 2012 NST Artur Serrano

C for Caring scenario

• Who is the patient? • We care for patients, but who cares for

carers? • “She is my granddaughter!”• Non-specialised working force• Multiple actors

© 2012 NST Artur Serrano

R for Relate

• Relate – ”To establish or demonstrate a connection between”– Long-term effects -> unfeasible trials due to high

costs and difficult logistics– Co-morbidity -> confounding variables– additional outcome parameters -> functional

dependency scales (SF-36, International Classification of Functioning Disability and Health ICF, Short Functional Dependence Scale SFDS, PADL-H, Functional Independence Measure FIM)

© 2012 NST Artur Serrano

U for Unique-User Trial

• Instead of small or large pilots…• create real services’ trials with ANY number of

users - Yes, 1 user is enough!!!

Pilots and more pilots...

© 2011 NST © 2012 NST Artur Serrano

I for Immersion

• How many researchers in this field have been in touch with the real care environments?

• E.g. GITWiC [Get In Touch With Care] give care hours in elderly care instead of money for CO2 compensation

Understand and

try to feel!

What do they feel?

© 2012 NST Artur Serrano

S for Spreading

• Expanding service• Viral marketing – ”small changes in the

environment lead to huge results” Andreas Kaplan and Michael Haenlein

© 2012 NST Artur Serrano

E for Endogenous• Endogenous – ”growing from within”• NO ”adapt technology to the user”• YES ”the user is the reason for creating the

technology”• Universal Design• The user leads

– When? The start!– How? Listen– How often? When decisions must be made– When stopping? Never

© 2012 NST Artur Serrano

3. Where are we going?

How to shape the future by novel design of IT in an evolving world? or "How to be futuristic when all is changing so fast"?

Elderly in a research trial

© 2012 NST Artur Serrano

The Giraff robot

Where are we REALLY going?!

“Men do not quit playing because they grow old; they grow old because they quit playing.”

Oliver Wendell Holmes

© 2012 NST Artur Serrano

“The oldest treesoften bear the sweetest fruit” German proverb

© 2012 NST Artur Serrano

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