telecare development
DESCRIPTION
Telecare Development. Meduse Conference 20 th September 2007. Nigel Barnes BT Group Chief Technology Office. Telecare Definition. The use of Information and Communication Technology (ICT) to support independent living for older, frail and disabled people. 3 Generations of Telecare. - PowerPoint PPT PresentationTRANSCRIPT
Telecare DevelopmentMeduse Conference 20th September 2007
Nigel BarnesBT Group Chief Technology Office
© British Telecommunications plc
Telecare Definition
The use of Information and Communication Technology (ICT) to support independent living for older,
frail and disabled people
© British Telecommunications plc
3 Generations of Telecare
• 1st generation– Social alarms - dispersed panic alarm with pendant and pull
cords– Addition of passive sensors for auto alerts– An existing care intervention package
• 2nd generation– Telecare systems - adaptive, personalised but event driven – Exhibits aspects of reasoning– An emerging care intervention package
• 3rd generation– Well-being analysis - pre-emptive, long term trend analysis– Migrates telecare from a crisis safety net to an assessment tool– Will enable intervention outcome measures and optimisation
© British Telecommunications plc
Our research
• Intelligent alarms– Proactive alarm to immediate situations– Personalised to individual behaviours/profiles
• Wellbeing analysis– Determination of performance of ADLs– Trend analysis of ADLs– Use for preventative care strategies
• Holistic care management– Fusion of social and health + ambient and worn– Continuous contextual analysis for preventative care
• Pervasive living– Whole population wellbeing strategies– Promotion of healthy living and self management
Liverpool Pilot
DTI Care in the Community
DTI SAPHE
© British Telecommunications plc
There are now 1.5 million alarm support systems in the UK which use simple technology to provide support to vulnerable people ...
… but systems using new technology could provide much better support.
1st Generation Telecare
© British Telecommunications plc
Non-invasive home monitoring
Data capture and intelligent analysis
Automated alerting to client
Automated alarm escalation to carer
2nd Generation Call Centre
Carer
© British Telecommunications plc
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4 April 1998
FALSE TRUE
AWAKE ASLEEP
ON OFF
IN OUT
Temp (Lounge)22.0
24.0
PIR (Bedroom)257
PIR (Lounge)231
PIR (Kitchen)324
PIR (Hall)21
PIR (Bathroom)10
Closedoor (Entrance Door)8
Closedoor (Fridge Door)15
Activity (CDEFGI)865
Activity monitoring
© British Telecommunications plc
Event Based Algorithms
Time
Front Door
Door Open Alarm
- Configurable Event Timings
- Currently non-adaptive
© British Telecommunications plc
Behaviour based algorithms
Time
Lounge
Kitchen
Hall
Front Door
No Room Change
or No Activity
- Based on Individual’s Profile
- Dynamic & Fixed Thresholds
© British Telecommunications plc
Inter-event time value
• Example using actual client data
• Bedroom threshold from 0 to 2 am
• Varies between 3.3 and 8.5 hours over 40 week period
• Tracks changing client sleeping pattern
alert
Threshold
Adaptive Thresholds
© British Telecommunications plc
Carer
Voice call(PSTN)
Liverpool Direct
call centre
Alert messaging
BroadbandEncrypted
Voice call(PSTN)
Monitoringdata
Internet
Back office
Managementinterface
Data server
Telecare platform
Firewall Messaging server
Voice server
Monitored residence
RMUAutomated Voice Call (PSTN)
BroadbandEncrypted
Carer
Daily summaries
Dailysummaries
© British Telecommunications plc
• Example showing typical activity
• Client in bed between 11pm and 8:30am
© British Telecommunications plc
• Example showing cause for concern
• Client leaves dwelling at 10pm and does not return till 3am
© British Telecommunications plc
3rd Generation Telecare
• 3rd generation Telecare is a tool for providing the carer with activity information enabling them to identify significant changes in the general well-being of their client.
• Its aim is to enable carers to prevent incidents from occurring in the home.
– Shift from response (r-mode) to prevention (p-mode)
© British Telecommunications plc
DTI Centre for Care in Community
Led by BT this Centre, by focusing on Telecare, aimed to design and prove a system for continuous monitoring
of client health and social well-being in the home.
© British Telecommunications plc
Focus for MEDUSE
• Design process and stakeholder engagement
• Four groups:– Academics– Technologists– Carers– Service users
• Parallel projects:– Domain Specific Modelling (DSM)– Sensor Networks– Intelligent Data Analysis (IDA)– Demonstrator – note not a pilot.
© British Telecommunications plc
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4 April 1998
FALSE TRUE
AWAKE ASLEEP
ON OFF
IN OUT
Temp (Lounge)22.0
24.0
PIR (Bedroom)257
PIR (Lounge)231
PIR (Kitchen)324
PIR (Hall)21
PIR (Bathroom)10
Closedoor (Entrance Door)8
Closedoor (Fridge Door)15
Activity (CDEFGI)865
Sense Analyse Display
…combining a multiplicity of instrumented data with known human intervention to generate a sophisticated well-being indicator and assessment aid…..
0 2 4 6 8 10 12 14
0.0
0.2
0.4
0.6
0.8
1.0
Inter-event Time (ln[seconds-10])
Pro
babi
lity
Den
sity
Ref Client: 23s3BHKLT.txt
Event Count: 134285
ExponentialLog-GammaLognormalGammaWeibull
Longitudinal Trend Analysis
© British Telecommunications plc
Av Err: 12%
38 39 40 41 42 43 44 45 46 47 48 49 50 51 52PERIOD
TODAY
2nd FALLMEDICATIONCHANGE
1st FALL
PREDICTIVE REGION
Well-being INDEX:
100
80
50
10
00
20
04
(Without Intervention)
HISTORY REGION
STAIR LIFTINSTALLED
CAREINTERVENTION
STARTS
MajorModerateMildNoneINTERVENTION
LEVEL:Accommodation Change Medication ChangeWithout InterventionPREDICTION
TYPE:X
Care Well-being IndexCALCULATEOPTIMISATION:
XCost (£ per Week)X
© British Telecommunications plc
What is wellbeing?
• Conceptual model development– Led by Andrew Sixsmith– Verhoven model– World Health Organisation (WHO)
• Jill Jepson (OT, UEA)• Initial focus on physical conditions• Incorporation of mental state• Socialisation of model with peers and care managers
– Positive feedback
© British Telecommunications plc
C O N D I T I O N S T E C H N O L O G I E S
Activity Problem
Sen
sor i
dent
ified
Num
ber o
f pro
blem
/con
ditio
n hi
ts
Par
kins
on's
dis
ease
Stro
ke
Rhe
umat
oid
arth
ritis
Dem
entia
Res
pira
tory
dis
ease
Ost
eo-a
rthrit
is (O
A) -
low
er li
mb
Dia
bete
s
Ana
emia
Dep
ress
ion
Ost
eo-a
rthrit
is (O
A)
Isch
aem
ic h
eart
dise
ase
& M
I
Per
iphe
ral a
rtery
dis
ease
Ost
eo-a
rthrit
is (
OA
) – h
ip
Ost
eo-a
rthrit
is -
knee
Hea
rt fa
ilure
Ost
eo-a
rthr
itis
- spi
ne
Cat
arac
t
Gla
ucom
a
Mac
ular
deg
ener
atio
n
Ost
eo-a
rthrit
is (O
A) -
upp
er li
mb
CO
PD
Car
diov
ascu
lar d
isea
se
Ost
eopo
rosi
s
Anx
iety
dis
orde
rs
Ver
tigo
Dea
fnes
s
Ost
eo-a
rthrit
is -
hand
Can
cer
Problem
PIR
Ligh
t bea
m
Pre
ssur
e m
ats
Stra
in g
auge
load
cel
l
Pie
zo e
lect
ric
Pre
ssur
e se
nsiti
ve re
sist
or
Forc
e se
nsiti
ve s
witc
h
Wat
er fl
owm
eter
Tilt
switc
h (fl
ush
sens
or)
Doo
r sw
itch
(ree
d re
lay)
Tag
and
read
er
Ther
moc
oupl
e
App
lianc
e C
urre
nt S
enso
r
Cen
tral P
ower
Mon
itor
Aco
ustic
ene
rgy
Ele
ctric
al s
ubsy
stem
Lock
sen
sor
Vib
ratio
ns/S
hock
Sen
sor
Com
men
ts
Opening front door Time taken 16 Time taken Time taken from the moment the bell is rung to when the door is opened
Bed Sleep 11 Sleep Need to identify quality of sleep. Proposed solution is to monitor the amount of movement I.e. tossing and
turning
Walking Trips/falls 7 Trips/falls Monitor seismic eventy caused by slip or fallGeneral (non activity specific) Weight loss/gain 7 Weight loss/gain Use chair leg sensor to gauge weight
Bed Standing up from bed 6 Standing up from bed Pressure mat signal indicates standing - no load on
bed indicates end of activity. Time taken gives quality of activity
Chair/Sitting Standing up 6 Standing up Pressure mat signal indicates standing - no load on
chair indicates end of activity. Time taken gives quality of activity,
Walking Speed 6 Speed Chair/Sitting Time spent sitting 7 Time spent sitting
Bed Lifting legs into bed 4 Lifting legs into bed Pressure mat signal indicates standing - increased and steady load on bed indicates end of activity. Time taken gives quality of activity.
Walking Incidence / mobility patterns 4 Incidence / mobility patterns Chair/Sitting Sitting down heavily 4 Sitting down heavily Bed Getting up frequently (pain) 4 Getting up frequently (pain) Bed Moving around in bed / turning 3 Moving around in bed / turning Bed Sitting up 4 Sitting upWalking Gait 3 Gait Chair/Sitting Difficulty maintaining posture 5 Difficulty maintaining postureWalking Gait pattern 2 Gait patternToilet Frequency 2 Frequency Bed Getting up frequently (toilet) 1 Getting up frequently (toilet) Bed Laying down 1 Laying downWalking Wandering 1 Wandering Chair/Sitting Moving away from chair 1 Moving away from chair Chair/Sitting Sleeping in chair at night 1 Sleeping in chair at night Opening front door Not closing/locking 1 Not closing/locking
Number of related 'problems' 12 10 11 7 7 5 5 5 4 4 3 3 3 3 3 3 2 2 2 2 2 2 2 1 1 1 1 1
Walking Bumping into things 6 Bumping into things Feeding (and drinking) Cutting food 5 Cutting foodToilet Inability to manage clothes 5 Inability to manage clothesFeeding (and drinking) Amount eaten 4 Amount eatenFeeding (and drinking) Gripping cutlery 4 Gripping cutleryFeeding (and drinking) Speed 4 SpeedFeeding (and drinking) Swallow 4 SwallowToilet Cleaning self 4 Cleaning selfToilet Sitting down heavily or slowly/carefully 4 Sitting down heavily or slowly/carefully Toilet Standing up -speed,poor balance, increasing reliance on support. 4 Standing up -speed,poor balance, increasing reliance on support.Opening front door Manipulating knob/locks 4 Manipulating knob/locks Bed Managing bedclothes 3 Managing bedclothesOpening front door Not responding to bell 3 Not responding to bell Feeding (and drinking) Lifting food/cup to mouth 2 Lifting food/cup to mouthChair/Sitting Pulling dining chair up to table 2 Pulling dining chair up to tableChair/Sitting Unsteadiness on standing up 2 Unsteadiness on standing upToilet Moving around in small space 2 Moving around in small spaceFeeding (and drinking) Effort 1 EffortFeeding (and drinking) Loading fork/spoon 1 Loading fork/spoonToilet Losing way 1 Losing wayOpening front door Not closing/locking 1 Not closing/locking Toilet Inability to manage clothes 0 Inability to manage clothes
Number of related 'problems' 15 15 9 9 2 2 0 1 3 1 0 0 0 0 0 0 1 1 1 2 0 1 0 0 0 1 2 0
Preparing hot food/drink Accessing low shelves/oven/fridge 3 Accessing low shelves/oven/fridgePreparing hot food/drink Carrying items 2 Carrying itemsPreparing hot food/drink Dropping items 2 Dropping items Preparing hot food/drink Gas/electricity safety 2 Gas/electricity safetyPreparing hot food/drink Heat sensitivity 5 Heat sensitivityPreparing hot food/drink Leaving pans on/filling kettle etc. 2 Leaving pans on/filling kettle etc.Preparing hot food/drink Lifting utensils/saucepans/kettle etc. 3 Lifting utensils/saucepans/kettle etc.Preparing hot food/drink Opening packaging 3 Opening packagingPreparing hot food/drink Preparing food to cook 7 Preparing food to cookPreparing hot food/drink Preparing food to drink 1 Preparing food to drinkPreparing hot food/drink Response to timers/alarms etc 3 Response to timers/alarms etcPreparing hot food/drink Storage of food 1 Storage of foodDressing Fastenings (buttons, zips etc) 3 Fastenings (buttons, zips etc)Dressing Inappropriate dressing 2 Inappropriate dressing Dressing Lower garments 3 Lower garmentsDressing Not dressing 2 Not dressing Dressing Shoe laces 3 Shoe lacesDressing Speed and effort 4 Speed and effortDressing Task sequencing 2 Task sequencingDressing Upper garments 2 Upper garmentsWashing/Grooming Effort 1 EffortWashing/Grooming Flooding bathroom 1 Flooding bathroomWashing/Grooming Hair 3 HairWashing/Grooming Managing taps 2 Managing tapsWashing/Grooming Not washing 2 Not washingWashing/Grooming Reaching parts of body 4 Reaching parts of bodyWashing/Grooming Shaving 4 ShavingWashing/Grooming Teeth 3 TeethTelephone Making calls 3 Making callsTelephone Speaking 3 SpeakingTelephone Time to answer 12 Time to answerTelephone Understanding 3 UnderstandingBath/Shower Drying self 1 Drying selfBath/Shower Flooding bathroom 1 Flooding bathroomBath/Shower Getting in and out 4 Getting in and outBath/Shower Managing taps/plugs/shower 2 Managing taps/plugs/showerBath/Shower Reaching parts of body 2 Reaching parts of bodyBath/Shower Sensing temperature 3 Sensing temperatureBath/Shower Standing balance (shower) 2 Standing balance (shower)Stairs/Steps Gait pattern 3 Gait pattern Stairs/Steps Resting 4 Resting Stairs/Steps Slips/trips 6 Slips/trips Stairs/Steps Speed 4 Speed Managing medication Opening bottles / packs 3 Opening bottles / packsManaging medication Reading instructions 5 Reading instructionsManaging medication Remembering medication 3 Remembering medicationManaging medication Swallowing 2 SwallowingHousehold tasks Lifting & bending 6 Lifting & bendingHousehold tasks Manipulating equipment e.g. plugs 5 Manipulating equipment e.g. plugs Household tasks Motivation 1 Motivation Household tasks Recognition of need 2 Recognition of needHandling money Cognitive ability/understanding 2 Cognitive ability/understandingHandling money Losing money/purse 4 Losing money/purseHandling money Manipulation of money 6 Manipulation of moneyWriting Ability to write 1 Ability to writeWriting Accuracy of writing 3 Accuracy of writingWriting Gripping pen 2 Gripping penWriting Size of script 4 Size of scriptGeneral (non activity specific) Continence 2 ContinenceGeneral (non activity specific) Social withdrawal 11 Social withdrawalGeneral (non activity specific) Speech alteration 6 Speech alterationGeneral (non activity specific) Standing 4 StandingGeneral (non activity specific) Volume of sound 1 Volume of sound
Number of related 'problems' 21 42 25 30 9 5 6 4 8 7 5 4 0 0 1 0 8 8 8 1 1 3 1 3 2 5 10 0
Activity Problem
Sen
sor i
dent
ified
Par
kins
on's
dis
ease
Stro
ke
Rhe
umat
oid
arth
ritis
Dem
entia
Res
pira
tory
dis
ease
Ost
eo-a
rthrit
is (O
A) -
low
er li
mb
Dia
bete
s
Ana
emia
Dep
ress
ion
Ost
eo-a
rthrit
is (O
A)
Isch
aem
ic h
eart
dise
ase
& M
I
Per
iphe
ral a
rtery
dis
ease
Ost
eo-a
rthrit
is (O
A) –
hip
Ost
eo-a
rthrit
is -
knee
Hea
rt fa
ilure
Ost
eo-a
rthr
itis
- spi
ne
Cat
arac
t
Gla
ucom
a
Mac
ular
deg
ener
atio
n
Ost
eo-a
rthrit
is (O
A) -
upp
er li
mb
CO
PD
Car
diov
ascu
lar d
isea
se
Ost
eopo
rosi
s
Anx
iety
dis
orde
rs
Ver
tigo
Dea
fnes
s
Ost
eo-a
rthrit
is -
hand
Can
cer
Poss
ible
s
Cum
ulat
ivel
y - a
ll co
nditi
ons
cove
red
No
tech
nolo
gy s
olut
ion
/ not
des
irabl
eTh
ird p
arty
influ
ence
and
/ or
not
app
licab
le to
all
clie
nts
© British Telecommunications plc
Well-being concept model
Person factors
Context factors
Activity Experience Well-being outcome
© British Telecommunications plc
Well-being concept model
© British Telecommunications plc
Activities monitored
Well-beingelement
Activity type
Activities
Physical ADL’s Preparing food & eating
Sleeping
Social Social Interaction
Leaving & returning home
Visitors
Mental Personal goals
Personal appearance
Leisure activities
© British Telecommunications plc
Sensors “tool box”
• Water flow• Gas flow• Power usage• Vibration• Pressure• PIR• Active IR• Telephone usage• Gait analysis• others ….
• Wireless connectivity• Self powered, battery and scavenged• Jiffy-bag deployment
© British Telecommunications plc
Sensor locations
Client 1Downstairs plan view24 sensors installed Kitchen
Lounge
cupboard
Back doorTV
Coffeetable
‘Radio’chair
Fire
plac
e
Fridge/freezer RMU
Gas
Cooker
Sofa &
armchairs
Window sill
sink drainer
‘TV’’chair
Spare bedroom
Master bedroom
Bath
W.C.
Basin
BathroomLand
ing
Double bed
War
drob
es
War
drob
es
Draws
Pile of various objects
© British Telecommunications plc
It’s all a bit fuzzy…
• Wellbeing is a fuzzy concept• ADLs and routines are not prescriptive or regimented• Changes and trends are not absolute• Need for easily understandable output
• All lends itself to fuzzy data analysis and simple output reporting
• Use of “plain English” questions to query the analysis
© British Telecommunications plc
Sleeping Patterns
Question:
• Are the locations of the sleep-periods within the house changing?
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The Silence of the Lounge
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No such thing as too much data…
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Intelligent Data Analysis interface
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However, need for simple overview…
• RAG rating
• Busy-ness index– Is the service user as activity as usual?– Is there any unusual behaviour?
• Is there a change that needs looking at?– Ability to drill down in data.
© British Telecommunications plc
Sample ‘Wellbeing’ interface
Q4. Eating Habits
Q3. Sleeping Habits
© British Telecommunications plc
The mobile care worker
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Issues
• Parallel projects– Each heads in own direction– Diversions of design and ambitions
• Academic/technologist led– Need for strong carer input - champion– Technology understanding– Time– Short term pressures vs. long term research
• Alarm conditions – liability – Funding
© British Telecommunications plc
Pervasive ICT for wellbeing
Holistic Well-Being Monitoring:• Integration with health monitoring (SAPHE)• Chronic disease management• Enabler for joined up care
Opportunity for continuous objective measurement and support:
• Peace of mind for clients and carers• Optimisation of home care services• Timely intervention ahead of crises
Many questions still to be answered:• Low cost ubiquitous sensor devices• Scalable intelligent data analysis• Seamless links to ICRS• Privacy and ethics
www.saphe.info
Supported by DTI Technology Programme
SAPHE
Project Overview
• To develop a novel architecture for unobtrusive pervasive sensing to link physiological/metabolic parameters and lifestyle patterns for improved well-being monitoring and early detection of changes in disease.
By sensing under normal physiological conditions combined with intelligent trend analysis, SAPHE opens up new opportunities for the UK ICT and healthcare sectors in meeting the challenges of demographic changes associated with the aging population
DTI Technology Programme
© British Telecommunications plc
From Telecare…to holistic care
• Activity monitoring• Social care• Home setting• Fixed deployment• Technology led
• Activity & physiological monitoring• Social care & healthcare• Holistic data analysis and intelligence• Home & mobile settings• Flexible deployment• Technology & business drivers
NHS Central systems
hub
wirelesssensor
Internet Telecare Platform
Firewall
OpenZone
Family Social care
providers Health care
providers
GSM/GPRS/3G
Wi-Fi
© British Telecommunications plc
Chronic condition management
Wellbeing and Independence
Mon
itorin
g in
con
text
: C
orre
latio
n of
phy
siol
ogy
and
daily
act
iviti
es
Con
tinuo
us ri
sk a
sses
smen
t: pr
even
tativ
e ca
re a
nd e
arly
ch
ange
det
ectio
n
Info
rmat
ion
diss
emin
atio
n:
App
ropr
iate
and
tim
ely
to c
arer
s
Ubiquitous non-invasive monitoring infrastructure
• £3.3M Collaborative research project co-funded by the DTI Technology Programme• Commenced March 2006 for three years
• Liverpool care economy – trial partner– PCT, Social Services, Liverpool Direct Ltd– Trial in 2008 • To increase efficiencies within the PCT
• “To be able to do more with what we have.”
• Combined health and social monitoring
• Contextual understanding– New intelligence that adds value to
care processes
• Trend analysis
• Prediction
• Support
• Reassurance
© British Telecommunications plc
…and better support this group to prevent them moving up.
• Non invasive monitoring of activity and physiology
• Continuous monitoring – home and away
• Reassurance
• Independence
• Self management
• Medication / regime reminders
• Education
• Continuous evidence based risk assessment
• flagging of early changes in disease state
• Reduce acute admissions
• Support earlier release
• Monitoring in context
• Trend analysis
• Improve compliance
High Intensity Users (HIUs).Those requiring repeated admission to acute care. 5%
‘Unwell’ patients. Worsening symptoms and whose condition may require more professional care. 5-10%
‘Nearly well’.Managed through contact with GPs, community matrons, etc. 70-80%
‘Well’. Self-management. 10%
Use pervasive healthcare to prevent this group becoming HIUs and move them down the pyramid…
• Reassurance
• Support
• Access to wellbeing summaries
• Alerted to problems
• Manage alerts
• Access to monitoring data
• Access to records
• Escalation to professionals
Service users
Informal carers
Professionals
Call Centre