Telecare

Assistive technologies for the healthcare market

Demographic forecasts indicate that the number of over 65s is set to double in developed and developing nations over the next few decades. This will concern the Department of Health, which is already spending almost 60% of the NHS budget on the over-60s. 1 Falling birth rates, meanwhile, will inevitably reduce the pool of professionals available to serve this population. Current models of care will need to be revised dramatically to cope with the increasing demand.

Integrated delivery of healthcare and socialcare services, coupled with widespread use of AT in the community, may provide a solution to this pending crisis. Not only does it have the potential to enable people to live independent lives for longer, but it will also dramatically reduce the demands placed on healthcare providers.

The Northern Ireland healthcare service

Northern Ireland provides a good example of how community healthcare services can be used effectively. Because GPs and other care providers practise in local health centres under one roof, patients can be seen and then referred to local specialist community hospitals for the treatment of specific ailments, enabling them to be provided for much more efficiently.

Imagine a telecare facility that collects medical and environmental information from around an elderly person’s property and sends it to a secure database for analysis. This data can be analysed by the experts at the local health centre, enabling a whole range of long term conditions to be monitored and helping GPs to provide patients with the best possible treatment. The development of broadband widens the possibilities for telecare, and as Northern Ireland is set to become the first region in Europe with 100% broadband coverage, it offers an ideal environment in which to develop these AT network systems.2 If there is a major shakeup of healthcare services in the UK and the Republic of Ireland, the Northern Irish model may be the easiest one to adopt when developing a new healthcare service.

Assistive technology

Fortunately, the majority of technological capabilities required to develop healthcare applications for AT are already being used in industry, making its transition into healthcare settings far easier. Telecare is already moving towards its second-and thirdgeneration technologies, which are capable of monitoring the patient’s living environment and using mobile and wireless technology to transmit blood pressure and other vital signs.3 The research currently being carried out at several universities is helping to support this.

The Department of Trade and Industry Global Watch mission to the USA, researching home-based healthcare, identified the ‘one-box solution’ as the “holy grail” of telecare.4 A central controller of a property’s telecare facilities, capable of communicating with a variety of devices and providing two-way visual communication, this ‘plug and play’ solution, when combined with a broadband connection, can collect, send and receive information about the patient continuously, or automatically raise an alarm if a sensor output reaches a predefined level. It can then be used as a dynamic interface capable of handling the various telecare solutions that enable the user to remain independent.

Information transmission

There are several ways of sending the information collected by the sensors securely to the database. The one-box solution should be capable of using a variety of wireless, wired and ‘over-powerline’ communication methods, which can send data securely around a building through its electrical cabling, removing the need to adapt the existing wiring.

INSTEON is the latest development in information transmission for properties, providing both types of communication method — while being backwards compatible with X10 technology, the current industry standard. Bluetooth, meanwhile, provides an excellent platform for third-generation telecare applications, as it provides a secure personal area network which can be used to transmit vital signs from remote readers to receiving devices. Finally, wireless fidelity provides the strongest and fastest remote data-communication method, allowing information to be sent securely over the network without a physical connection.

Radio frequency identification

Radio frequency identification (RFID) can be used to monitor patients’ movement and activities around a property.5 Placing an RFID tag in their clothing allows tracking of their movements using receivers placed in the property. These readings can then be used to raise an alarm if the user leaves the property during the night, or can provide information on how they use their property; if this usage changes it may indicate a change in their condition. Similar information can be gathered from motion detectors. An RFID chip placed in the base of a pillbox, for example, can provide accurate information on when medication has been taken. This can then be compared with other medical information to see if there is any correlation between two separate yet interdependent events. Pressure pads Pads placed in a bathroom can be set to automatically measure a person’s weight or to download information without their needing to remember to carry out certain tasks. A pressure pad placed under a bed can assist in the monitoring of renal disorders and raise an alarm if the occupier has got up but not returned to bed within a certain time, which may indicate a fall.

Near-patient testing

Near-patient testing enables onthe- spot testing of patients for certain diseases and genetic disorders, allowing almost simultaneous medical feedback. One application being developed will use biomarkers which can assist in measuring disease progression and adherence with self-medication, allowing the earlier detection of any change in condition.

Human-machine interfaces

Human-machine interfaces (HMIs) — once referred to as manmachine interfaces — will play a pivotal role in providing effective telecare in the future. A wireless HMI can be set to remind patients to take medication if a push-button or RFID tag has not shown they have done so, or guide them through a complex task by breaking it down into manageable stages. It can then be used to provide timely feedback and advise on any remedial action needed.

By installing a camera on an HMI, visual communications can also be provided, providing valuable interaction between the occupier and carers. With the information collected from remote monitoring devices a patient can effectively attend a medical appointment without leaving home, but still have visual contact. Environmental monitoring Monitoring the environment can take several forms, from video door-entry and remote door opening through passive infrared technology to smoke and flood detectors.6 Detectors can be used to shut off, remotely, gas rings that have accidentally been left on, or raise an alarm if a bath starts to overflow. Environmental monitoring devices can provide the added safety and security needed for a person to remain safely independent at home.

Home automation

Although not directly linked to telecare, home automation is becoming more common, meaning that the infrastructure needed for telecare will probably become standard in the homes of the future. This will increase the ease with which a property can be adapted for telecare.

HA applications such as lighting and heating controls can help the elderly and vulnerable to remain independent in their homes. PIR can turn the lights on automatically as they enter a room, while remote thermostats can ensure that the property remains at a habitable and comfortable living temperature.

Benefits of assistive technology

Assistive technology can provide both the occupier and carer with the knowledge that continual support is being offered, which assists the patient in remaining independent at home. Allowing the elderly and vulnerable to remain in the comfortable and familiar surroundings of their home also provides psychological benefits, as they are afforded the dignity of remaining in control of their situation.

Healthcare providers will benefit from providing a modern healthcare service, which spreads the workload throughout the healthcare community. This will be dependent on telecare providing an infrastructure which will allow carers to take preventative measures at an early stage, instead of reactive measures after a major event.

AT can assist in the monitoring of a plethora of long-term conditions including angina, circulatory disorders, diabetes, dementia, epilepsy and chronic obstructive pulmonary disease. It can also help in the rehabilitation of certain disorders, allowing patients to be discharged from hospital earlier, with the remaining care coming from the wider healthcare community.

Barriers to AT

The main barriers to AT are not the devices or their applications, but human resistance to change and the ability to adapt to these innovative approaches. By educating the general population of the benefits of telecare, it should reassure the elderly and vulnerable that telecare is there to help and assist them in remaining independent, and not part of a ‘big brother’ state, which can be a concern to some. Healthcare professionals need to buy into the benefits of telecare and their applications, so that they can realise the full potential of this emerging healthcare market. The potential applications of AT are vast and, with new technological developments emerging every day, telecare is undoubtedly going to become a major tool for managing our aging population’s health.

Robert Moran is Managing Director of automotion firm BootRooms.com The company is based in Crumlin, Northern Ireland.

References

1. BBC news. £1 billion cost of elderly falls. BBC website: 20 August 2003. http://news.bbc.co.uk/1/hi/health/3167005.stm  [accessed 25.04.07].

2. BT Wholesale. Northern Ireland is set to become the first region in Europe with 100% broadband facilities. http://eco.btwholesale.com/broadband1/where_i_live/region_3.asp   [accessed 25/04/07].

3. Care Service Improvement Partnership Health and Social Care Change Agent Team. Telecare implementation guide: version 19. July 2005. www.cat.csip.org.uk/index.cfm?pid=433  [accessed 25.4.07].

4. DTI. Healthcare at home: US solutions. Global Watch Magazine. Pera, February 2007. Crown copyright URN07/251A. www.globalwatchservice.com

5. The Royal Society. Digital healthcare: the impact of information and communication technologies on health and healthcare. London: The Royal Society, 2006.

6. King N. Housing Learning & Improvement Network: assistive technologies in extra care housing. Fact sheet no: 5. London: Department of Health, 2004.