Multiple meanings of the words ‘telecare’, ‘telehealth’, ‘telemedicine’, etc. abound. Conversely, similar concepts have many names. As a consequence:
Professionals use their preferred terminology and confuse journalists
Journalists’ misconceptions spread public confusion
Speed of adoption of the technology is retarded
People suffer without appropriate monitoring systems
Suppliers have to work harder to thrive
The development of new technologies falters
What’s the solution and where will it come from?
I used to believe that the matter would evolve towards a solution. However, I now see it evolving towards greater confusion. We have reached a situation where a standard, internationally recognised taxonomy and set of definitions needs to be agreed and adopted.
However, it is no one’s responsibility to take on this task. The only organisation that has a broad base of worldwide technology suppliers and which has a remit to develop any international standards (albeit only in the health technology arena at the moment) is the Continua Alliance. It is in the Alliance’s members’ long term interest to tackle this problem.
What role will Telecare Aware play?
During 2008 Telecare Aware will post links to news items that illustrate the problems. I am happy to open up these pages to everyone who is interested in this issue and invite contributions by way of articles and comments. Although I have some views about how words should be applied in this field (see the What is Telecare page, for example) I am more concerned that an international consensus is formed than I am about promoting my particular usage.
Where shall we start?
Start with this excellent blog posting by Guy Dewsbury: The Language of Telecare. It begins: “I am not sure about you, but I think it is time to resurrect the debate about terminology. I have recently been to a number of conferences and at these events people use the words Telecare, Telehealth, Telemedicine and Assistive Technology…
…people who know me will anticipate that I have a huge problem with Norfolk’s conflation of ‘assistive technology’ with telecare and telehealth. (See comments on the Terminology Campaign item.)
Let’s get this straight: ‘assistive technology’ is a very broad term for any equipment that helps compensate for some form of functional impairment. Or, as the Foundation for Assistive Technology (FAST) defines it, “Assistive Technology (AT) is any product or service designed to enable independence for disabled and older people.”
A few shots at the beginning of the video imply that they understand this, but it soon slips into referring to the telecare and telehealth as AT. Although can be regarded as a subset of AT, there is no implication that AT has a remote component in any way, which is the key defining characteristic of telecare, telehealth, telemedicine, etc. When I was contracted to work at the Department of Health I frequently reminded civil servants and Ministers not to refer to telecare as ‘assistive technology’ and I thought that eventually the message did get through. At least by the time the Preventative Technology Grant conditions were published. And now it raises its head again…
In this 6½ minute video of US Senator for South Dakota John Thune successfully advocates an increase in funding for telehealth in October 2007. It is interesting to observe his superordinate use of the term ‘telehealth’, with ‘telemedicine’ sometimes seeming to be used interchangeably, and sometimes subordinately to it when contrasted with ‘telehomecare”.
I’m grateful to Marnee Brick, a speech therapist, for spotting this video. As an ex-speech and language therapist I am delighted to see that she is promoting online therapy. See her site: TinyEYE.
However, I do have a problem with her construction of online speech therapy under ‘telehealth’ in her blog. As I’ve mentioned previously, the terminology issue here is not with ‘tele’. It’s what comes after: is speech therapy is a health or an education-related discipline – or something else? This was a debate going on in the UK from at least the ’60s. She also uses the term ‘telespeech’ and ‘telepractice’.
1min 34sec 15 Aug 2006. Older people benefit from home alarms (West Lothian) View here 1min 32sec 23 May 2007. New healthcare system piloted (Kent) View here 1min 47sec 29 Jan 2008. Bed sensor helps elderly coupleView here 2min 18 sec 30 Jan 2008. Advances in telecare devices (People with Learning Difficulties and Older People) View here
They like robots in Japan and are working hard to turn them into human replacement care givers. RI-MAN, developed by Riken BMC, can ‘see’, ‘hear’ ‘touch’ and ‘smell’ and can lift and carry a person – well, mannequin in the demo. TIME selected RI-MAN as one of the best products of 2006. See the two videos near the top of this page. Watch them both. Scroll down for more information and pictures. After that, you may like to visit the Secom Meal Assistance My Spoon robot site. No video, but an interesting development for the right clients.
Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:
• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.
• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.
Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.