PARO: The robotic therapy seal that benefits so few

click to enlargeI have a problem with that cute, robotic seal cub PARO.

More accurately, I have a problem with the ethics of the business model of the Japanese company that makes it, Intelligent System Co. Ltd.

PARO started development in 1993 and the first English press release was in 2004 – a year before Telehealth and Telecare Aware started! Since then the indications that PARO is good for people with dementia have been building and building, as Editor Donna most recently highlighted in this item: PARO therapy robot tested, cleared by NHS for — hygiene.

I have no problem believing, as Donna summarised, “the research has shown that it lowers stress and anxiety, promotes social interaction, facilitates emotional expression, and improves mood and speech fluency.”

However, in response to an enquiry last week, it was confirmed to me that neither price or delivery time information is available but that PARO seals continue to be made individually, by hand. This is a huge production bottleneck and cost.

It is entirely proper for a company that produces handmade cars to have high prices and long waiting lists for their rich man’s toys but I am completely at a loss to conjure up any justification to apply that thinking to PARO. (PARO cost $6,400 in 2017.)

I believe that the insistence that PARO continues to be made in this way is an unethical denial of a benefit to millions of people.

Does Intelligent System not have the will or the skill to scale up production and bring down the cost so that every care home or dementia ward could acquire a PARO (or even a ‘PARO lite’) within a few years? If not, they should license it to a company that can.

At least they should stop pretending that PARO is benefiting people with dementia when it reaches so few.

This Telehealth and Telecare Aware Soapbox item is the personal opinion of TTA founder and Editor Emeritus Steve Hards.

Blockchains, EHRs, roadblocks and baby steps

TTA founder and former editor Steve Hards crawls out of his retirement tent to squint at the misty landscape of blockchain technology.

In a recent dream I was observing an auditorium full of people chanting “Blockchain! Blockchain! Blockchain!” and yes, mantra-like, blockchain is now popping up all the time in health technology articles and presentations.

It has taken a while to get to this stage. It was January 2016 when Editor-in-Chief Donna first mentioned blockchain. Since then there appears to have been more talk than action.

A year ago, in February 2017, health IT guru Brian Ahier was able to say in a comment here “Blockchain of course, is going to sneak up on a lot of people…”

Where we have seen developments occurring is in the trickle of ‘coins’ or ‘tokens’ in health-related Initial Coin Offerings (ICOs) of dubious investment worthiness. I may rant about those in a follow-up article if anyone is interested. (Let me know in a comment.)

The terminology is still in its ‘shakedown phase’ (see this great terminology rant) and, because of the publicity around Bitcoin, which is on a blockchain, the distinction between blockchains and distributed ledger databases is blurred. There are technical differences: blockchains are a sub-set of distributed ledgers (Wikipedia), which is the term I’ll generally use in this article.

Distributed ledgers and EHRs

What are the implications of distributed ledgers for the biggest databases in healthcare, electronic health records (EHRs)?

The two principal characteristics that differentiate distributed ledgers from the databases with which we are familiar are that they are more robust and, potentially, more private. Some even claim to be quantum computing hack proof although we will have to wait for hackers with quantum computers to test that.

Traditional databases are formed from one large or several linked entities that have a centralised control from where performance, data integrity and security are monitored and managed. There are human and technological factors that introduce weaknesses to all such systems, as the number of data breaches reported here over the years testify.

(more…)

On the passing of Bob Pyke Jr.

Bob Pyke Jr. Many readers of Telehealth and Telecare Aware will join our editors in sending condolences to the family of Bob Pyke, who died on Sunday 24th January 2016. (Obituary and condolences link here.)

Bob’s enthusiastic promotion of all things telehealth by linking to relevant articles online pre-dated TTA by many years. A Google search of his name will show up thousands of items and associations to which he was linked. He continued to post articles to his Facebook page up until last November, despite the debilitating effects of his amyotrophic lateral sclerosis (ALS), or motor neurone disease (MND) as it is known in the UK.

In July 2014 he announced his illness with typical frankness and simplicity “I wish I could write as well as Danny Sands who recently wrote about his own health experiences, my writing style is a cross between Monty Python and Mark Twain. On this past Friday, I was diagnosed with ALS. I am blessed to have a loving family and friends who support me and encouraged me to keep a journal about my changed life.”

Bob was a nurse and the humanity which led him into that profession always shone through: “Since being diagnosed with ALS, I am not a patient with ALS, I am a person who has ALS.” Nor did he shrink from noting some of the more difficult aspects of his illness “…living with ALS or dying is the most singular and solitary experience one undergoes.”

Ten years ago Bob and I collaborated on setting up a social networking site for community nurses. Unfortunately it did not get past the early stages but it was always a pleasure working with him. Looking back through my emails I see that I once described Bob to a colleague as “a long term avid sniffer out of news”. I think he’d have liked that.

Bob built up a worldwide network of people interested in nursing and telehealth and he inspired and encouraged them. We will miss him.

Steve Hards
Founder and ex-editor, TTA

 

Friday’s Alert: Telehealth and Telecare Aware Updated

Owing to an elusive problem on our server our adoption of a new alerts emailing system is still not complete, so we are unable to send out the usual alerts email today (see apology above). We appreciate your patience. In the interim, please spread the word by tweeting this post. Thank you.

Today’s alert is brought to you by:

2014 Digital Health Conference | November 17-18, New York, NY
Join the NY eHealth Collaborative at the Digital Health Conference
10% registration discount with Code TTA. www.digitalhealthconference.com

Five new articles including further commentary on the TSA chair selection and a look at the worldwide black market in medical ID theft

TSA chair selection critiqued
(Paul Harper’s article in Roy Lilley’s newsletter reviewed)

Health apps presently of little use, says Australian telehealth expert
(CE Dr George Margelis debunks current state of the art)

Panasonic enters telehealth, debuts On4Today
(USA unit goes social, plus pilots a TV telehealth interface)

The sheer screaming attractiveness of medical ID theft
(Harry Lime would find this new black market more lucrative than stealing off Army trucks)


Roundup: data breaches ’round the world

(Hungary’s CEU takes a long hard look at it, and even FDA is vulnerable)

Earlier this week:
Home telehealth projected to outpace ‘telehospital’ by 2019 (Pick your forecast!)
Telehealth for Motor Neurone Disease (Sheffield Institute trial patient monitoring report)

Last week in TTA:
Ebola and health tech: where it can help, where it failed
Life expectancy up, but so is death from falls (US)
Google testing telemedicine program via Helpouts
12 percent of US veterans now using VA telehealth services
Faux Glass: not just a knockoff, but a sendup
TSA appoints new chair (Heraclitus’ comment a must-read)
Telemedicine getting out of the waiting room–perhaps
Three seminars on negotiating IP licensing, IT procurement and services (US)

Friday Alert: Telehealth and Telecare Aware Updated

We have been unable to send the alerts email today (see apology above) but these are the main features of what it would have said…

Today’s alert is brought to you by:

2014 Digital Health Conference | November 17-18, New York, NY
Join the NY eHealth Collaborative at the Digital Health Conference
10% registration discount with code TTA.

Five articles posted since last Tuesday, plus a comment on the TSA chair appointment announcement

Ebola and health tech: where it can help, where it failed
(Disinfection, temperature measurement, crowdfunding research help–but EHRs failed the test)

Life expectancy up, but so is death from falls (US)
(From hopeful early 2000s Telecare Time to ‘curb feelers’ )

Google testing telemedicine program via Helpouts
(One way or another, they’ll help you…and help themselves to your data)

12 percent of US veterans now using VA telehealth services
(Growth in a good way, but much more to be done)

Faux Glass: not just a knockoff, but a sendup
(All in fun, and not a ‘scampaign’…we get to those later)

Earlier this week in TTA:
TSA appoints new chair (Heraclitus’ comment a must-read)
Telemedicine getting out of the waiting room–perhaps
Three seminars on negotiating IP licensing, IT procurement and services (US)

Telecare Soapbox: Falling outside the box

[Editor Donna’s note: Even if you have already read this great article by Steve, read on to the first comment as to ‘what happened’.]

Before you read the rest of this item, read or re-read the following two popular recent falls-related articles:

Accelerometers, false positives/negatives and fall detection (Tom Doris)

A five-point rebuttal to ‘Accelerometers, false positives/negatives and fall detection’ (Andy Schoonover)

The acceptability of false positive fall alerts and the risk of false negatives has dogged fall detection ever since the first detector was invented. It is great to see this fundamental matter still being debated on this website by experienced practitioners!

However, given that calibration of devices has, as Tom Doris points out, inherent problems however sophisticated they become, I see no one putting their finger on what I consider to be the ‘real’ issue. That is: where in the system is the intelligence that judges whether a fall is problematic or not?

Current systems place the intelligence either with (more…)

The future of Telehealth & Telecare Aware

As from today I, Editor Steve, am retiring from the Telehealth & Telecare Aware editorial team. After giving it my continuous attention for eight years it is time for me to focus on my other interests such as promoting my PowerPoint addins and nurturing my fledgling web design business. From now on I shall only be helping with the tech side of running the site.

I therefore thank you, loyal readers, whose comments and communications have kept me going during these years. I’d particularly like to express my appreciation to Tynetec which has advertised with TTA since it started and has never sought to influence editorial policy or content. Thanks too to Eldercare and Air Products for their sustained advertising support in recent years.

I have very special thanks, of course, for Donna Cusano for the amount of time that she has also put in since 2009 to keep us all up to speed on developments in the US. Without her TTA would have folded several years ago.

So…I am extremely pleased to announce that as I step back Donna has agreed to step forward as TTA’s new Editor in Chief. She will be supported by a number of volunteer contributing editors: Toni Bunting, Chrys Meewella, Mike Burton, Alasdair Morrison and Charles Lowe who will be covering UK developments and introducing their own observations as often seen already in the TANN Ireland and TANN England sites and in comments. My grateful thanks to them too.

I wish Donna and the team every success. They will no doubt set about reinventing and reinvigorating TTA. Donna has already indicated that she would like to shift more towards interpreting trends and that one of the contributing editors has a post for Monday that you will not want to miss!

Best wishes to you all, Ex-editor Steve.

End of life care: emotions and facts (UK)

Not telehealth directly but of concern to those in the field because of the links to people with long term conditions…

While the UK media is leaping on the current ‘bash the Liverpool Care Pathway’ bandwaggon, the end of life care experts at King’s College’s Cicely Saunders Institute have taken a more balanced view. In an insightful 30 minute podcast members of their team discuss questions such as:

  • What is the problem the LCP review tried to address?
  • What are the known research facts?
  • What can people do in advance of when they are no longer able to make decisions?
  • What are the implications for professional training?
  • What are the funding and practical inequities in the current health system?
  • What is the cost of care to families?

KCL press release here. Podcast here. Related TTA item, May 2013.

Mick’s House: Telecare publicity with a difference (UK)

click to enlargeSince 2007 when Mick Burkhill (a former Regional Sales Manager who had heart attacks at the age of 52) had his first telecare equipment he has turned into something of an expert and he now gives feedback on new equipment to his local council and its supplier. Now he is aiming to share that expertise through a new website and to help raise public awareness. Mick is starting to blog from the site and would appreciate hearing from TTA readers who may want to suggest topics that he could write about from a telecare user’s point of view – use the contact form on the site: Mick’s House: One man’s insight into Telecare. Very much in the background Mick’s site is supported by Tynetec Ltd but they have made it clear that the content is all down to Mick and any community that he can develop.