The difficulty in differentiating telemedicine and telehealth

Our Editors have always tried to cleanly define the differences between telemedicine, telehealth and telecare, even as they blur in industry use. (See our Definitions sidebar for the latter two.) But telemedicine, at least on this side of the Atlantic, has lost linguistic ground to telehealth, which has become the umbrella term that eHealth wanted to be only two or three years ago. Similarly, digital health, connected health and mHealth have lost ground to health tech, since most devices now connect and incorporate mobility. And there are sub-genres, such as wearables, fitness trackers and aging tech.

Poor telehealth grows ever fuzzier emanations and penumbra! Now bearing the burden of virtual visits between doctor and patient, doctor-to-doctor professional consults, video conferencing (synchronous and asynchronous), remote patient monitoring of vital signs and qualitative information (ditto), and distance health monitoring to treat patients, it also begins to embrace its data: outcome-based analytics, population health and care modeling. Eric Wicklund accumulates a pile of studies from initial-heavy organizations: WHO, HIMSS, HHS, Center for Connected Health Policy (CCHP), ATA, TRC Network. All of which shows, perhaps contrary to Mr Wicklund’s intentions, how confusing simple concepts have become. mHealth Intelligence

Tunstall, world leader in telehealthcare, starts to evangelize the USA

We are interested to note that Tunstall is starting to claim the term ‘telehealthcare’ in the USA just as we notice it starting to downplay its use in its recent UK marketing materials in favour of ‘telecare and telehealth’. (In the UK the term ‘telehealthcare’ gained ground in general usage in some parts of the country after Tunstall started to use it and, as no other major suppliers used it, they succeeded in owning it in the way that a team which has the ball in its possession ‘owns’ the ball.)

How do we know that Tunstall is about to do its telehealthcare thing in the US? Read this press release: Telehealthcare Leaders Forum Welcomes Assoc. Chief Medical Officer at Northwestern Memorial to Speak About Healthcare Innovation. American and Canadian readers will be highly amused to learn that “The Telehealthcare Leaders Forum is North America’s only educational and professional event dedicated to stimulating innovation and leadership in the emerging era of technology and healthcare delivery.”

Is ‘telemedicine’ just ‘healthcare’ yet?

In English, there is a well-recognised pattern in the development of some terminologies. Beginning with the ‘old’ technology, a new descriptive element is added when ‘new’ technology comes along. In time, the new terminology is shortened – often just going back to the original. Take, for example: carriage > horseless carriage > motor carriage > car. Or, a more recent one that is still in a state of flux: telephone > phone > mobile(cell)phone > smartphone > phone. Is this happening yet with terms like ‘telemedicine’, ‘telehealth’, mhealth, etc? Some people like to think so, as in this blog post Redefining telemedicine as a routine clinical practice. However, as much as enthusiasts of the technology like to anticipate such changes and, in doing so, to ‘help them along’ (it has its origins in magic, perhaps) the weight of linguistic history indicates that such changes only happen when there is a consensus in the general population that the once-new technology is now the norm. Heads-up thanks to Bob Pyke.

Best use of telehealth and telecare (UK)

Illustrating the point that even in the UK the terms telehealth and telecare are used in a variety of ways, the four EHealth Insider Awards 2012 finalists in the ‘Best use of telehealth and telecare’ category included three which were loosely ‘telecoaching’ (as defined by the National Framework Agreement) and only one which we would rate as telecare. Happily, it was the winner: NHS Lothian and East Lothian Council – telecare in care homes to reduce falls. Best use of telehealth and telecare finalists. Awards results.

New word on the block: Plesiocare

Picked up in a comment by Kevin Doughty, the newly coined terminology ‘plesiocare’. Do you know what it means? Do you want to know what it means? It’s ‘near-care’ as opposed to ‘telecare’. That is, technology which gives feedback straight to the carer, rather than being mediated through a call center. At least that’s this editor’s understanding. Will it be useful? Will it catch on? What do you think? (Sorry there are more questions than answers! Steve)

Terminology: ‘telecare’ v ‘assistive technology’

If you know anyone who persists in using the generic term ‘assistive technology’ (AT) when they mean something as specific as ‘telecare’, then direct them to the following excellent list of examples of AT from the British Assistive Technology Association. It is interesting that they have adopted the US term ‘PERS’ for telecare alarms, but we can live with that! Further Information on What Assistive Technology Is. Heads-up thanks to Guy Dewsbury.

UPDATE Fri 17th: A reader has reminded me (Ed. Steve) that I did not put the above into the context of the Foundation For Assistive Technology’s (FAST) definition, as supported by the AT Alliance. As I was involved in the development of the FAST definition in 2001 I fully support the AT Alliance’s comment that “to define the term too closely using illustrative lists of equipment ran the risk that any associated legislation, funding or regulatory measures failed to cover emerging technologies not included in the listing.” However, there are still people who refer to ‘telecare’ as if it were the whole of, and not a subset of, ‘assistive technology’ and one wonders why the message still has not got through. That’s the reason why I liked the BATA page for giving so many examples.

Telecare Aware’s Terminology Campaign

What’s the problem?

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…

Then move on to this article Telecare, telehealth and assistive technologies – do we know what we’re talking about? Doughty, K et al, published in the Journal of Assistive Technologies (Volume 1 Issue 2, December 2007) and made available to Telecare Aware readers by kind permission of Pavilion Journals (Brighton) Ltd.

Steve Hards

Baby boomers? Older people? Senior citizens? Elders?

Not telecare, but a terminology issue as it refers to the target client group for telecare/telehealth companies. When I read about ‘the elderly’ or worse, the near-meaningless, ‘the vulnerable’, I imagine that the writer is probably hardly out of their twenties or thirties, or still has that mindset. If you want to alienate your potential clients, this is the language to use.

A brief read, with an American perspective, but with interesting survey results. Baby boomers? Older people? Senior citizens? Elders? What would you like to be called in your middle and later years? by Rita R. Robison.

Nottingham telehealth monitoring (UK)

Nottingham PCT aims to monitor around 800 people each year with long-term conditions such as chronic obstructive pulmonary disease and congestive heart failure, using Tunstall equipment. Press release.

[Comment: This is the third press release in recent times to headline the word ‘mainstreaming’ in the context of a deployment that is bigger than the usual pilot study. Is ‘mainstream’ now becoming redefined to mean ‘large scale pilot’? Surely something isn’t mainstream until it is routinely offered to everyone who could benefit from it? I’ve flagged this item for the ‘Terminology’ category because perhaps the meaning of ‘mainstream’ should be part of the terminology debate.]

Two free reports

Here are two free reports you should consider downloading.

First, The Center for ConnectedHealth’s 2007 Progress Report. Good if you want a wide-ranging look at current remote health monitoring and care delivery trends in the US. [And in Second Life…I wonder if not being able to fly or grow a tail count as health problems in that virtual world?] Interesting stuff, and you can download it from this page on the Center’s website.

Second, there’s the S2S (Strategies to Solutions) discussion paper, called Technology to Support the Ageing Global Population 2007 to 2027. It is 25 pages of balanced, well written information that ranges over assistive technology [a term used in its broad sense – compare with this post] including health- and care-related AT, and highlights various issues for society and emerging technology. You have to join the S2S mailing list to get it, but don’t let that put you off. Get it here.

Telecare and telehealth coming together in Norfolk (UK)

With a bit of editing and a slightly revamped commentary this video could become a useful introduction to telecare and telehealth for the public. However, people who know me will anticipate that I have a huge problem with Norfolk’s conflation of ‘assistive technology’ with telecare and telehealth, hence I’ve also categorised the video under ‘terminology’.

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…

OK, rant over! My thanks to Saneth Wijayaratna of Telemedcare Ltd for alerting me to the 7 minute video.

 

[youtube=http://www.youtube.com/watch?v=0ukJMscqLak]

 

Terminology: Telehealth, telemedicine, telehomecare and telespeech

This post continues the focus on the terminology problems.

Watch this 6½ minute video of US Senator for South Dakota John Thune advocating (successfully) 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’.

Tech Savvy Elderly May Boost Telecare Market

As regular Telecare Aware readers will know, Wireless Healthcare is a favourite source of articles, so it is a pity that in this commercial report they have produced they chose to perpetuate the use of the pejorative term ‘elderly’ instead of the less value-laden ‘older people’. Wireless Healthcare’s story on the report [Page URL “http://www.wirelesshealthcare.co.uk/wh/news/wk05-08-0003.htm” reported to be compromised by malware 16 March 2015].