Published last week in the Journal of Internet Research (JMIR) is the study by Malcolm Fisk, PhD which TTA previewed last month on telehealth’s part in the two-week response, starting 12 March, in response to COVID-19 in Australia, UK, and the US. Malcolm Fisk, PhD, who our readers know as Senior Researcher at the De Montfort University in Leicester, led a group from Australia in comparing these three countries in including telehealth in their responses to the pandemic. It looks at how telehealth models were used, awareness of the role of telehealth in response, and how restrictions previously in place were dealt with.
The study’s conclusions, briefly summarized:
- Australia: immediately funded on 11 March with AUS $100 million (US $68 million) a “new Medicare service,” at no cost for patients, for telehealth consultations. Telehealth in Australia is well developed, particularly in rural areas, for health and social care needs. The added funding will aid in the rollout.
- UK: at the same time, the UK was in a ‘containment’ phase with the PM’s admission that “many more families will lose loved ones before their time”. At that point, telehealth was not in the plans, but the Imperial College projections and recommendations on home quarantining and ‘social distancing’ severely affected the most vulnerable, older people. COVID wound up being quite a jolt to the NHS since telehealth is underdeveloped in most of the UK with the exception being Scotland. Clinicians to this point did not see a need, and many older people do not have access to smartphones, tablets, or the internet. Intents are good–NHSX and the Topol Report setting a framework for telehealth–but to this point telehealth rollout is limited.
- US: 17 March could be called ‘Telehealth on Steroids’ Day, as CMS announced the ‘dramatic’ expansion of telehealth services via non HIPAA compliant platforms such as Skype and Facetime for Medicare, retroactive to 6 March. Telehealth mushroomed starting 11 March in hospitals first, reporting 15 and 20-fold increases in telehealth consults. Then CDC and the AARP got on board. The US has an uneven system, between differences in state parity reimbursement, Medicare concentrating on rural health, state Medicaid, private pay, and integrated hospital systems’ approaches. What holds telehealth back are providers and areas in the US that simply do not have the internet connectivity that telehealth consults demand.
Good reading. Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States Hat tip to Dr. Fisk for sending it our way!
Malcolm Fisk, whom our Readers know as Senior Researcher at the De Montfort University in Leicester, was kind enough to forward information on a recent video interview with André Martinuzzi of the Living Innovation Project, a Europe-wide innovation group with 14 partners ‘co-creating the way we will live in 2030’.
This 17:30-minute video covers a lot of ground on the UK response to the coronavirus (the uncertainty as of mid-April), how the UK, US, and Australia have used telehealth in response, and how telehealth can ‘stick’ after the crisis, but only if we design an inclusive infrastructure. You can view the video on the Living Innovation page by clicking on ‘View Video’ on the upper right hand side, or go directly to YouTube.
There’s a brief preview in the video of Dr. Fisk’s paper (awaiting publication, co-authored with Anne Livingstone and Sabrina Pit) on ‘Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom and the United States’. Telehealth was very rapidly put into use for diagnosis, monitoring, and home treatment of COVID patients. Restrictions were lifted and investments made in communicating the availability of telehealth. However, the infrastructure for telehealth is strained, especially in the US with a mixed, primarily private model dependent on payers or individuals paying per virtual visit. In the UK, health trusts have encouraged the use of telephonic and audio/video models. In Australia, telehealth, particularly in remote areas, is well established. TTA will keep Readers posted on the publication of this paper. A big hat tip to Malcolm Fisk.
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/02/Utopia-project-report-2018.jpg” thumb_width=”150″ /]An important and comprehensive evaluation of telecare in use in UK social care has been published this past week by King’s College London. The UTOPIA Project (Using Telecare for Older People In Adult social care) surveyed local authority telecare managers (114 valid responses or 75 percent of responders) November 2016-January 2017 to find out how telecare is being used by local authority adult social care departments in England to support older people.
This study springboards from the £80m Whole System Demonstrator (WSD) and its “curious neglect” by those engaged in UK telecare. The WSD’s findings contradicted earlier research in finding that telecare did not have long-term improvement of outcomes, gauged after only 12 months. It created, in the UTOPIA’s study’s terms, a ‘policy problem’ among major stakeholders. “The WSD remains an important study and its neglect is curious. The research team wondered why the findings had been overlooked and what, if any, consequences might have flowed from this.” The study thus looks at local authority aims, how local evidence is being collected, and how telecare is operationalized and delivered.
The areas surveyed and some highlights of the findings are:
- Use of research: 33 percent were informed by research and 47 percent were aware of but did not agree with the WSD’s findings which were negative on the long-term value of telecare.
- Where does telecare fit in?: “Telecare ‘fitted’ best if it was provided alongside social care (77%), to support reablement (77%), for people eligible for and funded by the adult social care department (75%) as well as for people who pay for their own care (75%).” Only 24 percent collaborated with the NHS or other partners. There was full (100 percent) agreement that telecare helps to reduce risk and promote safety and 81 percent agreement that it supports unpaid carers.
- Achieving strategic aims and monitoring of progress: Over half (53 percent) of respondents said their local authority was accredited to the Telecare Services Association (TSA) Codes of Practice for Telecare and Telehealth.
- Barriers and facilitators: Barriers mentioned were skill deficits among professionals and installers, as well as contract inflexibility with suppliers. There was also concern about the reduction of face-to-face contact and care. Access to telecare and availability of advice and support were good for both users and family carers, but levels of awareness about it were only average.
- Financial commitment: Not surprisingly, funding is scarce and usually cobbled together from several sources including local authorities, CCGs, and users. 24 percent felt it saved money but many found it difficult to provide hard evidence.
- What’s considered in telecare assessments?: Nearly all (92 percent) agreed that a key assessment included the user’s ability to move around, their memory status, the person’s ability to communicate, and their daily routines. Flipping the script, “40% of respondents said that their local authority’s telecare assessment focused on what it was hoped would be achieved through using telecare.”
- Who are the assessors, and is assessment always required?: (more…)
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/06/Robot-Belgique-1.png” thumb_width=”200″ /]Something that has been bothersome to Deep Thinkers (and Not Such Deep Thinkers like this Editor) is the almost-forced loss of control
inherent in discussion of AI-powered technology. There is a elitist Wagging of Fingers that generally accompanies the Inevitable Questions and Qualms.
- If you don’t think 100 percent self-driving cars are an Unalloyed Wonder, like Elon Musk and Google tells you, you’re a Luddite
- If you have concerns about nanny tech or smart homes which can spy on you, you’re paranoid
- If you are concerned that robots will take the ‘social’ out of ‘social care’, likely replace human carers for people, or lose your neighbor their job, you are not with the program
I have likely led with the reason why: loss of control. Control does not motivate just Control Freaks. Think about the decisions you like versus the ones you don’t. Think about how helpless you felt as a child or teenager when big decisions were made without any of your input. It goes that deep.
In the smart home, robotic/AI world then, who has the control? Someone unknown, faceless, well meaning but with their own rationale? (Yes, those metrics–quality, cost, savings) Recall ‘Uninvited Guests’, the video which demonstrated that Dad Ain’t Gonna Take Nannying and is good at sabotage.
Let’s stop and consider: what are we doing? Where are we going? What fills the need for assistance and care, yet retains that person’s human autonomy and that old term…dignity? Maybe they might even like it? For your consideration:
How a robot could be grandma’s new carer (plastic dogs to the contrary in The Guardian)
AI Is Not out to Get Us (Scientific American)
Hat tip on both to reader Malcolm Fisk, Senior Research Fellow (CCSR) at De Montfort University via LinkedIn
Wednesday 23rd November 2016, 9:15am – 4:30pm
Village Hotel Club Ashton Moss, Pamir Drive, Ashton-Under-Lyne UK (close to Ashton Moss Metrolink Station)
This is a free event for housing and healthcare professionals with a full day of workshops on telecare in supporting independent living, case studies of best practices and demonstrations of the latest products. There are four workshops which run both in the AM and PM sessions. There are also three guest speakers: Dr Malcolm Fisk, Director of the Telehealth Quality Group, De Montfort University, Leicester; Gill Drummond, Dementia Lead for Greater Manchester West Mental Health NHS Foundation Trust; Alyson Scurfield, Chief Executive of the TSA. More information and registration here. Hat tip to reader Dawn Thornber of Contour Homes. UPDATE If you have last minute difficulty booking, please contact directly Andrew.Townsend@contourhomes.co.uk
The Telehealth Quality Group kicks off its campaign to stimulate new thinking around telehealth and telecare with a UK event in Manchester on June 21st. The focus of the event is on ‘Integrated Care’ – the route to which has been exercising strategists, policy-makers, commissioners and those tasked with delivery for some time.
The programme includes the likes of Malcolm Fisk, Kevin Doughty and this editor as well as Dr Laura Ryan of NHS24 … bringing news of the experience in Scotland, and Professor Andrew Sixsmith … bringing practice examples and insights from Canada.
Participants will also learn more about the TQG’s International Code of Practice for Telehealth Services – for which apparently three services are now seeking certification.
Other treats at the Manchester event include sessions that:
• look back and learn lessons from the Whole System Demonstrators;
• consider some of the technological developments and market trends around telehealth and telecare;
• check out developments in Rochdale as they pursue integrated care in the context of Manchester’s new devolved powers;
• draw on the telehealth experience of a West Yorkshire GP; and
• make sure the position of carers and service users is not overlooked.
A potpourri, maybe…and hopefully of interest to readers. Details are on the TQG website here
The increasing awareness of abuse of older people by their caregivers, whether at home or in care homes/assisted living/nursing homes, invites discussion of the role that technology can play. This presentation by Malcolm J. Fisk, PhD, co-director of the Age Research Centre of Coventry University, in the BSG Ageing Bites series on YouTube looks at technologies viewed by level of control and intrusiveness:
- Social alarms, which include pull cords (nurse call) and PERS–what we think of as ‘1st generation’ telecare: high level of control, low intrusiveness–but often useless if not reachable in emergency
- Activity monitoring, which can be room sensor-based or wearable (the 2nd generation): less control, slightly more intrusive–also dependent on monitoring and subject to false positives/negatives
- Audio and video monitoring, while achieving greater security, are largely uncontrolled by the older person and highly intrusive to the point of unacceptability. (In fact, some feedback on tablet-based telehealth devices indicates that a built-in camera, even if not activated, can be regarded with suspicion and trigger unwanted reactions.)
The issues of consent, and balancing the value of autonomy and privacy versus factors such as cognitive impairment, personal safety and, this Editor would add, detecting attacks by strangers and not caregivers, are explored here. How do we ethically observe yet respect individual privacy? This leads to a set of seven principles Dr Fisk has published on guiding the use of surveillance technologies within care homes in the latest issue of Emerald|Insight (unfortunately abstract access only) Video 11:03. Hat tip to Malcolm Fisk via Twitter.
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/07/logo_catel-ISfTeH.png” thumb_width=”150″ /]16 – 17 October 2014. Cité des Sciences et de l’Industrie, Paris
The annual fall “Telesante” meeting’s theme this year is “Towards an international eHealth?” Sessions will center on success stories of eHealth applications, connected tools and services, methodologies, eHealth and economic development, and legal/regulatory frameworks. Organized by CATEL, the French Network for eHealth providers, and the ISfTeH, the International Society for Telemedicine and eHealth. Website and registration
Also: July ISfTeH newsletter Hat tip to Malcolm Fisk, CoDirector of Age Research Centre, Coventry University
Perhaps because we have covered the topic before, a cryptic email arrives from Malcolm Fisk, the driving force behind the development of the European Code for Telehealth Services, suggesting I consult the TeleSCoPE website and his Med-e-Tel presentation last week where “you’ll see a little announcement that indicates that things are moving forward”.
The website now includes a yellow box with the statement:
The framework for telehealth services to be assessed against the requirements of the European Code of Practice for Telehealth Services is being released on May 16th 2014. This follows collaborative work between the Telescope Partnership and DNV Healthcare. A four year cycle has been agreed that includes a Foundation Assessment followed by (mostly off-site) reviews and conformity checks. Accompanying the framework will be the new version of the Code by which the first tranche of services will become accredited.
…and the presentation includes, at the end, (more…)