Telecare Soapbox: Is mHealth/eHealth becoming a ‘Field of Dreams’?

Editor Donna muses on the link in the telecare chain where it can all fall down – the person who is expected to use the device.

“If you build it, they will come”–misattributed to the film Field of Dreams, 1989

We can get telehealth and mhealth into the home care or healthcare provider, payer, ‘app store’ or ‘ecosystem’ (the ‘push’), but you cannot force the client or patient to use it.

The buzz may be about how slick a system or app is, how to sell it to the C-suite or even the Four Big Questions, but have we forgotten someone? We assume that end users/clients/patients will be delighted to use our wonderful devices, in the way they should be used–consistently, correctly, continuously until they… expire. Step back and think about human behavior, however, and you realize…that cannot be true. (more…)

KF Congress 2012: reflections on third day, 8 March

the poster session presenters. There were 17 over two days, each constrained to a 3 minute presentation. They therefore made their main points concisely. I observed that having identified themselves in this way there were plenty of people following up with them after the sessions. I had the impression that the other presenters in the parallel breakout sessions, who had 20 minutes to present did slightly less well but that is based on the small sample I attended.

There must be a version of Parkinson’s Law that states that ‘Presentations expand to fill the time allotted to them (and then some)’.

Poster sessions that got a special mention from Nick Goodwin, the Congress Chair (who also gets a thumbs up for his hard work), were the session on the Israel-wide EHR system by Orit Jacobson, the ‘TalkMeHome’ service for people with early dementia (Netherlands) and ‘Memory and Memories’ (Digital PhotoFrame Therapy, UK).

Keeping the best for last kept most of the attendees at the conference to the end: Magdalene Rosenmöller from IESE Business School, Barcelona and Adam Darkins, from the UD Dept. of Veterans Affairs (VA); the whole topped with a ringing speech from Jeremy Hughes of the UK’s Alzheimer’s Society.

Dr Rosenmöller gave a fast helicopter flight over much of the telehealth (in its broadest sense) landscape, while Dr Darkins showed why he has done so well since joining the VA: his style is visionary but clear, broad in scope but illustrated with relevant detail. Most refreshingly amongst the tidal wave of research data presented these past three days, his data are drawn from the VA’s management reports. Oh, the credibility that gives! It is a session to watch again if you missed it.

KF Congress 2012: reflections on second day, 7 March

the Minister Paul Burstow’s keynote speech. The speech was full of the usual warm stuff about how significant telecare and telehealth is, so that was not the reason for its significance.

It was because he gave an outrageous plug to one company – Tunstall. This endorsement was highly inappropriate in a Ministerial speech, particularly as it was not just confined to the hall but was being streamed to viewers around the world.

The other suppliers in the hall, particularly the principal sponsors, must have been very cross once they were over the shock. It was probably also more ‘evidence’ for the conspiracy theorists [I’m not one of them: Editor Steve] who believe that it is Tunstall, and not the Minister, directing the UK Government’s policy on telecare and telehealth.

The ultimate twist to this gaffe is that, just a few minutes before, the Minister had been criticising services that stockpile kit. It is not a secret (apart from to the speech writer, perhaps) that stockpiling kit is a characteristic of a number of Tunstall’s large-purchase customers!

To his credit, the Minister risked taking questions from the floor. I asked about the contrast between his support for the 3millionlives initiative and his lack of support for the use of telehealth with prisoners [TA item, scroll to bottom]. His reply, in relation to prisoners, was “Ministerial edict is not the best way to make sure something happens”…so why is he pronouncing on 3millionlives? The words ‘cake’, ‘have’ and ‘eat’ come to mind.

Other than that, there were some interesting presentation topics during the rest of the day and I will follow them up in future items.

UPDATE 8 March 8am: Full text of the Minister’s speech here. Heads-up thanks to Mike Clark.

UPDATE 8 March 10:30 am. Tunstall milks it: Press release. Paul Burstow MP advocates NHS Gloucestershire and Tunstall’s work…

KF Congress 2012: reflections on first day, 6 March

able to live with multiple and contradictory notions heads swirling around their heads, so no one seemed to mind.

Professor Stan Newman, still gagged by the conventions of peer-reviewed journal publishing and still not, therefore, able to reveal any significant WSD results, talked about results that have been in the public domain for some time. These concern the numbers of GPs and patients recruited into the WSD trials. The most striking finding was the lack of people in the cohorts who required both telehealth and telecare equipment. “We couldn’t find them” he said. Attendees were left with the impression that either people with both needs do not exist in the population or that services tend to ‘prescribe’ what they know; either telecare or telehealth. However, I gleaned outside the session that they were there, but they were people who were particularly prone to decline to participate because they feared that answering the study’s health questionnaires was a threat to their social care services and benefits.

Clearly, there is going to be much debate over interpretation when the full results are published.

The session by Professor Jeremy Wyatt was more thought-provoking than its title (Using Evidence to innovate in clinical practice and self care: role of randomised control trials) led one to expect. He emphasised that amongst all the data analysis the question ‘What does this mean to the patients?’ needs to be asked. For example, for a particular set of telehealth users, the technology may enable them to make more informed rejection of treatment, leading to an increase in mortality. Without understanding that, the researchers may assume the increase to be a negative outcome. If that were the case, how would you build a business case on the evidence? [Head swirling, editor Steve retreats to bed.]