Signs of a home monitoring bubble?

August 27, 2013 | by | 3 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/Ambio-health.jpg” thumb_width=”175″ /]Suddenly home-based remote monitoring is very warm, if not hot. The news of investments at all levels–from Medtronic’s purchase of Cardiocom [TTA 12 Aug] to a $525,000 third angel round investment in AmbioHealth (which this Editor doubts would have been on MedCityNews’ radar a year ago)–sounds like home telehealth is finally, finally gaining traction with investors, which have been more attracted to hospital-based and fitness monitoring. But is it the right type of traction based on reasonable expectations? We were among the first to point out in 2010 in positing the FBQs* that where the data goes, how it’s being used and who’s taking action on it was critical. Now Robert Pearl MD in Forbes is also examining the new song of home RPM and finding a few off notes (or to mix metaphors, finding a pan of fool’s gold):

That’s because some promoters of home monitoring technology believe doctors will carefully scrutinize each EKG or blood sugar reading and use the information to tailor perfect regimens for their patients. This is not how medicine works.

and

Looking at thousands of EKG tracings won’t add much value either. In fact, putting all that information into an electronic medical record (EMR) only makes it more difficult for doctors to identify other, more vital pieces of information. Instead, doctors need to understand which of a few possible patterns are happening to determine the appropriate course of action.

Dr. Pearl’s prescription is for smartphones to embed telehealth monitoring capabilities at a price point slightly above the current cost, but less expensive than stand-alone devices (more…)

Don’t be put off by the title, or the conclusion, of this review of reviews

August 25, 2013 | by

Whenever I see the word “telehealthcare” I feel there should be an ® or perhaps a ™ after it as it so often appears in connection with a particular organisation. However no such connection is evident is this paper entitled “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview” (published on the PLOS ONE site), especially as the overall conclusion is far from that often found in articles toting that word:

“Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.”

If you stop there though, you miss some very important points (more…)

Falling in Torbay – a mine of useful information (UK)

August 22, 2013 | by | 2 Comments

The Kings Fund has just produced a detailed analysis of the total health & social care costs for older people admitted to hospital following a fall in Torbay over a 12 month period.  This should be of serious interest to anyone writing business cases for falls-related technology or generally doing any financial calculations in that area. (Torbay has excellent integration of patient/service user records that enables this analysis to be done with great accuracy).

The headline finding is that the total health and social care costs of dealing with older people who have had a fall that they have had to go to hospital for, in the year after that fall, is almost four times the immediate cost of the unplanned hospitalisation after the fall.  Unsurprisingly, for those who die within a year of the fall, total costs are somewhat higher than for those who survive.  Using the Kings Fund’s figures I calculate that the incremental health & social care cost of a fall is just under £7,000 (which includes both the immediate hospitalisation cost and the following years’ costs, less the previous year’s costs). This of course ignores the costs to the individual, their family and community.

Many readers will by now doubtless be wondering whether the costs of falling were reduced for those fallers who were Torbay Lifeline users as conventional wisdom is that the cost is very dependent on the length of time someone remains on the ground before being rescued.  Sad to report that analysis was not done (see comments on the paper – I have requested it). Nevertheless it is a brilliant resource for anyone looking for cost information on this very important topic.

Ambient Assisted Living Forum 2013

August 22, 2013 | by

The AAL Forum is billed as an annual platform for the growing “ambient assisted living” – telehealth and telecare – community in Europe to meet and discuss AAL. It is also a showcase event for people involved in the Ambient Assisted Living Joint Programme which is an initiative involving 20 EU and 3 non-EU countries, with public funding from EU and partner states. This year the Forum meets in Norrköping in Sweden from 24th to 26th of September.

The full programme, a link to the online registration web page, information on the associated exhibition and archived information on the past 4 years’ AAL Forums can be accessed from the AAL Forum website.

 

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/EKTG-logo.png” thumb_width=”150″ /]European Knowledge Tree Group Workshop

A side event at this year’s AAL Forum, this workshop will be held on the 24th of September.  The EKTG is  an  ad-hoc group concerned with the real impact of R&D in the area of ageing and “brings together users, technologists, financiers and governments”. The workshop aims to review the technology of Apps from development, opportunities, appropriateness to costs and finance. To register for the EKTG workshop visit the registration page here.

How best to help older people to understand the benefit of technology? (UK)

August 18, 2013 | by | 4 Comments

Last week we reported on the survey commissioned by the National Telehealth Forum that found that 9 out of 10 people didn’t know what the word ‘telehealth’ meant, a proportion that was worse for those who were more likely to need it. We suggested that asking a different question about whether they knew that technology could enable them to remain in their own home might give a more positive response.

Well no sooner said than (sort of) done – Invicta Telecare reported a similar-sized poll that, among many, included the finding that “more than three out of five over-65s (65%)…admit they hadn’t seriously thought about the type of care and support they would prefer as they get older during the last five years”. Other responses in the interesting survey seem to confirm that a significant number of older people are in denial of the implications of their age so are inadequately prepared to remain independent.

This clearly strengthens the conclusion from our earlier piece, and from our retrospective on why O2 pulled out of this field of the increasingly pressing need to make people aware of how technology can support independent living. Is 3millionlives the way forward?

This is obviously a topic of great interest that will undoubtedly be debated this autumn particularly at the two conferences specifically aimed at how technology can supporting people to age well, run by the Kings Fund on 22nd October and the Royal Society of Medicine on 25 and 26th November. (Disclosure: Charles Lowe is one of the organisers of the latter).

O2 – a retrospective

August 8, 2013 | by | 2 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/O2.jpg” thumb_width=”100″ /]With 1734 hits (and counting) the Telecareaware post on O2 Health’s telecare & telehealth withdrawal and associated comments was one of our most popular. It therefore seems appropriate to try to crystallise some important lessons from all those brilliant comments, so here’s my starter – please feel free to add your thoughts. (Almost all the comments are related to the retail telecare offering so unless specifically stated otherwise, all the following relates only to this side.)

Overall there was a huge sense of sadness that came through from many comments – many had seen the move into retail sales a confirmation that telecare had finally arrived as a mainstream technology in the UK, so a withdrawal so soon afterwards caused much grief.  It was touching to see the concern for the staff too, who have worked so hard to get this venture airborne.

Although there were few comments specifically about the retail telecare kit, none were complimentary; it was seen as being single purpose, limited and hard to use. The ability to replicate the hardware functionality on a standard smartphone, (more…)

The Berwick report on patient safety – is there a place for telemonitoring? (UK)

August 7, 2013 | by

Reading and listening to the debates in recent days about whether the excellent Berwick report should have mandated staffing ratios, instead of leaving such guidance, as his report does, to NICE, I wondered to what extent technology had been considered to have an important role in improving patient safety.

The best example I can think of why this can be important, from my Newham days, was people prone to night-time fits that used to require dedicated human monitoring throughout the night.  By installing appropriate telecare we were able both to improve patient outcomes by enabling people to sleep on their own without outside disturbance at the same time as reducing significantly the cost of night-time care: a case where technology simultaneously enabled an improved level of care and a reduced staffing level.

It was therefore reassuring to find on Page 22 under the heading “A note on staffing ratios”:

“Our primary recommendation on staffing patterns is that NICE undertake as soon as possible to develop and promulgate guidance based on science and data. Such guidance, we assume, would include methods by which organisations should monitor the status of patient acuity and staff workload in real time, and make adjustments accordingly to protect patients and staff against the dangers of inadequate staffing. We also assume, and hope, that innovations will develop and continue in technologies, job designs, and skill mix that will and should change ideal staffing ratios, so that this role for NICE ought to be ongoing.”

I’d hasten to add that I am not advocating general use of telemonitoring in response to the report – merely to point out that there are some specific occasions where technology can help, and those are increasing as new technologies, possibly such as smart floors, are developed.

Maximising independence, managing costs – Event (UK)

August 6, 2013 | by

Maximising independence, managing costs: reablement and telecare in the evolving public health landscape is a conference taking place in London on 13th November 2013. The conference is organised by Pavilion Publishing and Media. Speakers from local government, academia and private sector have been announced. Further details from the Pavilion Publishing website here.

Telecare LIN July newsletter is out

July 29, 2013 | by

The July Telecare LIN newsletter has been published and is available for download here. This month Mike has two short items on the Kings Fund congress earlier in the month and the transfer of 3ML from DH to NHS England plus the usual monthly round up of news with the top item being O2’s pull out from telecare and telehealth.

Smart flooring that can simplify alerting

July 28, 2013 | by | 2 Comments

The ELSI Smart Floor underfloor sensing laminate is a thin laminated copper based sensor that offers some potentially very valuable benefits. According to the website, the capacitative sensing technology can be used to trigger alerts created by patient movements. Examples given are:

  • Falling/slumping on the floor
  • Getting out of bed
  • Triggering lighting when getting out of bed
  • Going to the toilet
  • Leaving the room at night time
  • Staying anywhere where someone shouldn’t stay for any length of time such as the toilet, or on a balcony in wintertime

There’s no indication of price or the difficulty of installation; one presumes it would be best suited for hospitals and residential care establishments as a permanent installation.  There’s also no indication of sensitivity and the danger of false alerts – it’s clearly got to be pretty sensitive to pickup changes in the capacitance of a floor so false alerts is a topic I’d want to explore before making an investment.

That said, it looks to be a very exciting development, that does not require users to wear devices, cannot be fiddled with or switched off by users and, sadly equally important, cannot easily be tampered with by cleaning staff or require regular replacement (as opposed for example to bed sensors).

There would also seem to be the benefit that the output could be used for ADL (activities of daily living) monitoring too (though there is no mention of equipment that this Finnish company provides that could do that).

Clearly this will potentially have other applications in addition to monitoring frail people – the website, under ‘ongoing developments’ also mentions:

  • gaming solutions
  • elevator systems
  • pedestrian counting systems
  • energy optimisation systems
  • prisons
  • intruder and flood detection systems.

This seems a most exciting addition to the array of sensors available, particularly because it requires nothing to be worn and cannot easily be disabled or wear out.

Soapbox: Further thoughts on CarelineUK, O2 & WSD

July 25, 2013 | by

The many, excellent, comments on O2’s withdrawal of their current telecare & telehealth offerings in the UK market, most notably from my fellow editor Alasdair Morrison, have prompted further thoughts on the post about CarelineUK’s 25th anniversary earlier today: what will CarelineUK,  and other organisations like it, look like in 25 years’ time?

Perhaps the most significant change that appears to be coming in the area of telemonitoring is  (more…)

CarelineUK celebrates 25th Anniversary

July 25, 2013 | by

Congratulations to CarelineUK on the 25th anniversary of the receipt of their first emergency call.  According to the announcement on their website they are now the largest monitoring centre in the UK, covering over 110,000 service users across the country.  Over 120 people work at their New Forest call centre which has the ability to integrate telecare & telehealth monitoring. and is compatible with digital networks.

Establishing high-level evidence for the safety and efficacy of medical devices and systems

July 22, 2013 | by

I have recently been made aware of an excellent publication jointly by the Royal Academy of Engineering and the Academy of Medical Sciences entitled Establishing high-level evidence for the safety and efficacy of medical devices and systems, so this post is to reach out to those like me who were previously unaware.

It is a major step forward in applying engineering methodology to evaluating the effectiveness of medical devices & systems and, even more important, ensuring their ongoing safety.  Those of us who have participated in a substantial randomised control trial such as the Whole System Demonstrator (see earlier post today) will take great interest at what follows the quote: “For pharmaceutical innovation, the randomised controlled trial is the acknowledged gold standard for creating a body of high-quality evidence. But designing clinical trials to establish the evidence for medical devices has proven more problematic.”

(Included in the paper is the observation  that the ultimate health improvement device when you leave an aeroplane that is in the air – the parachute – has never been proven by an RCT.)

Finally just to return to an earlier comment, the report makes the point that because medical devices can be changed far more often than the composition of a drug, the importance of appropriate safety monitoring is absolutely critical, an issue that is becoming increasingly relevant as penetration of telehealth (in particular) and telecare increases.  Whilst  we might choose to ignore the different nature of medical devices when assessing a trial, we cannot ignore the different nature of medical devices when designing and putting in place appropriate safety systems.

Telehealth Soapbox: Time to bid farewell to the WSD?

July 22, 2013 | by | 5 Comments

TTA Contributing Editor Charles Lowe asks whether it is now time to stop looking back to the UK’s pioneering Whole Systems Demonstrator (WSD) programme.

As the person who led the bid for Whole System Demonstrator status for LB Newham back in 2006/7, this is my case that it’s time now to bid farewell to the programme, as soon as is possible.

Why?  This was a great programme that came up with some encouraging results for telehealth, and taught us a huge amount about how best to implement telehealth and telecare.  However the echoes from that long gone time are increasingly providing ammunition for the naysayers, when in reality the world is now a totally different place.  The technology is unrecognisable from that that we considered when bidding for the WSD in 2006; it is far more efficacious and far cheaper; and it can be deployed much faster & for many more conditions, opening up many possibilities not available to us when we won in 2007.  We now know much more about how to implement the technology too: in particular it delivers greatest benefit when a part of an overall programme for improving care and not, as the WSD randomised control trial (RCT) treated it, as a simple intervention, like most drugs.  In retrospect therefore there were significant weaknesses in the way the trial was run.

The continuing drip-feed of WSD results is sadly resulting in (more…)

Local telecare publicity, West Midlands, UK

July 1, 2013 | by

Local radio is a great way to reach people who are not glued to the internet over breakfast, so congratulations to Eastbourne-based Welbeing for getting BBC West Midlands to run a two-part feature on telecare on Friday. Readers who want to listen have a couple of days left. As this is a radio programme it may be available outside the UK – skip to 1hr 07min 58s for the first part and 2hr 06min 27s for the second. Each section is about 8 minutes long. The clips feature a widow called Mavis who has had two strokes, who falls frequently but who is determined to live in her own home as long as possible. When the broadcast is no longer available read her story here: Welbeing Lifeline is a ‘Life Saver’ for five falls Mavis.