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BCS University of Warwick, Coventry17th January 2018
Innovation and Developments inTelehealth and Telecare
Dr Malcolm J [email protected]
MF Activities
www.clearcare.com
• Lead for the PROGRESSIVE Project www.progressivestandards.org
• Director of Telehealth Quality Group www.telehealth.global
• Expert Advisor to ANEC: European Consumer Voice on Standardisation
www.anec.eu
• Mirror Committee Member for BSI:
ISO Technical Committee 314 ‘Ageing Societies’
www.iso.org/committee/6810883.html
PROGRESSIVE Project
• Lead the PROGRESSIVE Project www.progressivestandards.org
• Focus on standards and standardisation around ICT and ‘Active & Healthy Ageing’
• Building repository of relevant standards
• Wide range of AHA ‘domains’
• Producing Guidelines for
o Age-Friendly Design
o Smart Homes
o Interoperability
o Co-production approaches to standardisation
MF Activities
www.clearcare.com
• Director of Telehealth Quality Group www.telehealth.global
• Promoting quality standards in telehealth services
• International Code of Practice for Telehealth Services
• Broad understandingof ‘telehealth’
MF Activities
www.clearcare.com
• Director of Telehealth Quality Group www.telehealth.global
• Broad understandingof ‘telehealth’ … and 5 key pointers
Telehealth is
…the means by which technologies and related services that are concerned with
health and wellbeing are accessed by peopleor provided for them at a distance
irrespective of their location
… a subset of eHealth... embraces telemedicine
Telecare is part of this
MF Activities
• Expert Advisor to ANEC: European Consumer Voice on Standardisation www.anec.eu
• Representing consumer interests in three ‘key’ CEN fora
(CEN = European Committee for Standardization)
o Health Services Focus Group
o CEN TC 449 Quality of Care for Older People
o CEN TC 431 Service Chain for Social Alarms
• Ensuring that the consumer voice is heard …and especially the older person’s
• Links to the PROGRESSIVE Project
MF Activities
• Member BSI Mirror Committee for ISO/TC314: Ageing Societies
www.iso.org/committee/6810883.html
• Looking at role of standards around (per work-programme)
o Technologies and systems for an ageing society
o Accessibility
o Social connectedness
o Chronic disease prevention (diabetes, depression)
o Dementia-friendly communities
southgippsland.vic.gov.au
ConsumerActive and involvedFinancially secureHealth literateDecision-maker… but not enabled to self-manage her health?SurvivorDigitally literate?
Patient / Consumer No 1
What are her needs and choices?Services … andTechnologies
Patient No 2
theherald.com.au
Future consumerActive and involvedLearning about his healthFuture decision-makerDefinitely going to be digitally literateDefinitely needs to be enabled self-manage his health?
Patient / Consumer No 2
What are his needs and choices?Services … andTechnologies
Patient Perspective
• Patients = people = consumers
• Technological world
• Increasing digital literacy
• Widening access to services and information
o smart telephony devices
o laptops and tablets
o interactive TV
• Changing aspirations
• Changing expectations
• Challenging old service frameworks
• The technologists and service providers must recognise the changes
Demographic Perspective
• Ageing population
• Increased numbers of older people with support needs
• Increased numbers of older people without support needs
o living longer healthier lives
o but often out of the workplace
o often unnecessarily dependent
o victims of ageist views and ‘negative planning’
• Think of ‘age-ratios’ not ‘dependency ratios
• Increased numbers of
• younger people with health needs
Demographic Perspective
• Ageing population
• Increased numbers of older people with support needs
• Increased numbers of older people without support needs
o living longer healthier lives
o but often out of the workplace
o often unnecessarily dependent
o victims of ageist views and ‘negative planning’
• Think of ‘age-ratios’ not ‘dependency ratios
• Increased numbers of
• younger people with health needs
Clinically Driven Services Perspective
• Saturated with ICT
• Driven by need for clinical outcomes (cure, management)
o medication and therapy regimes
o assumption of ‘patient’ compliance
o services delivered (a one-way process), rather than ‘provided’
• Focus on hospitals and secondary (even tertiary) health care
o under-recognition of public and preventative health agenda
o insufficient attention to behaviours and lifestyles
Ethical Perspective 1• Some ethical considerations already indicated
• Responsible Research and Innovation (RRI) – European agenda around ‘thematic elements’ of
o Good Governance
o Ethics
o Gender Equality
o Science Education
o Openness / Transparency
o Engagement
…but this is not enough
Ethical Perspective 2
• Responding to consumer needs / choices (‘listening’?)
• People not patients (issues for language and service ethos)
• Challenging ageist views and approaches
• Taking an ‘all age’ perspective?
• Implication for technology and service designs
… see table of ethical tenets derivingfrom work in the PROGRESSIVE project (re. ICT for ‘Active and Healthy Ageing’)
Accessibility and UsabilityRelevant for buildings and the wider environment, products and services - therefore assistive technologies,
‘Design for All’ and Age-Friendly communities.
AffordabilityImpacting on the ‘accessibility’ of products and services for people with limited means.
Autonomy and EmpowermentImperative for products and services to be designed and configured in ways that engage with, afford choices
and facilitate control by older people.
Beneficence and Non-MaleficenceContext for any products or services. Relates to assessment of risks and doing good or harm.
Care, Protection and SupportRelevance for products or services provided for or used by dependent, frail and vulnerable older people.
Equality, Equity and JusticeAffirming the equal status and right of older people to access products and services. Links with accessibility
and affordability.
Inclusion, Non-Discrimination and Social ImpactProduct and service approaches to challenge disadvantage faced by older people through inappropriate and
ageist practices and beliefs.
InteroperabilityEmbracing both technical (for ICT) and semantic interoperability in supporting products and services where
consumer options and choices are enhanced.
Privacy, Safety and SecurityRecognising rights both in the context of ‘traditional’ ranges of products and services and special
considerations (e.g. for cybersecurity) in the context of ICT.
Accessibility and UsabilityRelevant for buildings and the wider environment, products and services - therefore assistive technologies,
‘Design for All’ and Age-Friendly communities.
AffordabilityImpacting on the ‘accessibility’ of products and services for people with limited means.
Autonomy and EmpowermentImperative for products and services to be designed and configured in ways that engage with, afford choices
and facilitate control by older people.
Beneficence and Non-MaleficenceContext for any products or services. Relates to assessment of risks and doing good or harm.
Care, Protection and SupportRelevance for products or services provided for or used by dependent, frail and vulnerable older people.
Equality, Equity and JusticeAffirming the equal status and right of older people to access products and services. Links with accessibility
and affordability.
Inclusion, Non-Discrimination and Social ImpactProduct and service approaches to challenge disadvantage faced by older people through inappropriate and
ageist practices and beliefs.
InteroperabilityEmbracing both technical (for ICT) and semantic interoperability in supporting products and services where
consumer options and choices are enhanced.
Privacy, Safety and SecurityRecognising rights both in the context of ‘traditional’ ranges of products and services and special
considerations (e.g. for cybersecurity) in the context of ICT.
• This is where much of the innovation lies (and to which
developments in products andservices must relate)
… it’s more than just about the technologies
… it’s about ‘changing mindsets’
… in a moment to telehealth (and telecare)
… but, first, a little ‘diversion’ that poses some interesting ethical questions at the edge of
telehealth
Robots!
And so to Robots! R1/2
• Robear
o Japanese ‘experimental nursing-care robot’
o lifting patients out of bed and into wheelchairs
o giving assistance to people to stand
o ‘powerful yet gentle care to elderly people’
o ‘looking after you when you get old’
And so to Robots! R2/2
• Robear
o Japanese ‘experimental nursing-care robot’
o lifting patients out of bed and into wheelchairs
o giving assistance to people to stand
o ‘powerful yet gentle care to elderly people’
• Why the face?
• Why just two arms?
• Why anthropomorphism … what’s wrong with just a machine?
• Is some kind of relationship envisaged?
And so to Robots! P1/3
• Paro
o Japanese ‘therapeutic’ robot for ‘hospitals and extended care facilities’
… reducing patient (and caregiver) stress
…stimulates interaction between patients and caregivers
o Sensors - tactile, light, sound (and direction), name recognition, etc.
o Imitates voice of baby harp seal
And so to Robots! P2/3
• Paro
o Imitates voice of ‘real’ baby harp seal
o Evidence building of positive effects for older people with dementia
• Paro
o My encounter!
• Do therapeutic pets infantalise older
people?
• What are the lessons for ‘realism’?
• What links with doll therapy?
• What impact on ‘traditional’ modes of
care?
And so to Robots! P3/3
And so to Robots! RMD1/2
• ReMeDi
o European project
o robot to undertake medical tele-
examination of patients – using ‘advanced
sensorized head and/or ultrasonic probe, active
vision and locomotion capabilities’
o ‘a diagnostic assistant’ offering ‘support for the
doctor’
And so to Robots! RMD2/2
• ReMeDi
o remote control
… therefore usable at any distance (subject to
reliability and capacity of communications
links)
• What impact of loss of face to face contact?
• Any wider gains for effectiveness of
diagnoses and treatments?o Link to broader area of digital
health … including telehealth
And so to Robots! N1/2
• Nadine
o Companion robot from Singapore
o ‘socially and emotionally intelligent’ … learning to develop their language and etiquette
o ‘physical resemblance to ordinary people could help interaction’
o make most sense as companions for children and the elderly at
home, and serve as a platform for healthcare services
• Another way of dying even more miserably (per Michele Hanson in
The Guardian)
And so to Robots! N2/2
• Nadine
• Whither relationships with robots?
• What are acceptable roles for such robots?
• What makes Paro more (or less) acceptable than Nadine?
• Why have robots that are humanoid or animaloid?
• What robot functions are needed and/or appropriate?
… companionship, love, sex
… functional tasks such as lifting, carrying, washing
… conveying information
… gathering personal data
Facing the Facts!
• Robots are with us …
o they will be increasingly sophisticated and have a huge potential contribution to make in all parts of our lives (so can be ‘innovative’)
• What form should they take in the world of care?
o is there a danger of commodification (viz. people becoming objects)?
o how is the companionship ‘element’ of care to be reconciled?
• What roles for Robear, Paro, ReMeDi and Nadine?
Facing the Facts!
… back to to telehealth (and telecare)
and the broader context of
‘Assistive Technologies’
… and being more specific about telehealth
Telehealth is …Telehealth is
…the means by which technologies
and related services that are concerned with
health and wellbeing are
accessed by peopleor provided for
them at a distance irrespective of their
location (TQG def’n)
… a subset of eHealth
... embraces telemedicine
www.telehealth.global
Telehealth DomainsTelehealth is
…the means by which technologies
and related services that are concerned with
health and wellbeing are
accessed by peopleor provided for
them at a distance irrespective of their
location (TQG def’n)
… a subset of eHealth
... embraces telemedicine
Health and motivational coaching
Activity, behavioural and lifestyle monitoring
Gait, seizure and falls monitoring
Point of care testing, and support for diagnoses/decision making
Vital signs monitoring
mHealth
Telecare and social alarms
Prompting for medication or therapy adherence
Rehabilitation and (re)ablement
Tele-consultation
… and (much) more
www.telehealth.global
Telehealth DomainsTelehealth is
…the means by which technologies
and related services that are concerned with
health and wellbeing are
accessed by peopleor provided for
them at a distance irrespective of their
location (TQG def’n)
… a subset of eHealth
... embraces telemedicine
Health and motivational coaching
Activity, behavioural and lifestyle monitoring
Gait, seizure and falls monitoring
Point of care testing, and support for diagnoses/decision making
Vital signs monitoring
mHealth
Prompting for medication or therapy adherence
Rehabilitation and (re)ablement
Responding to ‘events’
Tele-consultation
… and (much) more
www.telehealth.global
… with varying levels of innovation
… varying degrees of (and speed of) development
at home
in school
at college
in work
on the move
Telehealth for Everyone, Everywhere, Anytime… people of all ages
Doctor
Community Nurse
Pharmacist
S&L Therapist
SocialWorker
Telehealth for Everyone, Everywhere, Anytime…providers (not ‘deliverers’)
Towards Innovation in Telehealth 1
• Innovative thinking
o (Changing?) ethical perspectives – recognising rights
o Responding to realities on the ground – including consumer ‘push’
o Recognising role of standards
• Services
o Changed mindsets, new benchmarks of ‘good practice’
o Recognising demographic reality
o Promoting self-management, responsible lifestyles
• Technologies
o ‘Design for All’, accessibility and usability
o Empowerment, control
o Interoperability
o Privacy, Security, Confidentiality
For Younger Consumers
• Particular needs / challenges because ofpeer pressure (and social media)
o social isolation and depression (+ self-harming behaviours)o lifestyle challenges with health implications (obesity, diabetes)
o real wish to interact with health services in new ways (new technologies being a clear choice)
Younger people will show their consumer credentials because …o commonplace usage of texts, emails, Skype, phone, etc.
o their ‘trust’ of the same (and social media) … less stigma, confidentiality, etc.
o convenience of timely communication in relation to needo they see the scope for better (easier) self-management
… helping establish a longer term (new) pattern for service access and usage.
For Older Consumers
Particular needs / challenges because ofo greater social isolation (incl. more single households)
o poor mobility, frailty, low incomes, poor digital literacy, etc.o depression and multi-morbidity (including dementia)
But older people will increasingly show their consumer credentials because …
o there is increasing digital and health literacy amongst them (and carers)
o they will demand (are demanding) greater consideration of accessibility and usability
o they will ‘vote’ (are voting) with their savings and incomeso they are increasingly engaged in work, education or training
Towards Innovation in Telehealth 2
• Innovative thinking
o (Changing?) ethical perspectives – recognising rights
o Responding to realities on the ground – including consumer ‘push’
o Recognising role of standards
• Services
o Changed mindsets, new benchmarks of ‘good practice’
o Recognising demographic reality
o Promoting self-management, responsible lifestyles
• Technologies
o ‘Design for All’, accessibility and usability
o Empowerment, control
o Interoperability
o Privacy, Security, Confidentiality
to Future Telehealth
Future Telehealth 1
• Responding to pressures in health and care services
o not just management of LTCs, better clinical decision-making, more timely discharges, reduced admissions … but
o greater use of technologies by patients (=people) at home, in work and ‘on the move’
o substitution of ‘traditional’ modes of service provision
• What are the barriers?
o fears around liability
o mixed evidence base
o some (most?) technologies not guided by ‘new’ ethics’
o challenges to health professional / patient relationships
o new kinds of threat (around inaccurate information, cyber-security, etc.) that weaken trust
Future Telehealth 2
• What are the barriers?
o fears around liability
o mixed evidence base
o technologies not guided by ‘new’ ethics’
o challenges to health professional / patient relationships
o new kinds of threat (around inaccurate information, cyber-security, etc.) weakening trust
• What are the opportunities?
• AI … monitoring, etc. (but ethical issues come to the fore)
• self-management, lifestyles, etc e.g. Fitbit
• wearables, implants
• robots and (more to the point) robotics!
to The Bottom Line
The Bottom Line?
• Telehealth has a way to go
o must be underpinned by the right ethics
o there is real innovation, but not always of the right kind
… and it relates to both products and services
• We must all re-think our offerings (change our
‘mindsets’?) if the potential of telehealth is to be harnessed for
the benefit of us all…
The Bottom Line?
• Telehealth has a way to go
o must be underpinned by the right ethics
o there is real innovation, but not always of the right kind
… and it relates to both products and services
• We must all re-think our offerings (change our
‘mindsets’?) if the potential of telehealth is to be harnessed for
the benefit of us all ***
