Ebook: Essential Lessons for the Success of Telehomecare

In our own work on development of the behavioral monitoring system that eventually came to market as GE/QuietCare^® we continuously used a concept which we called PAT—“Pay Attention To”. We began using PAT when we realized that there was often a tell-tale pattern to the combination of alerts that were being generated from the data collected by the motion sensors. The individual alerts themselves obviously had validity and meaning and were being used by emergency responders and carers. However, as we analyzed the specific combination of alerts for monitored individuals over time, it became clear that some of these patterns themselves required an “alert” because since they also provided valid information about the status and needs of the client. This finding became PAT and we incorporated it as a guiding principle in the monthly reports to carers on their clients who were being monitored. In this way, PAT became the focus of much more comprehensive discussions of the client's needs and the heart of the records being maintained on each client. We continued to use the PAT concept as we developed an electronic record to be used in the home environment and it became a core component of the mobile application that is being currently used in Europe.

Although we run the risk of being accused of being a “one-trick-pony” we want to use the PAT to focus this short Preface. Having spent hundreds of hours recruiting the chapter authors—many of whom have never written an academic publication—cajoling them to produce the chapter, editing subsequent drafts of the chapters and then formatting them, we believe that we can extract the most salient themes from the chapters. This does not mean that the reader could not and will not do the same thing, just as the carers could have “read” the alerts and determined the underlying pattern. It's just that we can use the PAT concept to allow the reader of the chapters to look for the patterns among the chapters more efficiently.

So here's the PAT for our book:

1. How innovative care organizations have attempted to integrate Telehomecare into their care delivery model, because the only way to evaluate Telehomecare is to observe how it is being employed in the real world of care provision;

2. How pilot studies have been used to evaluate various Telehomecare applications, especially their emphasis on testing of the technology, rather than on its impact on care outcomes;

3. How implementation of Telehomecare applications face a series of barriers that have much more to do with organizational culture than the use of new technology;

4. How a vicious cycle exists that is driven by a lack of evidence supporting the claims made for Telehomecare, leading to the reluctance of care organizations to introduce the applications, that restricts the market for Telehomecare, which limits the investment of the companies involved in the development of Telehomecare that would make the applications more widely available, that would increase the installations, that would produce the evidence needed to...

5. How the absence of a viable business model that answers the fundamental question of, who pays, is at the heart of the slow implementation of Telehomecare.

Of course there are many more points to pay attention to than these five, both within individual chapters and within the book as a whole. But, we believe that of all of the significant points made by the authors coming to Telehomecare from a wide variety of backgrounds and perspectives, these five points are the ones that coalesce at the top of any scale of importance. Please do not only focus on these points, but also please pay attention to how these five points tie together the chapters, whether the authors are from the United States, the Netherlands or the United Kingdom, whether the authors are care providers, business people, developers, or academics and whether the authors are enthusiastic or cautious about the future of Telehomecare. In the great digital era, we are witnessing many rapid scientific and technological developments in human-centered, seamless computing environments, interfaces, devices, and systems with applications ranging from business and communication to entertainment and learning. These developments are collectively best characterized as Active Media Technology (AMT), a new area of intelligent information technology and computer science that emphasizes the proactive, seamless roles of interfaces and systems as well as new media in all aspects of digital life. An AMT based computer system offers services that enable the rapid design, implementation, deploying and support of customized solutions.

This introduction outlines the Five Zone Model of Telehomecare presented by the editors as a more accurate depiction of Telehomecare than other models and rubrics found in the literature. The authors show how the tracking of the flow of information through the Five Zones allows for the barriers and challenges faced by care organizations and businesses in their attempt to develop and implement Telehomecare applications to be clearly seen. A definitional rubric that places Telehomecare within the framework of other health care technologies is presented and discussed. Additionally, the organizing principles of the volume are presented and the major themes outlined.

Using Five Zone Telehomecare model, this chapter traces the data flow from sensors in the residences of monitored individuals (Zone 1) through its translation into actionable information on the remote server (Zone 2). Special attention is paid to the role and business models of technology companies that create, implement and support the Telehomecare infrastructure. Using the case example of the QuietCare® behavioral monitoring system, the business and technological challenges and potential barriers to successful implementation are analyzed in detail.

This chapter continues to trace the flow of information through the Five Zone Telehomecare model by considering Zone 3—the Dispatcher; Zone 4—the Responders; and Zone 5—the Informatics. Emphasis is placed on the need for each of these three Zones to have a company with a viable business plan and appropriate infrastructure in place in order to function properly and move the information to the next Zone. In addition, the vital role played by carefully crafted and continuously updated protocols is discussed, as well as the challenges facing the integration of all Five Zones and possible solutions to overcoming the challenges.

The authors discuss the use of Telehomecare technologies by Selfhelp Community Services, Inc., a comprehensive care organization located in New York City and Nassau County to achieve their organization's mission of helping individuals to live independently in their homes and communities. Five Telehomecare applications are selected as examples of how such technologies can be used within a specific care delivery context. The authors consider the benefits brought about by the use of the technologies, as well the barriers which they have encountered over the last several years, placing emphasis on the need for a sustainable financial model to ensure success.

This chapter discusses the testing and implementation of Telehomecare technologies by KeystoneCare, a diversified home health care provider in Wyndmoor, Pennsylvania USA. Special attention is paid to the use of appropriate Telehomecare technologies in serving the poorest, sickest, most costly clients to improve their health behaviors and reduce repeated hospitalizations. Challenges with technology, patients, staff, and financing are discussed in terms of solutions and potential barriers to incorporating Telehomecare into the care delivery model.

Telehomecare research has been going on for many years now, but few significant products have made it to market. Researchers, both outside of and within the companies that would productize telehomecare solutions, may not fully understand the challenges of moving technologies from the lab to the store shelf. In this chapter, I examine some of these challenges, including the relative costs of research vs. productization, how that difference affects the separate attitudes and expectations of researchers and product managers, and what the opportunities are for innovation in this area in today's technology landscape.

This chapter discusses the attempt to develop a profitable business model for a specific Telehomecare application: QuietCare^®. Issues surrounding the challenges associated with being first-to-market are discussed, as are the technological difficulties encountered in early pilots. Emphasis is placed on the necessity of developing a viable and sustainable business model that balances the requirements for a reasonable return on investment with the limited financial resources of many care organizations. Pricing issues are discussed in the context of different markets—not-for-profit versus for-profit; retail versus congregate housing. Finally, an argument is made that behavioral monitoring may not reach its full potential for another decade.

Successful pervasive wellness programs require subject compliance and receptivity to personalized wellness information and advice. Novel technology focused approaches can leverage ubiquitous physiologic sensing, the power of data mining and informatics that can “nudge” subjects toward health positive lifestyles. We developed a ubiquitous wellness monitoring system embedded in a home environment (termed “telehomecare”) that measured cardiovascular/pulmonary parameters, body temperature, gait, breathing, mood, and socialization passively (termed “passive wellness monitoring”). The direct result of employing pervasive wellness monitoring programs are reduced costs of healthcare since it delays or avoids many of the outcomes of chronic disease, reduced medical interventions, an improvement in mental health, and a reduction in caregiver burdens.

This chapter presents the experiences of four organizations in the United States that successfully implemented telehealth-based programs, and describes the numerous mechanical factors – such as patient and technology selection, reimbursement and return on investment, and regulatory and policy issues – that are central to ensuring program success. The primary theme that emerges is that the human element is essential – particularly in meeting the core challenges of engaging other providers and patients in successfully deploying telehealth programs. The authors posit that human factors represent 90 percent of the effort of successfully implementing such programs – the technology in and of itself represents only 10 percent.

Telehomecare is one of the solutions for ageing-in-place in addition to care support for daily functioning, architectural and technological solutions. Telehomecare solutions were examined by the use of the framework of ICF and MIBD. Telehomecare projects address the needs of care recipients and family carers. Some projects also did consider functional value needs, as how to get commitment of professionals and management. Only a few projects consider economic value needs in the sense that a social business case is made. To achieve full implementation, all stakeholder values should be taken into account. Furthermore, exchange of knowledge and experience is needed.

Future demographics related to elderly care indicate an increasing demand. Technology may play a supportive role in care delivery to seniors living independently. In this paper three projects are described, each of them directed towards the use of technology as part of the provision of homecare to elderly persons. A description of the individual projects is followed by an analysis of the aspects involved in the implementation of technology as part of routine care delivery. The results are discussed to optimize the strategy to introduce technology as a supportive means in home-care delivery.

This chapter discusses the implementation model employed by Proteion Thuiszorg, a comprehensive care organization located in Limburg Province of the Netherlands, for Telecare technology. Over a six year period, Proteion has piloted three Telecare technologies—a care alarm system, a screen-to-screen application and a behavioral monitoring system. The first two applications have been integrated into Proteion's normal care delivery model, while plans are in place for a similar integration for the third. Both barriers to implementation and benefits for Proteion and its clients are discussed, as are Proteion's plans for future utilization of Telecare.

The author discusses the experience with four Telecare technologies deployed by the Perth-Kinross Council to enable vulnerable clients, especially those with cognitive disabilities and functional disabilities, to remain safely in their homes with the support of formal and informal carers. This chapter presents the challenges of moving Telecare services from government funded demonstrations to locally supported permanent programs. Special attention is paid to potential barriers relating to sustainable funding and insufficient evidence of effectiveness.

This chapter discusses the need to develop financially sustainable organizations in order to ensure that Telehomecare is able to support the delivery of care. The author combines her experience in care delivery, health management, health business investment and running companies to introduce a set of challenges facing the successful implementation of Telehomecare in the United Kingdom. She suggests ways to overcome these challenges, in particular, the lack of meaningful evidence that Telehomecare brings about desired health care objectives, the need to simplify Telehomecare by making it more informatics driven and the need to focus on the needs and outcomes for individuals using the system rather than the system itself.

There are two main barriers stifling the development of telehomecare in the UK. First, the complexity of providing an end-to-end service from referral to response and second the lack of a large scale market to drive investment. This chapter identifies the “prescribed” market and the “elective” market, the former being within the public sector and the latter a new and potentially very large service for those not covered by public sector provision. The elective market includes preventative care thus addressing important public health agendas. To realise its potential, telehomecare needs to become part of the fabric of life. It will not do so until there is a robust delivery infrastructure, interoperable products and a clear regulatory framework. This chapter discusses some of these issues.

Since 2006 a series of government sponsored initiatives in the United Kingdom have sought to increase the adoption of remote care – telehealth and telecare. These aim to address the increased demand on health and social care services caused by an ageing population and rise in the number of people with long term chronic conditions. The scale of activity, including the world's largest randomised controlled trial, have made the UK a test bed for learning about the potential of remote care, as well as the challenges in deploying it as a mainstreadkm part of health and social care. The chapter discusses the scope of this activity and the lessons that can be learnt.

There is an ever increasing number of people with Long Term Conditions for which telehomecare is being promoted to offer support. In this emerging area little attention has been given to the barriers and challenges faced when introducing such systems. Yet it is important to avoid known pitfalls as well as building upon known successes. This chapter discusses barriers often encountered with particular attention given to lessons categorized under the following headings.(1) Structural – determining whether telehomecare should be embraced; (2) Implementation – obstacles experienced when implementing telehomecare, (3) Adoption – difficulties translating small scale initiatives to mainstream service delivery. In so doing, we trust initiatives prove to be more ‘successful’, better health care is delivered, and a more accurate and reliable evidence base is generated.

There is an increased recognition of the potential of assistive technologies to address the challenges of an aging population and the ongoing requirements of older people. To ensure that technology is reflective of the information technology needs of older people, and that it supports independence and well-being, there is a requirement that users are involved in the application and development of proposed interventions. This challenge has stimulated a programme of research across the European Union designed to develop AAL responses to assist older people in their everyday lives. This chapter describes a case study from an EU funded project which adopted a user-centred approach to the development of assistive technology amongst community-dwelling adults. The research process and the lessons from it are presented, whilst identifying key challenges for the inclusion of older people in the research and development process.