Tag: telecare

There is a strong interest in using Internet-based connectivity as a tool for facilitating in-home healthcare.

A Bluetooth-connected pulse oximeter in action

This involves the use of a mix of sensor types that are typically used to observe a patient along with the use of regular, mobile and other computing devices to process and present this information to the carers and to the medical professionals. It also includes implementing voice and video telephony to allow medical professionals to communicate with the patient without the need to frequently travel to where they live.

Why the interest?

Ageing at home

This is where a senior citizen is able to live independently at their home as much as possible but have supporting care from relatives, friends and professional carers.

A tablet used as part of an in-home telemedicine setup

One of the reasons driving “ageing at home” is the fact that the generation of people born through World War II and the post-war Baby Boomers will be entering their senior years which will place strong demands on health care and welfare facilities that cater to this group of people.

Another is that an increasing number of aged-care facilities have been associated with substandard quality of care – “I don’t want to end up in the nursing home”.  This is brought about with more of us being aware of this level of care either through observing how those we have known in our life’s journey that were looked after in those facilities were being treated, or hearing about instances of substandard care in the media such as the infamous “kerosene bath” incident that hit the news in Australia in the early 2000s.

This has also been driven by the trend towards health-care deinstitutionalisation affecting geriatric and palliative care where there isn’t a desire to rely on large facilities for this kind of care.

Other healthcare needs

Increasingly hospitals are looking towards “hospital in the home” or similar programs as a way to provide ongoing care for convalescent patients and those with illnesses that require long-term attention. Here, the care associated with what would typically be provided in a hospital, typically nursing-focused procedures, would be offered at the patient’s home but with visiting nurses, doctors and allied staff.

Even obstetric care is also affected by this trend, with an increased preference for minimal hands-on professional care for low-risk mothers when they go in to labour. Similarly, low-risk psychiatric care is being delivered at home thanks to telecommunications-based technologies.

The advantages that are being put forward for this kind of care is that the patient can stay in the familiar surroundings of their home and, again, has been underscored by the concept of deinstitutionalisation in healthcare. Governments and others also see it as a cost-saving because they can focus a hospital’s beds towards those needing acute care.

The rural community are seeing an application for this kind of technology so as to avoid the need for frequent long-distance travel which would be of importance when it comes to specialised or advanced healthcare.

How is the kind of healthcare delivered?

Here, the focus is on observational healthcare where medical professionals can assess the situation based on either the data that is collected or through communications with the patient. In some cases, it may be based on an event-driven principle where the professional is alerted if the situation goes beyond certain limits.

This is facilitated through the concept of “telemedicine” where the data is conveyed through an Internet connection and has been facilitated through various technologies.

One of these is “machine vision” where one or more cost-effective high-resolution cameras feeds images in to a platform-based computer which runs software that recognises and interprets these images for medical use. One application that was put forward was to observe a patient’s pulse using a camera that observed the brightness of one’s face as the heart beats. Another application is to use a smartphone’s or tablet’s camera to read fluid-analysis strips as part of assessing urine or blood while an app in that device interprets this information rather than a person comparing what is seen on the strip against a chart.

Another of these is the implementation of common communications technologies like Bluetooth, Zigbee or Wi-Fi in sensor devices. This can lead towards the existence of cost-effective sensor devices that can work with existing computer devices with a minimal need for extra hardware, while these devices can use cost-effective software to interpret and present this information. This has led to startup companies and tech innovators developing devices like “wandering-alert” socks that work with Bluetooth and apps.

What needs to be done?

An issue that will affect in-home telehealth is where device manufacturers and health providers legally stand when it comes to providing these services.

One of the questions that is being raised is the use of non-medical sensor devices for medical applications. One of the scenarios is the use of a general wellness device like a fitness band or a wellness-focused thermometer as a medical sensor for clinical purposes. Another scenario would be the use of a “non-wellness” sensor like a security system’s PIR and door sensors, a home-automation sensor, or a smartphone’s camera for medical-observation purposes with these devices feeding their data to software running on a platform-based computing device.

These questions are being examined by the US’s Food and Drug Administration with respect to wellness-focused devices serving as medical devices in this context. But implementing home automation and security in this context may require a case-by-case assessment based on the actual installation and would only work with geriatric, psychiatric or allied situations where observational healthcare is the order of the day.

Similarly, software that uses devices like cameras for medical reasons like “machine vision” may have to be certified by medical-device authorities to be sure that the software provides accurate results no matter the input device. In the case of software that uses cameras, there would be a requirement for a minimum resolution for the camera to turn out consistently accurate results.

Conclusion

Once the issues that affect the provision of Internet-assisted in-home health care are identified and worked out, then it could be feasible for the home to be a place to deliver continual health care.

On Thursday and Friday this past week, I had visited the Connect 2014 technology convention as an expo visitor mainly to observe key trends affecting business and personal computing that were surfacing over the past few years.

IP-based telephony

A few companies had shown some IP-based telephony systems at Connect 2014. This is due to telephony moving from the traditional circuit between the local exchange (central office) and the customer’s premises towards Internet-based packet-driven end-to-end connectivity. The trend is being assisted by the goal for reduced operating costs, increased competition in the telephony space and the move towards next-generation broadband infrastructure. It is also being assisted by the prevalence of various “over-the-top” IP telephony programs for mobile devices like Skype and Viber.

One company even showed a desktop IP videophones with wired handsets along with  IP DECT cordless-phone bases. I even raised the issue of integrating Skype in these videophones because this is seen as the preferred “consumer, small-business and community-organisation” video telephony solution. One path that organisations would have to use is an IP PBX server with a Skype video “trunk” which likes Skype to the videophones. On the other hand, he showed me one of the desk videophones which had an app platform of some sort and mentioned that a Skype front-end could be deployed in these units.

Mobile-device computing in the workplace

A key workplace computing trend is to implement mobile computing devices like smartphones and tablets. This can be as a fleet of equipment owned by the organisation or a “bring-your-own-device” model where employees bring their own devices to the workplace and use them for their job. Here, they may be seen as supplanting regular desktop and laptop computers or serving as a highly-portable adjunct to the regular computers.

If these devices were used in the workplace, they would either work with document-viewing and communications tools, and a Web browser to support office tasks typically performed on a regular computer. On the other hand, they would ether work with a purpose-built device-side app or a Web front (task-specific Web page) as part of a business-specific workflow or system.

A few companies were showcasing mobile-device management systems, typically pitched at large corporate and government customers. These worked on a platform-independent manner yet allowed data security whether by implementing a managed “business realm” and “business app store” on a BYOD device or providing a highly-locked-down device.

BlackBerry have set up presence at Connect 2014 in order to show that they are moving from a hardware-based operation to something that is more software-based. This means that they can provide managed mobile computing to all of the platforms such as iOS, Android and Windows and covering all management arrangements ranging from a totally managed and locked-down fleet to a BYOD setup with a managed “business space” on the employee’s device.

In my conversation with a BlackBerry representative, I raised the issue of small businesses and community organisations neither knowing nor defining their intellectual property. We were raising the issue in relationship to these organisations neither being careful or wise about their data security nor being interested in corporate-grade information-security products and services. He stated it in a simple way as being whatever information places your organisation at risk if it falls in to the wrong hands.

A lot of these systems don’t embrace what I covered in the last paragraph because they are pitched at a larger business with its own IT department and significantly-sized server equipment. An effort that I would like to see achieved is the development of “small-business” variations that can run on a hosted cloud service or on-premises using modest equipment like “business-in-a-box” servers or classic “tower-style” server PCs. They would also have to implement a user interface that simplifies this kind of management for a small-business owner.

3D Printing

Heated 3D printer in action

A technology that has been given a fair bit of Web coverage of late is 3D printing. This is where a single-piece object is constructed using a special machine that builds up that object in layers. An analogy of this is the “3D Jigsaw” which had cardboard pieces that were stacked in a particular way to become a known object, typically a figurine.

There were a few companies who were presenting 3D printers that were in action turning out various pieces. One of these machines, which was a freestanding one the same size as those larger gas barbecues that have adorned may Aussie backyards, is able to “paint” colour on to a piece it is printing using an inkjet system. Another machine, this time about the size of a small fridge, used a heated environment to improve accuracy and reliability.

I had a conversation with a representative of one of the companies who do 3D printing and he and I reckoned that the technology would suit a wide range of short-order fabrication jobs. One application I was even thinking of was the ability to reconstruct a replacement part even though the part is no longer manufactured in quantity. One example that came to mind was a mechanism that has a highly-worn or damaged component that needs to be replaced, something encountered by people who are restoring late-20th-century consumer electronics, especially record players, tape recorders and the like, as a hobby. Here, he could scan the component using a 3D scanner and effectively “re-design” that component to what it was like when new, then make it with the 3D printer for reinstallation in that mechanical subsystem.

Similarly, the car-restoration scene could benefit from 3D printing at least when it comes to re-constituting vehicle detail-work such as marque badges and hood ornaments which have been often damaged or stolen from vehicles. This could allow a vehicle owner to make sure their pride and joy is still complete even if any of the detail-work went missing.

The connected home

It was often said that the connected home concept was “nearly there but not complete”. The problems hightlghted here were lack of a desire by industry to implement application-level standards for home-automation setups. This is manifesting in the form of manufacturers developing their own control apps for mobile platforms, making it harder for customers to use competing “smart devices” at the one location or establish task-appropriate control setups in a “smart-home” environment.

Similarly, the home-AV market is being centered around content producers tying up deals with smart-TV and video-peripheral manufacturers or connected-AV platforms. This affects consumers because they are not sure if their favourite content producers or distributors, or their favourite titles are going to appear on a particular connected-AV platform that they intend to buy into. Similarly, it affects content producers and distributors who want to run an IPTV or video-on-demand service because they have to obtain deals with various equipment manufacturers and connected-AV platforms.

Both these situations effectively have the manufacturers, content producers and other companies effectively owning the consumers and stifling innovation and competition in the connected-home space.

In-home telemedicine

A tablet used as part of an in-home telemedicine setup

One concept that was being shown at Connect 2014 was in-home telemedicine, known also as in-home telehealth or simply as telecare. This is something I have covered in this Website in relation to standing for access to proper broadband in rural and peri-urban communities. Here, this technology allows people in these sparse communities access to continual specialist medical care without the need for the patient or caregiver to frequently travel between home and larger towns or cities when clinical supervision is needed.

Bluetooth-connected medical sensors

A functioning demonstration setup which is currently used in the field involved the use of medical-parameter sensors like a blood-pressure monitor or pulse oximeter linked to a tablet via Bluetooth with this setup at the patient’s home. This, in turn was linked to the clinic via mobile-broadband technology and the staff at the clinic were able to look at what’s going on using a Web-based dashboard that highlights critical conditions affecting patients in their care.

A Bluetooth-connected pulse oximeter in action

It is being pitched at community-care organisations and would typically be seen as being useful for rural applications. But there have been some Melbourne hospitals implementing this as part of a “hospital-at-home” program for managing certain chronic diseases. But there was a setup being shown that allowed this kind of telemedicine setup to work as part of an “independent ageing” setup to assure older people the ability to live independently but know they are still being looked after, which is also being factored as the baby boomers become the ageing population.

Conclusion

These technologies that were presented at Connect 2014 are being more about what the connected work and home life is all about with the current technologies.