Making Sophisticated Sensing Accessible - swig.org.uk · PDF file30/04/2014 SWIG Making...

Making Sophisticated SensingAccessible

Lessons from Telehealthcare

Stephen Hope

Business Development Manager

Docobo Ltd

30/04/2014 1SWIG Making SophisticatedSensing Accessible

Copyright © Docobo Limited Not to be reproduced without permission

Docobo LtdEnabling Technologies supporting Community care

• UK company formed in 2001

• Regulatory Status - A medical device and solutions company (accredited toEN13485)– doc@HOME Telehealth System is a Class I medical device, HealthHUB and

CarePortal are Class IIa

• Telehealth – Managing patients– Self care

– Risk Stratification and Professional care

• Care delivery logistics – Managing Staff– Staff self management

– Performance management

• Assisted Living – Managing the elderly and vulnerable– Social isolation, fragmented families, digital divide

– Daughter/son responsibilities

– Access to support and wider world

30/04/2014 2

TELEHEALTH

30/04/2014 3SWIG Making Sophisticated Sensing Accessible


Telehealth

Remotely monitoring vital signs and lifestyle ofpatients on a regular basis and as frequently asthe patient’s condition requires

Passing and sharing this information toappropriate clinicians to allow early intervention;on going management of patients

Improving outcomes

30/04/2014 4


doc@HOME® Telehealth System Overview

30/04/2014 5

ACCESSIBLE ?



Accessibility• Making a product that can be used by people with different

needs and abilities– Design for All

• Lowest Common Denominator

• Legal Connotations

– Assistive Technology Approach• Helping people use the features available that suit them ?

• Increasing availability to a wider market demographic– making a product available at an affordable consumer level price point

• One drives the other through economies of scale

• “I want one of those” is just as important in the HealthMarket both private and statutory to ensure compliance

30/04/2014 7

USABILITY

Making a product or service that can be used bypeople with different needs and abilities



Telehealth Intervention Process• Telehealth supports care delivery, it doesn’t do the care. But it

provides:– Regular collection of information from the home

• Vital signs, symptoms, quality of life, patient experience, various validatedquestionnaires

– Self Management functionality

• Need to understand NEED and ABILITY– NEED – What is a patients condition and what care do they need

– ABILITY – How Activated are they and how IT literate are they?

• Need Intelligent identification– Risk Stratification, Patient Activation Measure (PAM) and IT capability

• Need Care Delivery process change

30/04/2014 9


Need-Ability Index

30/04/2014

10


Patient Activation Measure (PAM) Stages of Activation

Stage 1 – Believes Active Role Important:

Taking an active role in my own health care is the most important factor indetermining my health and ability to function.

Stage 2 – Confidence and Knowledge to Take Action:

I am confident that I can follow through on medical treatments I need to do athome.

Stage 3 – Taking Action:

I am able to handle symptoms of my health condition on my own at home.

I have made the changes in my lifestyle like diet and exercise that arerecommended for my health condition.

Stage 4 – Staying the Course Under Stress:I am confident I can figure out solutions when new situations or problems arisewith my health condition.

I am confident that I can maintain lifestyle changes like diet and exercise evenduring times of stress.

30/04/2014 11

TELEHEALTH

The Human Sensor System



The Human Sensor System• The use of Sensors in the remote monitoring Telehealthcare

domain is different from many M2M applications in thatmostly there is a human being at both ends of the sensorsystem.

• In addition it is not just the capturing of physiological datathrough medical device sensors that is required but alsosymptomatic data needs to be captured in order to give aholistic view of the patient.

• In designing such a system consideration has to be given thatthere are two different user groups with differentrequirements.

• The Patient and The Clinician

30/04/2014 13

The Patient Perspective

User Centred Design



Options to meet need and ability

30/04/2014 15

30/04/2014 SWIG Making Sophisticated Sensing Accessible 16

GPRS, 3GBroadband

Patient & Care GiverPatient & Care Giver

•Elderly•Poorly•Symptomatic


•IT Literate•Mild LTC’sDiabetes IIAsthma


Case Management Wellness

GPRS, 3GBroadbandPSTN

CarePortal™

GPRS, 3GBroadband

Smartphones

DocoboAPP & DocoboWEB™ (Email/SMS with URL

Encrypted and secure data

TabletPCs & Macs Laptop

GPRS, 3GBroadband

GPRS, 3GWiFi/Broadband

Telehealth: Access choice according to clinical need, nurse/patient preferenceand cost

TV

GPRS, 3GBroadband

ClinicalDatabase

ClinicalDatabase

doc@HOME®

Flexible question selection to enable management of all co-morbidities and clinical pathways for each patient


Designing for the Patient• The patient may suffer from a range of Co-Morbid conditions

and disabilities and may be quite poorly

• The patient needs to be encouraged to maintain complianceto achieve a consistent result over a long period of time

• The equipment has to be easy to use and adaptable forpeople with different needs and abilities – even theTechnophobes!

• Handheld Equipment in particular has to be rugged!

• The equipment still has to perform the clinical role for which itis intended

• User-centred design processes are key for product andservice success remembering the Clinician and Patient areboth users

30/04/2014 17

Copyright © Docobo Limited Not to be reproduced without permission30/04/2014 18


CAREPORTAL® – Solution for Assisted Living

• CAREPORTAL® is asolution consisting ofbespoke Docobodesigned hardware andan open source softwareplatform

• Designed to be able togive an older or lesstechnically capable useraccess to health, socialnetworks and services

30/04/2014 19

CAREPORTAL® is a Class IIa Medical Device Platform

CAREPORTAL®

• Typical Lead I ECG recording• Heart Rate and Pulse Rate display• 20 second rhythm strip• 20 second heart rate variability• 20 second Aortic Arch Blood Flow

30/04/2014 20SWIG Making Sophisticated SensingAccessible

Asking the Customer

The Customer may be the Patient or the Commissioner of theService



Age UK Headquarters, Leeds

30/04/2014 22


COPD Patients Group Solent NHS Trust

30/04/2014 23

From This....


25

Becker’s Disease Subject working with M3S Joystick

30/04/2014 SWIG Making Sophisticated Sensing Accessible

26

Rheumatoid Subject working with Mini Keyboard

30/04/2014 SWIG Making Sophisticated Sensing Accessible

To This....


30/04/2014 28

Home Screen

SWIG Making Sophisticated Sensing Accessible

30/04/2014 29

Entry of Symptomatic Data


30/04/2014 30

Manual or Automated Entry of Physiological Data



CAREPORTAL® – Solution for Assisted Living

• CAREPORTAL® is asolution consisting ofbespoke Docobodesigned hardware andan open source softwareplatform

• Designed to be able togive an older or lesstechnically capable useraccess to health, socialnetworks and services

• Buttons as well as aTouchscreen

30/04/2014 31

CAREPORTAL® is a Class IIa Medical Device Platform

The Clinician Perspective

Still User Centred Design!



Patient & Care GiverPatient & Care Giver•Elderly•Poorly•Symptomatic





GPRS, 3GBroadband

CarePortal® HealthHUB®

GPRS, POTS GPRS, 3GBroadband

Tablet Apps

Email / SMSwith URL

WebApplication

WebApplication

BrowserBrowser

•Case Co-ordinators•Clinical Teams

ClinicalDatabase

ClinicalDatabase

doc@HOME® Infrastructure Overview

doc@HOME®

Web ServicesHL7 InterfaceWeb ServicesHL7 Interface

3rd PartyAnalytics3rd PartyAnalytics

3rd PartyeHealthvendors

3rd PartyeHealthvendors

• Clinical decision support•Trending

docoboWEB™


Any peripheral manufacturer of yourchoice

Case NotesCase Notes

• Interventions• Observations• Free text

AlertGenerator

AlertGenerator

• Email/SMS• Multi Routing• Patient Specific

ReportGenerator

ReportGenerator

• pdf reports• .csv files• KPI reporting

Prompts andquestions etcPrompts andquestions etc

SchedulingEngine

SchedulingEngine

• Any combination of questions, changed anytime• Free text two-way messaging and notes• Education, Empowerment and Self Management

Individual Care Plan•Tailored toneeds of patient.•Self Management•Medication management


The Clinician Perspective• Clinicians – Doctors or often Community Matrons have to be

able to see all the collected data - physiological data from themedical sensors and symptomatic data from the humansensors

• The sensor data must be presented in a format from whichthey are able make a rapid assessment of the patient throughtrend analysis.

• The patient may be one of perhaps 50 - 100 within a virtualward so that the information from the patient has tovisualised in such a way to minimise the interaction time perpatient say around 2 minutes

• A course of action (if one is required) needs to be determinedand recorded in the patient record such as set alerts orarrange a visit of the Community Nurse

30/04/2014 34

Visualising the Data

Day-to-Day Patient Management



Web based Clinical Interface

30/04/2014 36


Clinicians View – Fixed or Mobile

30/04/2014 37

Closing the Loop

Day-to-Day Patient Management


30/04/2014 39

Communications with the Clinician


30/04/2014 40

Configurable Self Help Information


30/04/2014 41

Self Help Reports


EXTENDING THE BOUNDARIES OFTELEHEALTH

Increasing availability to a wider marketdemographic



Older/vulnerable people- Independence- Social Isolation

- Fragmented Families- Digital Divide

- Support for Daily livingactivities

- “Soft Assistance”

Medium LTC

(Less symptomatic )

Mild LTC

(Type2 Diabetes, Asthma,Hypertension

Complex LTC(poorly and

symptomaticCOPD and CHF etc)

Extending the boundaries of Telehealth.......

Telerehabilitation

Entering a new Sector



Telerehabilitation

• Use of advanced Telehealth techniques andsensors for the treatment of those with Spinaland Neurological Injuries

30/04/2014 45

The “One Stop Shop"

Addressing Social Isolation



TelehealthServices

TelehealthServices

doc@HOME®doc@HOME®

OtherHealth ITSystems

OtherHealth ITSystems

WebBrowser

WebBrowser

ClinicalTeamseNABLE™ Service ProvisioningeNABLE™ Service ProvisioningTelehealth Service Provisioning

ClientPatient & Care GiverClientPatient & Care Giver•Elderly•Poorly•Symptomatic





Docobo Independence Infrastructure Overview

30/04/2014 47

3rd PartyServices3rd PartyServices

DeliveredMeals

DeliveredMeals OtherOther

GPRS, 3GBroadband

Tablet Apps Email / SMSwith URL

HealthHUB®

GPRS, POTS

SocialContactSocial

Contact

Peer toPeer

groups

Peer toPeer

groups

Family Webaccess• Diary• Photos

Family Webaccess• Diary• Photos

BeTogether™

Communityaccess

Communityaccess

AssistanceServices

AssistanceServices

Community groups:• 3rd sector• Local volunteer• Private providers

CommunityAssist

CommunityAssist

WebBrowser

WebBrowser

concierge@HOME™

EnvironmentalControlsInterface

EnvironmentalControlsInterface

GPRS, 3GBroadband

LocationServicesLocationServices

CarePortal®

Increasing Customer Device Choice

From Illness to Wellness – Bring Your Own Device (BYOD)

(Remember Its not a Medical Device!)



DocoboWEB simply requires the device to run a browser.

MicrosoftInternetExplorer

AppleSafari

GoogleChrome

MozillaFirefox

DocoboWEB:

GPRS, 3GBroadband

GPRS, 3GBroadbandPSTN

Freedom® Tablet

GPRS, 3GBroadband

Smartphones

ClinicalDatabase

ClinicalDatabase

doc@HOME®


TabletPCs & Macs Laptop

GPRS, 3GBroadband

GPRS, 3GWiFi/Broadband

TV

GPRS, 3GBroadband

In operation the user is sent anemail or SMS containing a URLwhich links to the user’s webpage.

DocoboWEB does not apply toCarePortal or HealthHub

Integrated Telehealth and Telecare

Adding physical ADL Sensor data to physiologicaland symptomatic data



Interoperable Solutions for Assisted Living

30/04/2014 51

TynetecActivityTrend

Analysis

IP basedconnectivity

ADL Alerts

Assisted Livingand

EnvironmentalControl

Energy Management andEnvironmental Data to Health Record


Integrated Care Professional View – Visualising beyond Health

30/04/2014 52

THE BUSINESS MODEL

Can we afford to deploy more sophisticated sensing?

WHO PAYS!


Implementation Considerations - The Business Model

• In the UK Health services have been provided free at the Point ofdelivery– Still a strong cultural belief– Can you compete with free in a consumer market!

• Some Local Authority Services are free but others are paid for by theEnd Customer– Generally accepted as the status quo

• What will be the impact of the planned Integration of Health and SocialServices in 2015– Unlikely that more services will be free but nobody left to commission them

• Are Community and Social inclusion digital services deemedbeneficial for personal well being - health or welfare - free at the pointof delivery -or does the customer pay for the service and connectivity?– Currently Telehealth M2M telecom costs in the monitoring costs paid by the

authority– Greater expectation of Broadband Multimedia services

• For the Service Provider when does a controlled 2G M2Mconnection become an uncontrolled 3G Data service?

• Network Connectivity is key but how long will 2G M2M bethere with LTE-M on the horizon?


CONCLUSION

Only the beginning...


Conclusion• The value of involving our potential end user

customers throughout the design process is fullyproven and brought an enthusiastic response.

• Integrated interoperable services are key to deliveringeconomies of scale to make sophisticated sensingaccessible

• The enthusiasm from the various service providers toprovide integrated services is somewhat less (evenwith 2015 looming!)

• The huge cost of back office systems to support theindividual consumer market should not be forgottenwhen developing the Business Case.

• WHO PAYS, HOW and to WHOM is still the greatestconsideration


Thank You

30/04/2014 57

Docobo LimitedThe Old Granary21 High StreetGreat BookhamLeatherheadSurreyKT23 4AA

Tel: +44 (0)1372 459 866

[email protected]


Date post:	29-Mar-2018
Category:	Documents
Upload:	dangthien
View:	215 times
Download:	2 times

Making Sophisticated Sensing Accessible - swig.org.uk · PDF file30/04/2014 SWIG Making...

Documents