The Future of Ttechnology and Health BCS HIS Edinburgh University May 26th 2014

Guy Dewsbury PhD

www.gdewsbury.com

BCS Health Scotland, Edinburgh University26th May 2014

www.gdewbury.com: Enabling independence for older and disabled people through person-centred design technologies

Themes


Health and Technology: The Rationale

•Ageing Population

•Increasing disabilities

•Living longer

•Greater recognition of illnesses

• Limited economic resources

• How can an increasingly older/disabled population be supported?


The UK Govt response...

Introducing assistive technology in the form of telecare and telehealth.

Technologies that can enable people to maintain and support their health.

Technologies that support people in their own home environment.


Health and Technology: the Intersection

Maintaining health in the general population should increase the ‘older well’.

This is supported by

Health promotion

Nudging health technologies (e.g. apps)

Social media

Greater access to preventative care (e.g. screening)


Health and Technology: the Interconnection

An implicit assumption is that the population will embrace these new technologies and become fitter.

Technologies such as the “fitbit” are designed to support getting fit and take exercise

“The Fitbit family motivates you to stay active, live better, and reach your goals... We'll help you achieve what you set out to do, by sharing a full picture of your progress over time.” (fitbit.com)

Also see http://www.quanttus.com/ The Fitbit Flex mobile tracker


Supporting Personalisation

The idea of personalisation is central to the UK Govt’s response to the ageing society.

People should have control over their own health (Maintenance and Choice).

Technologies have been developed to support health promotion... For the able fit.


Personalised Health

YOUR health is ...Your responsibility.

YOUR illness is... Your responsibility.

YOUR health condition is... Your responsibility.

It is YOUR responsibility to obtain/purchase what ever technology would be beneficial to maintaining YOUR health and YOUR responsibility to sourceand determine the best solution for You.


Health at Home

Telecare and telehealth enable a person to manage their health remotely from their home.

Telecare alerts others when something happens.

Telehealth alerts health professionals and the person when their health condition changes.

These technologies promote independence and enable people to remain in their own home.

Telehealth allows for remote health management.


Health at Home

The rise of the virtual nurse and virtual ward are implicit in the increase use of these technologies’.

Currently their are few regulated criteria for the use or uptake of these technologies.

This means anyone can purchase them...


Health at Home

In previous research (e.g. Sommerville I & Dewsbury G (2007) ‘Dependable Domestic Systems Design: A Socio- Technical Approach’. Interacting with

Computers. 19 (4): 438-456) many of the issues with using technology to support older people at risk were outlined which included the poor design of technology in homes specifically designed to support older or disabled people in the community.


Health at Home

Technologies to support health tend to ignore the non-standard user.

They rely on assumptions such as:

1. The person having access to a computer;

2. The person being able to open and modify text;

3. The person having access to a range of movements;

4. The person being sighted and have full hearing.

Take one example: the pendant alert call button in telecare assumes the person can press at a certain pressure.


Health at Home

Three more assumptions:

Telehealth monitors assumethe person speaks, writes and reads a language (usually English).

They also assume the person will read the instructions, understandand act on them... using the device as intended.

They also assume the person knows how to correctly attach medical devices and to accurately take a reading for upload to the remote computers.

(see outputs from the ATHENE project www.atheneproject.org)


Health at Home

Just as the Fitbit assumes a certain level of ability to move, so do many current technologies used in health and social care.

Smart homes, smart devices, smart technology, pervasive systems, ubiquitous systems, ambient systems are often developed without the person who will use it in mind.


Enablement and containment

In 2008 I proposed the enablement/containment model in which I suggested that technology should enable a person and not contain them or their actions/activities.

It is important to consider how the technology will affect the person and the levels of enablement vs. containment in any system.

e.g. the door/wandering sensor


Person -Centred Design

Person - Centred Design (PCD) is a method I developed to enable the appropriate design of systems for older and disabled people.

PCD embodies and incorporates the person throughout the design process.

What it tries to avoid is over simplification of data and responses.

PCD deals with ‘People’, NOT ‘Humans’, ‘Patients’, ‘Conditions’ or ‘Users’.

People have emotions and do not think in linear lines.



People are diverse and every person has different needs.

People are not things or medical conditions.

Take two people with dementia, they might share the same medical condition but their lived experience of the condition is different and their needs are different.

This difference in ‘need’ is captured in DTA and MDDS.



When we design technology systems for people we design for the whole of them, including their activity patterns, and the technology should fit into their lives not them fit to the technology.

This means we have to take into account the variety of stakeholders (such as friends, family, relatives, support groups, hobbies etc) into the design.

Similarly, we should take their activities and levels of isolationinto account.



Most importantly although we can develop a generic design, we have a design that is fluid enough to incorporate the needs and wishes of people and their future needs and wishes.

Through a clear understanding of a person’s needs and their stakeholder needs’ any design should have better stick-value, and be less likely to be rejected.

Most importantly it is something that will be used.


PCD and Assessment

As a result I co-developed:

MDDS: The Method for Dependable Domestic Systems

and

DTA: The Dependability Telecare Assessment tool.

Both were developed as a result of ethnography, using cultural probes with older and disabled people.

MDDS was developed at Lancaster University as part of my PhD and DTA was developed and piloted whilst I was working at a large London Borough.


MDDS

The Method for the Dependable Domestic Systems (MDDS) provides a method for analysing assistive technologies and determining if they are suitable for a person.

MDDS also includes a large booklet of key questions for each section and subsection.


DTA

The Dependability Telecare Assessment tool (DTA) was developed after MDDS specifically to meet the need for a usable, robust assessment tool for telecare, as at the time there was none.

DTA is focused on the person, and their ability to live independently. It is based on three principles:

1. Technology should enable not contain a person.

2. Technology might not be the answer for everyone.

3. Not everyone requires or is best served by a technological response.


DTA

DTA is a qualitative framework that provides prompts for assessors to consider the person’s relative limitations and how these impact on their quality of life.

DTA is built around dependability factors which highlight the core issues in any system.

Armed with this type of information it provides a dependability pathway to the key elements of the possible technology required... or not.

Person

Environment

TelecareNeeds


Technological Responses to Health

Although technology is possibly the best response to the health crisis, poorly designed technology will only exacerbate conditions and have the potential to prove lethal, if not used appropriately.

Technologies designed for people must reflect the divergence of the individuals who will use them.

Standardisation is constructive providing there is also customisation and personalisation possible.


Future Trends and Possibilities

The future is now, as technology develops so fast.

We see apps appear that encourage healthy lifestyles but rely on able bodied people to use them.

We have fitness devices that rely on a number of presuppositions in their use.

We have robots entering hospitals and homes but they are designed by the able bodied.

We have a world that omits people who are not standard.


The Future of Technology and Health

Without a person-centred design framework in assessment, there is a likelihood of over spending on redundant and inappropriate technologies.

Technology is not a panacea and some people will reject it and require other forms of response.

As we technologise health and social care it is important to never lose sight of the person who is to use the technology in their daily routine.


Conclusions

Appropriate technologies should be a part of a person’s life and complement their lifestyle rather than be an appendage.

Telecare and telehealth technologies that support people should be person-centred and responsive to the changes in people as their abilities change.

Let’s not assume that because technology exists it is always the best response to a situation.


References And credits

All images courtesy of Google Image Search, Tynetec and gdewsbury

Suggested references

Wherton, J, Sugarhood, P, Procter, R, Rouncefield, M, Dewsbury, G, Hinder, S, Greenhalgh, T, (2012) Designing assisted living technologies 'in the wild': preliminary experiences with cultural probe methodology, Journal BMC Medical Research Methodology, 12(1), pp 1-13. http://dx.doi.org/10.1186/1471-2288-12-188.

Dewsbury G (2012) Telehealth: the hospital in your home, British Journal of Healthcare Assistants, 6(7): pp338 – 340.

Dewsbury G and Linskell J (2011) Smart Home Technology for Safety and Functional Independence: The UK Experience, NeuroRehabilitationJournal, 28 (3): pp249-260, DOI 10.3233/NRE-2011-0653.

Dewsbury, G., & Ballard, D. (2013). Telecare: a reactive service to enhance patient care. British Journal of Nursing, 22(7) pp 364.

Dewsbury G and Ballard D. (2013) The ethical Issues of Telecare: a help or a hindrance? Nursing and Residential Care, 15(7) pp490-493.


Any Questions?

Thank you

for listening

Contact Guy

[email protected]

Or go to: www.gdewsbury.com

And see:

thetelecareblog.blogspot.com

@dewsbury

Date post:	08-Jul-2015
Category:	Design
Upload:	guy-dewsbury
View:	100 times
Download:	1 times