Handbook of Digital Homecare

This study aims to assess the adoption potential of healthcare innovations in their infancy. Such an assessment is useful, since the context of the innovations change rapidly as a result of the health care reform process. Successful innovations comply to a complex system of social, technical, and financial attributes. First we narrow down the vast amount of innovations in healthcare into a review set of innovations and select attributes of successful innovations from literature. Next the compliance of the review set with the attributes is assessed by an expert panel. There exists no metric to objectively measure compliance and empirical data analysis cannot be performed because there are no data. Six innovations with high expectations were assessed: smart homes, eHealth, electronic health records, self management, robotic assisted devices and online health companion contacts. None complied convincingly to all attributes. Innovation in healthcare appears as a multi-level, multi-sector, multi-disciplinary transition and needs both successes and failures to make progress.

Sometimes overlooked from within the range of long term conditions that are being addressed via telecare (care service provision mediated by telecommunications technologies) are the needs of people with epilepsy. This chapter reports on a telecare project (the Epilepsy Project) in the Republic of Ireland that, through the use of bed epilepsy sensors, supported the needs of people with epilepsy and their carers at home. The service developed in the Project is now mainstreamed but operates on a relatively small scale. Positive conclusions were drawn in a comprehensive evaluation of the Project that explored the efficacy of bed epilepsy sensors and the merits of the associated telecare service. The evaluation used a number of tools that built on background research involving personal interviews and a postal survey of people with epilepsy and their carers, case studies and consultations with a range of stakeholders. This chapter sets out some of the issues dealt with in the evaluation and places these in a broader context. Verbatim quotes from service users and carers are included to illustrate some of the findings and the views expressed.

Demographic trends in southern Netherlands predict an increasing aging population in the next decade. There will not be enough health care providers available to meet the growing demand of care of elderly. Therefore, there is a need to reorganize the Dutch health care system in a more efficient way. In this process, innovative technologies can play an important role. Videocommunication enables elderly living at home to contact the health care organization by a 24/7 screen-to-screen video communication. Several care organizations started projects to implement videocommunication. Different combinations of technology were used, ranging from high speed remote controlled cameras combined with a set top box connected to a regular TV set, to a webcam using a computer based internet application. These experiments were enabled by grants from the Dutch government to support the investment by care organizations, as well as an experimental provision to arrange for the re-imbursement of the services. The introduction of videocommunication was accompanied by a monitor to clarify the progress made at client level as well as organizational level. In this paper a description of the developments between 2005 and 2010 will be given. From the introduction of videocommunication in the Netherlands, the authors of this paper have been working together to develop and implement videocommunication in a Dutch health care organization active in the province of Limburg the aim of this implementation project is to apply videocommunication to enable older people to live longer independently at home in a responsible and safe manner. A longitudinal study was conducted with 124 frail elderly clients of the home care organization. A regionally based communication infrastructure was organized to handle alerts and incoming messages from the elderly. A questionnaire was used to measure the clients’ feelings of loneliness and feelings of safety at baseline level and after 1 year (April 2010). Protocols for implementation and educational material have been developed to support organizations in the implementation of videocommunication. Applied research has been done at development level as well as implementation level of new applications and communication infrastructure supported by videocommunication. This paper, will shown how the introduction of videocommunication was carried out by the home-care organization. Information will be given on the development of services like a “Good morning, Good evening” service. The aim of this services is to provide daily structure, support of compliance with medication intake and prevention of social isolation by means of screen-to-screen videocommunication. Developments of consultation by means of videocommunication with a general practitioner and an application to facilitate memory training are currently under development and will be discussed. In the study almost all clients indicate that their feeling of loneliness has increased by the system. They feel that there is always someone who takes care for them which has a real positive impact on the clients. However, technical problems with the system still occur and finding a sustainable financial structure is a challenge.

ICTs offer great opportunities for delivering telemedicine and social care in a number of domains including services for the elderly. This area of application, however, presents many challenges at many different levels. The purpose of this chapter is to describe an approach followed, and explore some lessons learned in Bologna (Italy). The stated objective of these developments was to maintain independent living, in their own homes, by elderly people for as long as possible and as cost effectively as possible. Thus the approach was an attempt to address the challenges both of the quality and the economics of care. Part of the background to the project was that, over the previous 10 years, more than three hundred elderly people had been involved in different home care projects in the Municipality. These initiatives started with traditional approaches to the integration of home care applications (telemedicine devices or software applications) using proprietary and ad hoc mechanisms and culminated in the development of the concept of a technical and organizational platform with the potential to overcome many of the problems of traditional e-Care applications and to exploit some of the new potentialities offered by network technologies such as eHealth and web 2.0 in health.

A small regional telenetwork has been established in Lithuania and used for piloting homecare and remote care health care service delivery models on the grounds of the work of the Telemedicine Centre of the Lithuanian University of Health Sciences (formerly Kaunas University of Medicine) and private initiative of clinicians and researchers with the aim to promote bottom-up, self-sustainable telemedicine development and to increase accessibility to, and quality of, healthcare especially in rural or underserved areas. Stratelus, a small medical company, together with several family clinics in the rural areas of Lithuania and with support of the Family Medicine Centre of the Kaunas University of Medicine started screening and monitoring of elderly population for diabetic retinopathy, aging macular degeneration, optic nerve head evaluation, and glaucoma in their homes and near-home locations, in a mobile telenetwork mode, bringing the access point to the patient. The project demonstrated innovation in terms of the methodology (telehomecare), organization (small bottom-up structure), and technology (high quality handheld fundus camera). The argument behind this project was to test the viability of homecare and remote care service delivery in a small/medium scale, bottom-up organisational setting. This is important for elderly population with limited mobility in rural or remote areas.

Mobile computing is one of a growing number of information technologies applied in the context of homecare services. While home telemonitoring enables clinical interventions at a distance, mobile computing allows clinicians to integrate the care process on site at the patient’s home. As digital homecare is a fairly recent phenomenon and our understanding of the challenges and barriers associated with its implementation is still in its infancy, we used a clinical information system risk analysis framework to investigate how project risk management of mobile computing implementations was applied and how it shaped a project’s outcome. We followed the ongoing development and implementation of a mobile computing project in real time at nine homecare program sites in the Province of Québec, Canada. We analyzed each site’s implementation strategy, i.e., the pre-existing and emergent risks, the risk mitigation strategies aimed at eliminating the hindering factors and at favoring successful outcomes at each site. In studying the relations between the various elements (implementation strategy, risk occurrence, and level of success), we were able to draw a series of lessons to help decrease failures and further the success of mobile computing in homecare programs.

This chapter describes the research and development of AAL+, a new tool for continuous short-to-medium and long range patient monitoring. The system has two versions, each targeted at a different environment and at subjects with different needs: (a) AAL+ Institutional, for patients that live in healthcare institutions such as assisted living facilities, with delicate needs in terms of medical assistance and monitoring; and (b) AAL+ Home, for individuals that live in their homes, maintaining some independence and physical capabilities. In the next sections we describe the particular characteristics of each version as well as the development, test and deployment scenarios, in close collaboration with partners from the clinical field and end-users. Currently, the system is in a late prototype stage and was tested in a real environment at two healthcare institutions: an assisted living residence and a public hospital Users’ reactions show that this system brings advantages which extend to institutions, caregivers and end-users, and translate into faster assistance, higher efficiency of the services and new intervention models.

The implementation of a telehomecare medication management service, by a community health and care organisation, is described from pilot project to ongoing service. Nurses undertake virtual visits using videophones to guide and monitor medication administration for home-based clients with cognitive impairment, or for those receiving directly observed therapy for tuberculosis. Changes in nursing roles, the development of new clinical protocols and procedures, and a new method of providing flexible, high bandwidth connectivity to the home were developed. Clients reported the telehealth service to be convenient, reassuring, and less intrusive than face-to-face contact, and found the videophones easy to operate. The nursing service found the telehealth service was safe, reliable, cost-effective, and that clients improved their health status. The translation to service integration was accomplished by dedicated resourcing, staff education, addressing staff concerns, the development of a telehealth unit, and a clinical–technical partnership. The critical organizational success factors were the engagement of clinicians, clear development of new professional roles, a continuing change management strategy, and leadership.

Demographic trends in southern Netherlands predict an increasing aging population in the coming decade. Since there will not be enough health providers available to meet the growing demand of care of the elderly, there is a need to reorganize the Dutch health care system in a more efficient way. In this process, innovative technologies can play an important role. It is speculated that monitoring daily activities may be an effective way to obtain information on well-being of seniors living independently. Alterations in behavior could then be used to support the organization of care delivery to these persons. Technology has become available commercially by which the activities of the elderly living at home are automatically monitored. In the USA this technology mainly is used to support informal carers in their care after their relatives at a distance. The authors speculated that this technology may also be used as a communication infrastructure that can deliver information to care workers. Moreover, this could enable them to re-organize the process of care delivery in such a way that future challenges are met effectively. They were able to set up a series of projects in which this speculation was substantiated. First of all a small pilot experiment was started to demonstrate that the technology was applicable in the province of Limburg in The Netherlands. Not only the technical feasibility could be demonstrated, also the development of a communication infrastructure in which several (international) organizations, each with specific expertise, was completed successfully. Also at the user level (clients and care workers) evidence was gathered that this approach may deliver an adequate support. Next, a large scale implementation project was started. In this project the consequences of data delivery by the technology in the work process of care deliverers was investigated. Instructional courses and new care management tools targeted at home-care workers were developed to support the effective use of this infrastructure. In the mean time other care organizations were invited to participate in the projects. At the client level, evidence is gathered to demonstrate the effectiveness of the system. The research and implementation projects are now financed by grants. It is the intention of the care organization involved, to use this infrastructure in a regular way. This means that a structural financial scheme had to be developed. Thus information was gathered to set up a business case for the future use of this technology.The results obtained up to now will be discussed in this chapter.

The SAPHIRE project aimed to develop an intelligent healthcare monitoring and decision support system on a platform integrating the wireless medical sensor data with hospital information systems. In this paper one of the two demonstrator environments—the homecare scenario—is described from the medical and technical point of view. A retrospective view of the technical and medical internal challenges of the homecare scenario of the project is given. Also the external challenges that influenced the project, like economic aspects and legal issues, are being discussed. Furthermore, an outlook on the follow-up project OSAmI is given with regards to the experience learned from SAPHIRE (http://​www.​srdc.​com.​tr/​metu-srdc/​webpage/​projects/​saphire).

World population is ageing and increasingly scarce resources are required to cover the needs of everyone adequately. Medical conditions, especially memory problems, restrict the daily life of a broad slice of the elderly population, affect their independence. To prevent this, providing the right care and assistance while having in mind the costs implicated is essential. One possible path is to work with resources that we already have today and create innovative solutions to achieve the required level of support. There are not many solutions either technological or not to prevent memory loss. In this work we present a possible solution aimed at restoring or maintaining the independence of elderly people, through the use of so-called Memory Assistants. We thus present an Intelligent Multi-Agent Memory Assistant designed to help people with memory problems remember their events and activities. The implementation of an event manager, free time manger, medication remainder and a sensory system, to manage and monitor the user, we aim to improve their quality of life and increase their independence.

The sense of making good use of ICT applications in support of elderly care system seems all too obvious. However the actual adoption of such applications is very slow. It seems that good design, testing and intelligent value market analysis, are not sufficient to continue the life of many applications after the running-out of project subsidies. A Belgian multi-disciplinary team gained the hands-on-experience during two projects on this topic. This chapter describes these experiences and the lessons learned during the design, development and proof-of-concept testing phase in the field.