Director, international Centre for Usable Home Technology (iCUHTec).
CoDirector, Telehealth Quality Group EEIG.
Portable devices (most notably smartphones) are changing the way that people view their lives and the way that they access services and information relating to their health and wellbeing. Therefore the technological developments that are summarised here can be regarded as a threat to ‘old’ service models for telehealth (and telecare). But they also represent an opportunity that, if successfully harnessed, will empower people in relation to their health and well-being. Smart fabrics and wearable devices add to the options available. The International Code of Practice for Telehealth Services is pointed to as potentially accommodating such developments and as addressing related issues such as those concerned with data security.
This Monthly Feature draws on a paper presented by Kevin Doughty at the Life Sciences Hub in Cardiff on 24th November 2015. A more substantial article that develops much of the argument put forward in this Monthly Feature will be available on the iCUHTEC website (www.iCUHTec.org/articles) and a second paper, focusing on applications for wearable technology for social care and for rehabilitation by Doughty and Appleby is published in the Journal of Assistive Technologies (2016) Vol 10, Issue 1.
Vital Signs Monitoring – Moving Away from the Old Service Model
As the health benefits associated with monitoring vital signs and activity levels become more apparent, there is great interest in moving away from the old service model of taking occasional or daily readings (as might be done by a GP or in a hospital setting) towards continuous and ambulatory recordings of relevant physiological parameters. The latter approach offers both rapid detection of potential emergencies and the opportunity to use trend analysis to identify changes in personal health. Its adoption is fully consistent with the prevention agenda, and facilitates the use of ‘big data’ in the public health arena.
Portable and Wearable Devices
To enable the measurement and collection of these data, it will be essential to utilise portable technologies – so that people of all ages can go about their daily business and activities without restriction. Wearable technology is the logical extension to portable devices, but there are a number of challenges to be overcome before they might be widely adopted. Solutions are, however, emerging that are associated with service frameworks in which everyone can become partners. Here lie, it is suggested, the key ingredients for improving individual health and maximising the potential for people to live independently. Various technologies will help to bring this about – ranging from portable computers to body worn sensors and smart materials.
With regards to computers, their miniaturisation has been possible through major advances in processing power. Here it is staggering to note, over several decades, the doubling every two years (roughly speaking) in the number of transistors that can be embedded in a computer chip. The speed of their operation has increased, furthermore, at about the same rate and the cost of ‘memory’ has fallen. The consequence is that today’s computing devices are a fraction of the size and weight of those available even 10 years ago. But at the same time they are much more powerful.
The evolution is now manifested in smartphones and in wearable devices such as smart watches. And although worn devices will not totally replace other types of computer (due to limitations of user interfaces and controls) we can expect gestures and spoken commands to make keyboards and screens substantially obsolete. Linked with this there is a paramount need for telehealth services to link portable (including wearable) devices to monitoring centres or to cloud storage. This responds to the surge in home Internet access, improvements in data bandwidths, and free Wifi being available in many locations.
Homage to the Smartphone
The smartphone has emerged as the simplest way to access the Internet and to share information. It frequently has considerable built-in resources including a camera (or two), microphone, speaker, thermometer, GPS and accelerometer – with these having enabled it to become the ultimate ‘portable assistant’. As well as having such inbuilt functionality smartphones can, of course, operate with other devices (normally linked wirelessly). These can enable, for instance, the monitoring, non-invasively (i.e. from the body surface) of such measures as blood flow, pulse rate and blood oxygen content. Wearable devices will add to the options.
Developments in the powering of such devices help to make the possibilities a reality. Added to this are apps that can be downloaded quickly and then run (either continuously in the background or as a dedicate tool). With such developments we have the beginnings of a dramatic change the way that people think about their capacity to self-manage many health conditions; and about their overall perspective on both their physical and mental health and well-being. Some of the impact of these is now beginning to be evident through changes in people’s lifestyles and behaviours.
With regard to the range of apps and wearable devices we can note that the market is currently dominated by technologies worn around the wrist (as a bracelet or watch). The main reason for this may be assumed to be acceptability and ease of access. But, generally speaking, the wrist is unlikely to be the optimum location for many (and perhaps most) physiological measurements. In a particular area of concern within the world of telehealth and telecare, for instance, the detection of falls through a wrist-worn device can be compromised by the number of degrees of freedom of the wrist. This can make it impossible to determine the status of the body following a fall.
Finally we must raise an eye to the potential impact smart fabrics – where new processes can now turn clothing and other textiles into flexible, wearable electronic devices or sensors. The materials needed to make such textiles and threads have now moved out of university laboratories into the rude world of commerce. ‘Conductive’ clothing or clothing with embedded sensors will, therefore, complement other devices and could have especial relevance (from the point of view of service providers) for people with high level health or support needs – both in relation to gathering data on vital-signs or, potentially, of mood. The rapidity of the development of smart fabrics, meanwhile, can be linked to take-up and commercial opportunities in the world of sport and fitness.
We Know What’s Good for You (?)
In a context of on-going advances and developments, the smartphone and related developments around wearable technologies might be considered as a threat, for ‘old style’ telehealth (and telecare) services. This is because the smartphone can provide the memory, the processing and the interfacing required for a full and personalised ‘telehealth system’. This could make many hardware-based systems redundant. For (potential) service users, however, who may wish to take greater control of their health, the smartphone and related developments represent a real opportunity – with telehealth services necessarily having to respond in ways that reflect a much greater understanding of user wishes and choices. The way that people are using smartphones (and may, in the future, use wearable technologies) will expose earlier failures in imagination that both gave insufficient attention to emergent portable, miniaturised and wearable technologies; and to the way that people of all ages stood to be empowered by them.
There can be no doubt that telehealth services will, as a consequence, change from supporting simple prescription-based (‘we know what’s good for you’) models – where the provider installs and monitors a standard system based on a connection hub and associated sensor peripherals; to ones where a more personalised approach is taken (‘this is what you can use; here are your options’) which includes making different sensing devices available, some of which may be worn. The astute telehealth service will, therefore, be supporting or offering such personalised healthcare, and fostering opportunities to test new treatments, therapies, responses and interventions using the technologies in question.
Finally, the need for data security and patient confidentiality is evident for all aspects of telehealth – but the opportunities for hacking will be especially present for people with portable and wearable devices. Telehealth service providers will need to demonstrate their increased vigilance and explain to service users not just the options and choices available to them, but also the quality and nature of their data security. These and related aspects of service provision are covered in the new International Code of Practice for Telehealth (see www.telehealth.global) and will be addressed in future Monthly Features.