Seminar 2016
University of East Anglia, Norwich
Telehealth Services –
Meeting changing needs?
- Achievements and Challenges
Dr Malcolm J Fisk
[email protected]
Telehealth
What do we mean by telehealth? 1
Telehealth is the means by which technologies and
related services concerned with health and wellbeing are accessed by people or provided for them
irrespective of their location.
[Telehealth Quality Group: 2016 International Code of
Practice for Telehealth Services. See
www.telehealth.global]
Telehealth
What do we mean by telehealth? 2
Signals ‘fit’ in relation to
• Changing service paradigms that follow …
o demographic imperatives
o ethical and rights perspectives
o recognition of public and preventative health
agendas
o political realities
• Integrated service frameworks
• Person-centred care
• Promotion of self-management
Domains of Telehealth
Absolutely not just vital-signs monitoring!
Health and motivational coaching and advice
Activity and lifestyle monitoring
Safeguarding and monitoring in care settings
Gait, seizure and falls prediction / management
Point of care testing and diagnoses
Vital signs monitoring
Mobile Health technology systems (e.g. apps)
Medication or therapy adherence
Rehabilitation and (re)ablement
Responses to adverse ‘events’ and incidents
Tele-consultation and virtual presence
[Telehealth Quality Group:
2016 International
Code of Practice for
Telehealth Services.
See www.telehealth.global]
• …and more!
Telehealth
What do we mean by telehealth? 3
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at home
in school
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Telehealth
What do we mean by telehealth? 4
Not just …
• about the ‘delivery’ or top-down management of care
• concerned with clinical and acute conditions
• about vital-signs monitoring
• about saving money and avoiding hospital admissions
Rather it’s …
• about empowering people to manage their own care
• about maintaining and changing lifestyles and behaviours
• about better mental health as well as physical health
• about public and preventative (as well as clinical) health
• as relevant to a 26 year old managing her diabetes as it
is to an 86 year old being helped with his dementia
Examples of Telehealth Service Development
• Dignio (Norway)
• Svensk Telepsykiatri (Sweden)
• Fold Group (UK)
… an indication of the
breadth of telehealth
Dignio
An Example of Telehealth Service Development in Norway
• Service platform for self-care (‘seniors go
digital’) … and home care
• The ‘mobile’ becomes the new social alarm
• Focus on well-being as well as clinical health
• Involvement of users and carers … including
notifications
• GPS for people with dementia
• Mobile approach to monitoring as well as
through ‘fixed contact centre’
• Support to telecare / telehealth services
setting up
Svensk Telepsykiatri
An Example of Telehealth Service Development in Sweden
Image: Cloudvisit
• Psychiatric service on-line
o diagnosis and treatment
o CBT, motivational coaching
• Irrespective of user’s location or country of
residence
• Based on video-conferencing
o as good / better than other interventions (for
some)
• Clear protocols for interactions
• Support and training for other services
Fold Group
An Example of Telehealth Service Development in the UK
• Established telecare service
• Part of T3 Group ‘delivering’ tele-monitoring
service in Northern Ireland
… includes Tunstall and S3 Group
• 3,000 patients with LTCs
… helping them monitor vital-signs at home
• Telecare integral to assessments for dementia
care (Northern Trust)
www.clearcare.com
Telehealth: Some Ethical Issues 1
Some Reference Points
• Beauchamp and Childress: Four Principles of
Biomedical Ethics
o Autonomy, Beneficence, Non-Maleficence,
Justice
• Tronto: Ethical Elements for Nursing Care
o Attentiveness, Responsibility, Competence,
Responsiveness
• RRI (Responsible Research and Innovation): Key
Dimensions
o Ethics, Good and Reflexive Governance,
Creative Learning, Engagement & Involvement,
Gender Equality, Open Access
Telehealth: Some Ethical Issues 2
Inclusion, Engagement and Autonomy
• Autonomy
o how realistic?
o what is ‘care’?
o need for re-think?
• Inclusion and Engagement
o rights
o addressing ageism
o countering segregation
o changing service paradigms
o changing thinking
o integrating services
Telehealth: Some Ethical Issues 3
Control and Dependency
• Telehealth service operation
o how appropriate re. changing paradigms /
affording control or self-management?
• (Traditional) Vital Signs Monitoring
o auto collection of data or provided by ‘patients’
o health practitioners and clinicians decide based
on the information from the devices
o clinical health gains, greater dependency
• Webcam / Video-consultations
o ‘patients’ judge their conditions / health
o facilitates patient networks / knowledge sharing
o well-being gains, less dependency?
Telehealth: Some Ethical Issues 4
Privacy, Consent and Confidentiality
• Telehealth and the World of Big Data
o being drawn back into clinical arena (EHRs, etc)?
o barrier to service integration?
o ‘patients’ / people marginalised?
• Privacy Issues
o consent issues to be addressed … link to confidentiality
o some re-assurance through audit trails
o big issue of trust
• The Wider Public Interest
o public health gains?
Telehealth: Some Ethical Issues 5
Cameras in Care Homes
• An Ethical re-Think?
o Observation is OK!
o Need to see cameras in wider AT / telecare and
telehealth context (audio; activity monitoring;
entry-exit)
o Need to regard cameras as data gatherers
… helping ensure privacy thro’ digital
fragmentation
… reassembly (at different levels)
only in specified circumstances and with right
protocols and controls
www.clearcare.com
Round Up
Source:
Health IT
Outcomes
• Various imperatives for change
• Changing service paradigms
increasingly evident
• Telehealth part of the changes
• Telehealth Services beginning to demonstrate
potential of telehealth
… in public / preventative health arena
… for all people, all ages
• Herein lies some good (not great)
achievements
… but the challenges
Telehealth Services
The Challenges (and Dangers)
Source: Pivotell
Source: India Vision
• Public sector service divisions and
bureaucracies
…linked with failures in imagination
… need for culture change (?)
• Shortcomings in standards and/or frameworks
for service operation
• Agenda may be re-captured (in context of Big
data) by clinicians with
narrow perspective
• Failure to create context for
self-care, management of
lifestyles, etc.
Telehealth Services
The Opportunity
Source: Pivotell
Source: India Vision
• Doing things differently
• Telehealth services not ‘delivered’ but
‘provided’
• Telehealth ‘for all’ … linking with selfmanagement, behaviours and lifestyles
• Telehealth not as a way of saving money;
rather as a way of doing things better
… more power and
control to patients people
•
Power to the
People!
cassandralathamjones
bbc
Thank You
Diolch yn Fawr
Dr Malcolm Fisk
[email protected]