Consumer devices deliver telehealth in the home

Flinders University is trialling consumer-grade technologies such as the iPad and Fitbit devices as part of a project that is testing the remote provision of palliative care, aged care and rehabilitation therapies for older people at home.

Flinders University's Telehealth in the Home project was one of the successful bidders for the Telehealth Pilots Program, announced in 2013. Originally designed to test how the NBN could facilitate telehealth, the program has since been expanded to allow the use of other broadband access technologies such as 3G and ADSL.

Flinders University's project, which is being run in conjunction with the Repatriation General Hospital and several specialist clinical networks, is investigating how to use online technologies to support aged and palliative care patients in the community. It also aims to evaluate the effectiveness of providing care remotely to overcome the issue of long travel times for therapists and nurses who visit patients at home.

While this is relatively new for South Australia, there are a number of other projects currently being conducted around Australia into the effectiveness of telehealth in the home, many using high-tech devices that combine video conferencing with measurements of blood pressure, blood glucose levels and the like.

However, one of the issues confronted by several research groups when using these devices is their high cost, leading to questions about whether these services are financially sustainable.

One of the main focuses of the Flinders trial is how to effectively deliver telehealth using consumer-grade technologies. According to project manager Alan Taylor, the home is a very different environment than a healthcare facility, and healthcare providers wishing to provide that care will have to confront the use of consumer technologies.

“You need to give people something that is readily available, and we envisage technology moving in such a way that they will be doing it on their own iPads and over their own broadband plans, so we are testing whether consumer-grade technology is clinically adequate to deliver the services we want,” Mr Taylor said.

Flinders is leading the project in partnership with the SA Rehabilitation Statewide Clinical Network, the SA Older People Clinical Network and the SA Palliative Care Clinical Network. It uses a team approach that encompasses the patients' carers, aged care facilities and specialist services along with GPs and other primary healthcare providers.

The project aims to recruit up to 150 patients in the southern Adelaide region, most of whom will have received care at Repatriation General Hospital and are keen to continue their treatment in their own homes. They are provided with a tablet device – predominantly an iPad – that is configured to be fully managed remotely.

They are also provided with access to the Internet via 3G, ADSL or NBN, as well as a Fitbit activity monitor linked by Bluetooth to the tablet. A suite of software applications is loaded onto the iPad, including video conferencing capability for direct video access to a nurse or therapist, access to self-management websites and an online self-assessment form, to be completed on a regular basis.

Mr Taylor said the research team aims to evaluate the different technologies as the project progresses, including the different Internet access technologies.

“We believe that there are significant differences in capabilities and obviously in coverage,” he says. “Part of the research is directed at capturing that information, and that will help to both inform the technologists and also the health service providers as to how to manage delivery of health services into the home.

“The home is a very different situation and healthcare providers have to confront consumer issues and consumer technology. That is a substantial change that they need to think about because no longer can they say that they have quality of service absolutely guaranteed and available 24 hours a day. It doesn't happen like that in the home.”

Consumer technologies

Mr Taylor's team is investigating using Android and Windows platforms, but for historical reasons iPads were the first tablets used. They are simple to use and the patients in the trial seem to like them, and are providing feedback on how to improve their use, he said.

“One person did say that a problem she found with the iPad was that she couldn't find the button on the iPad, and she suggested sticking a little white sticker on it so it would be visible. Our aim is simplicity in this project, both with the devices being simple to use and also the applications, which are as far as possible one-button applications.”

As many of the patients are older – the rehab patients are all over 65, although the palliative care patients can be any age – software icons and font sizes are kept large and attention is being paid to audio quality.

Video conferencing is conducted through the tablet, enabling the patients to have direct video access at scheduled times with their therapist or nurse. Palliative care patients are provided with a self-assessment application designed along clinically validated protocols that they or their carer complete daily.

Patients and their carers are provided with a self-management website that has particular sets of information which may be useful in treating their condition, and the project team is currently building an exercise application which enables therapist to prescribe sets of exercises for particular rehabilitation purposes.

“We also give them a very simple activity monitor, the Fitbit, which is linked by Bluetooth to the tablet. It is fairly basic but it monitors their level of activity so we can see if someone hasn't got out of bed for a day, which may indicate the need for an in-person visit or clinical follow-up.”

These sorts of devices are proliferating and some are better than others, but Mr Taylor said the project was choosing those that are easiest to use. Fitbit is also reasonably cheap, which comes in handy for the project's finances as several have gone through the wash.

The project team did consider more high-tech devices, but the main aim was to make telehealth provision as simple as possible, Mr Taylor said.

“There is a tension in this because some of our clinicians would like extra cameras, as they'd like to be able to monitor another parameter. That's a lovely idea and it would certainly help some patients, but it would introduce a degree of complexity which would lessen the accessibility of the service.”

Posted in Australian eHealth

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