May 2007

Design Guidelines for Telecare Services

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In developed countries, telecare is emerging as a strategic enabler for the provision of independent living to older people in their own homes, driven by demographics and new technologies. The number of elderly people and people with special needs is growing rapidly, and so is the requirement of dedicated supportive efforts for those unable to carry out the activities of daily living. The changing demographics of Europe indicate a development towards a population getting older and living longer than ever before.

Developments in technology are enabling seamless and more continuous access to fixed and mobile broadband networks. Likewise, new technologies and efficient production methods continue to drive down the manufacturing costs of silicon memory and processors, whilst simultaneously improving their performance. The result is that ICT resources are becoming evermore ubiquitous and are able to support new applications, such as telecare, which can significantly improve the quality of life for older or vulnerable individuals. In developed countries, telecare is emerging as a strategic enabler for the provision of independent living to older people in their own homes, driven by demographics and new technologies.

The number of elderly people and people with special needs is growing rapidly, and so is the requirement of dedicated supportive efforts for those unable to carry out the activities of daily living. The changing demographics of Europe indicate a development towards a population getting older and living longer than ever before.

The ageing of our society has unveiled the problem of dependency, as the number of dependant citizens is increasing, especially at the higher levels of the population pyramid. The majority of the dependant population receives informal care, but the population of informal carers is decreasing and ageing. These facts may result in decrease of family support to elderly people and people with disabilities, and therefore demanding new paradigms to provide support for their independent living. Telecare can help health and social care service providers to meet the challenges of an ageing society, but these systems can sometimes fail to provide a positive user experience, due to poor design or poor implementations.

AGEING POPULATION

Responding to the demands for better healthcare raised by an ageing population can increase the cost pressure at a time when healthcare spending is already on the rise. In 1970, the healthcare related spending of the Organization for Economic Co-operation and Development (OECD, www.oecd.org) countries averaged 5 percent of GDP. This increased to 7 percent in 1990 and exceeds 10 percent in Germany, Sweden, Switzerland and the United States. More than 75 percent of all OECD health spending is publicly financed. Based on an assessment of experiences, analysis of underlying issues and a review of evidence, the OECD recommends that to control the increasing pressure we will need to implement automated health data systems, and strategies making use of new technologies and improved quality of care through better information.

The European Commission encourages EU member-states to seek a balanced status among the detected needs of providing quality care and social services to citizens- being compliant to standards, containing costs at a national level, and managing services at a local level. A key ambition is better care services at the same or a lower cost. Human factors and the user experience related to the delivery of health and social care to individuals within the home or a wider community, with the support of systems enabled by ICT, is a complex and in most dimensions, a largely unexplored area.

It involves a large number of influencing elements, including the establishment of human confidence, device setup, configuration, calibration and maintenance, data collection, user procedures, cultural issues such as the use of language and illustrations, the organization of the care provisioning process and communication with diagnostic systems and carers, human communication and confirmation and decision making, the presentation medium and accessibility issues. In addition, as telecare services may be required both inside and outside of the home, usability aspects relating to the specifics of mobile environments and equipment and service use need to be covered. Last but not the least, these services will largely be used by older, impaired and disabled people and should be designed accordingly.

Telecare services

Telecare should clearly be distinguished from telemedicine, which is customarily defined as the use of ICT to support cooperative work between health professionals: a business to business service. For the purpose of our work and in accordance with TR 102 415 [1], the following definition applies for telecare: “Telecare is the provision of health and social care services to individuals, within or outside of their homes, with the support of systems enabled by ICT.”

More than 75 percent of all OECD health spending is publicly financed. Based on an assessment of experiences, analysis of underlying issues and a review of evidence, the OECD recommends that to control the increasing pressure we will need to implement automated health data systems, and strategies making use of new technologies and improved quality of care through better information.

The main aim of telecare is to reduce the need for hospitalization and institutionalization and refers to cases where services are provided to an end user; it can thus be classified as a kind of business to consumer service. In a historical perspective, medical treatment, cure and care until the mid 1900s used to be provided by trained (or at least, experienced) physicians within the client's home; family and neighbours often acted as nursing and supportive staff. During the development of modern life of the 20th century, this healthcare model has changed quickly and dramatically. Medical care is nowadays most often care unit centric, often requiring access to advanced medical equipment. A general practitioner's visit to the client's home has become an unusual service.

There is no denying the fact that in the 1990s, digital technology enablers (infrastructures, terminals and services) became available to the mass market. At present, demographic changes, limited resources, high user expectations, globalization and technology are transforming medical and social care systems in many countries. The penetration of ever smarter devices connecting to mobile communication networks and the World Wide Web through fixed and mobile Internet, combined with society oriented, Europe wide initiatives, health and social care service providers' support, evidence of the existence of demographic and economical feasibility enablers, accepted changes in the delivery of health and social care services and the progress achieved in the area of medical technologies, pharmaceuticals and disposable products have together facilitated the deployment of telecare services.

Our approach

We have introduced user experience guidelines addressing trust, user interaction (including usability and accessibility) and service aspects, applicable to the research, design, development and deployment of telecare services. The work, co-funded by the European Commission and EFTA, is performed in European Telecommunications Standards Institute (ETSI) and is entering its final phase of development. Here it deserves a mention that ETSI is an independent, non-profit organization, based in Sophia Antipolis in France, whose mission is to produce telecommunications standards for today and future. In our approach to telecare services, personal monitoring, security management, electronic assistive technologies and information services are used to support personal health and well-being. The overall methodology, used to produce the ETSI Guidelines (EG), consists of three main components: the approach and structure of the document itself; the bibliographical review of related scientific, technological or standardization references; and the procedures followed by the team to identify and document the guidelines.

Several approaches were considered and were carefully analyzed for structuring the guidelines:

(i) The Human Factors Approach

The Human Factors approach would require the guideline clauses of the EG to be divided into five main sections,
with each section addressing a major human factors topic, which are:

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