Telemedicine Telehealth and Telecare 2010

Technology in healthcare : telemedicine,
telehealth and telecare

March 2010
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BOOKS/REPORTS
Organisation for Economic Co-Operation and Development. Directorate for

Employment, Labour and Social Affairs
Achieving efficiency improvements in the health sector through the
implementation of information and communication technologies : final report.
Paris : OECD, 2010 Web publication
This report presents an analysis of OECD countries’ efforts to implement
information and communication technologies (ICTs) in health care systems. It
provides advice on the range of policy options, conditions and practices that policy
makers can adapt to their own national circumstances to accelerate adoption and
effective use of these technologies. The analysis draws upon a considerable body of
recent literature and in, particular, lessons learned from case studies in six OECD
countries (Australia, Canada, the Netherlands, Spain, Sweden, and the United
States), all of which reported varying degrees of success deploying health ICT
solutions. These ranged from foundational communication infrastructures to
sophisticated electronic health record (EHR) systems.
http://ec.europa.eu/health/eu_world/docs/oecd_ict_en.pdf
Great Britain. Department of Health

Whole Systems Demonstrators : an overview of telecare and telehealth.
London : DH, 2009 Web publication
The Whole System Demonstrator (WSD) programme is a two year research project
funded by the Department of Health to find out how technology can help people
manage their own health while maintaining their independence.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_100946
Great Britain. Department of Health.

Telecare services for older people.
This briefing is part of the Department of Health's prevention package, a key
component of the government's strategy for an ageing society. The package aims
to raise the focus on older people's prevention services and encourage their use,
ultimately improving older people's health well-being and independence.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@pg/documents/digitala
sset/dh_103148.pdf
Other documents in the 'Prevention package for older people' collection on the DH website:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_103146
European Commission
Telemedicine for the benefit of patients, healthcare systems and society.
Brussels : European Commission, 2009 Web publication
The European Commission has published a new staff working paper on telemedicine
which adds further detail to the 'Communication’ on telemedicine published
November 2008. The new paper gives more detail of the consultation phase that
was undertaken in preparation of the initiative, the policy context and the relevant
legal aspects. The document also provides examples how wider deployment of
telemedicine can affect individual patients, healthcare systems and society.
Commission Staff Working Paper ; SEC(2009)943 final (June 2009)
http://ec.europa.eu/information_society/newsroom/cf/document.cfm?action=display&doc_id=622
Foundation for Assistive Technology and Great Britain. Department of Health.

Research & Development Directorate
Research and development work relating to assistive technology
2008-09 : presented pursuant to section 22 of the Chronically Sick and
Disabled Persons Act 1970.
This annual report covers the research and development work carried out by or on
behalf of any government department in relation to equipment that might increase
the mobility, activities and independence or well being of disabled people and those
with long-term conditions.
http://www.dh.gov.uk/en/Researchanddevelopment/A-Z/DH_062674
Ipsos MORI
Lancashire & South Cumbria Cardiac Network
Cardiac telemedicine in primary care : delivering benefits for patients
and the NHS in Lancashire & Cumbria : a report for commissioners.
NHS North West, [2009] HOHLA:HIA (Nhs)
http://www.lsccardiacnetwork.nhs.uk/uploads/files/cardiac/key_documents/local_documents/report
s/Cardiac_Telemedicine.pdf
ISBN: 9780755959846
Beale, Sophie, et al.
York Health Economics Consortium
Evaluation of the Telecare Development Programme : final report.
Edinburgh : Scottish Government, 2009 Web publication
The evaluation of the Telecare Development Programme, commissioned by Joint
Improvement Team and undertaken by York Health Economics Consortium (YHEC),
was launched at the Telecare/Telehealth Conference on 24th February 2009.
http://www.jitscotland.org.uk/downloads/1235404195-
B59058%20Final%20Report%20low%20res.pdf
Appendices:
http://www.jitscotland.org.uk/downloads/1235404260-B59058%20Final%20Appendices%20p1.pdf
Executive summary:
http://www.jitscotland.org.uk/downloads/1235404306-
B59058%20Executive%20Summary%20p1.pdf
ISBN: 9780763744502
Barrick, Ivan J.
Transforming health care management : integrating technology strategies.
London : Jones and Bartlett, 2008 HOHLA:HIA (Bar)
Brownsell, Simon
Care Services Improvement Partnership. Telecare and Learning and
Improvement Network
Supporting long term conditions and disease management through
telecare and telehealth : evidence and challenges.
London : CSIP, 2008 Web publication
http://www.icn.csip.org.uk/_library/Resources/Telecare/Support_Materials/Briefing_-
_Telehealth_SB_Final2.doc
Web publication
Care Services Improvement Partnership. Integrated Care Network

A summary of Lord Darzi's review of the NHS.
London : CSIP, 2008 Web publication
These four papers from the CSIP Networks provide an overview of Lord Darzi's
recently published review of the NHS, 'High quality care for all', and relevant
information for network members on integrated care and commissioning, care
closer to home (in relation to telecare and housing), and a summary of key issues
arising from the strategic health authority responses.
http://www.dhcarenetworks.org.uk/Integration/icn/Topics/Browse/NationalPolicy/NHSNextStageRevi
ew/?parent=4922&child=3844
ISBN: 9781857175745
Liddell, Alasdair, et al.
The King's Fund
Technology in the NHS : transforming the patient's experience of care.
London : The King's Fund, 2008 HOHLA:HIA (Kin)
Technology is widely used in many areas of life, and the NHS Next Stage Review
highlighted the role that technology can play in improving health outcomes. However,
the use of everyday technologies such as email and online booking systems is poor in
the health service. This report aims to improve the uptake by analysing the main
barriers to adoption and suggesting measures to overcome them. It sets out an ideal
scenario for the use of health care technology and the potential benefits to patients.
Using examples from other sectors, it makes recommendations at national and local
level to encourage the use of technology. [Introduction]
http://www.kingsfund.org.uk/publications/kings_fund_publications/technology_in_the.html
Beech, Roger and Roberts, Diane
Social Care Institute for Excellence
Assistive technology and older people.
London : SCIE, 2008 Web publication
Research Briefing ; 28
http://www.scie.org.uk/publications/briefings/files/briefing28.pdf
JOURNAL ARTICLES
Sarhan, Firas
Telemedicine in healthcare 2 : the legal and ethical aspects of using new technology.
Nursing Times 2009; 105 (43): 18-20 (3 November 2009)
This article explores the legal and ethical issues that nurses need to consider when planning,
designing and implementing telemedicine. It considers key issues such as patient confidentiality,
privacy, data security and transmission, and outlines key points for practice. 1 table 26 refs.
[Abstract]
http://www.nursingtimes.net/nursing-practice-clinical-research/students/using-interprofessional-
learning-in-practice-to-improve-multidisciplinary-working-/5008024.article
Fitzpatrick, Jane and Fry, Elescha

Information and communication technologies to support patients with long term
conditions.
Nursing Times 2009; 105 (42): 14-16 (27 October 2009)
This one part unit explores how nurses can harness technologies to provide efficient and effective
care for patients with long term conditions. It also examines the key issues nurses should consider
when developing such a programme and looks at some examples of existing systems. 1 fig. 1 table
13 refs. [Abstract]
http://www.nursingtimes.net/nursing-practice-clinical-research/information-and-communication-
technologies-to-support-patients-with-long-term-conditions/5007770.article
Firas, Sarhan
Telemedicine in healthcare 1 : exploring its uses, benefits and disadvantages.
This first in a two-part series on telemedicine in healthcare outlines the background and context for
using this technology. It discusses the various levels of telemedicine and its different possible
applications in healthcare, and examines the advantages and disadvantages. 1 table 21 refs.
[Abstract]
http://www.nursingtimes.net/nursing-practice-clinical-research/telemedicine-in-healthcare-1-
exploring-its-uses-benefits-and-disadvantages/5007796.article
Cooper, Kath and Doughty, Kevin

Preliminary results of a medical telecare pilot in Wrexham.
Journal of Assistive Technologies 2009; 3 (3): 36-42 (September 2009)
A pilot project was initiated in Wrexham in North Wales with two groups of patients suffering from
chronic obstructive pulmonary disease (COPD). One group was provided with a commercial
telehealth system (HomMed Genesis) while the other received a medical telecare service involving
standalone vital signs peripherals and a phone call from a respiratory nurse who collected data and
entered them into a spreadsheet. After four months of monitoring, the outcomes were analysed for
both groups and were found to be largely similar both in terms of the interventions, and the
perceived quality of life benefits for the patients. A cost benefit analysis showed that the savings to
the NHS exceeded the project costs by about £9,000 thanks mainly to a reduction in the number of
exacerbations exhibited by the patients. It is recommended that this form of telecare may greatly
increase the independence of people with a chronic disease or long-term condition and that further
studies need to be initiated to determine which measurement regime is most suitable. 2 figs. 7
tables [Abstract]
ap Dafydd, G. Ellen, et al.
Evaluation and value for money analysis of a new telecare service from a user
perspective.
Many telecare services will in the future rely on service users to subsidise their existence through a
charging policy. This will reduce the level of uptake, and hence the economic efficiency, unless
services are shown to offer value for money. As part of a wide audit and evaluation of telecare
provision in Gwynedd, service users were asked both about the value of the service to them and to
their families. The responses showed that the service was perceived to be valuable to the vast
majority of services users, but even more so to their families. Most thought that telecare played a
valuable role in helping them to maintain their independence. When asked about the financial value
of the service, more than half felt that it was worth *4.50 per week or more without a dedicated
response team. The majority would not wish to pay extra for a response team. 5 figs. [Abstract]
Darkins, Adam and Sanders, Jay H.

Remote patient monitoring in home healthcare : lessons learned from advanced users.
Journal of Management and Marketing in Healthcare 2009; 2 (3): 238-252 (July 2009)
Most healthcare organisations will face the challenge of having to reengineer their legacy care
delivery systems to accept health information technologies (HIT) that will improve their efficiency
and effectiveness. Current facility-based healthcare provision that was designed to cope with acute
exacerbations of disease and to undertake clinical procedures will need to adapt and restructure to
cope with the logistic and economic burden of caring for aging populations with a preponderance of
chronic healthcare needs related to conditions such as diabetes, heart failure, chronic obstructive
pulmonary disease and high blood pressure. HIT is revolutionising the way in which healthcare is
being provided and promises to make the home into the preferred place of care. The advantages of
this new paradigm are high levels of patient satisfaction, early intervention for disease progression,
support for care-givers, and economic benefits associated with reduced hospitalisation rates. This
paper reviews the underlying drivers to adopt home telehealth, an advanced HIT application, and
the related clinical, technological and business challenges this presents. It explains why this is an
essential strategy that forward-thinking healthcare providers must adopt. Given the associated
social and cultural changes the adoption of home telehealth will bring, a vision is outlined of how the
routine monitoring of health indices will promote health and not simply stave off disease. 4 tables 19
refs. [Abstract]
Mickel, Andrew
In the realm of the sensors.
Community Care 2009; (1775): 28-29 (18 June 2009)
Telecare systems can make savings while helping people to stay independent for longer, but it is
best to start off small. [Introduction]
http://www.communitycare.co.uk/Articles/Article.aspx?liArticleID=111841
Axelrod, Lesley, et al.

The reality of homes fit for heroes : design challenges for rehabilitation technology at
home.
Journal of Assistive Technologies 2009; 3 (2): 35-41 (June 2009)
It is widely accepted that rigorous rehabilitation exercises after a stroke can help restore some
functionality. However for many patients, this means exercises at home with minimal, if any,
clinician support. Technologies that help motivate and promote good exercises offer significant
potential but need to be designed to realistically take account of real homes and real lives of the
people who have had a stroke. As part of the Motivating Mobility project, we carried out a series of
visits to homes of people living with stroke and photographed their homes. In contrast to many
utopian smart home scenarios, the elderly of today live in homes that were built as homes fit for
heroes' but have been evolved and adapted over time and present significant challenges for the
design of in-home rehabilitation technologies. These challenges include the uses and repurposing of
use of rooms, attitudes to and uses of existing technologies, space available in the home, feelings
about different spaces within homes and individual preferences and interests. The findings provide a
set of sensitivities that will help shape and frame ongoing design work for the successful deployment
of rehabilitation technologies in real homes. 28 refs. [Abstract]
Griffiths, Julie
Telemedicine helps COPD patients' care.
GP 2009; 47 (24 April 2009)
Four practices in West Lothian, Scotland may have experienced a future model for caring for people
with long-term conditions. The practices were involved in a small-scale telemedicine pilot for
managing patient care remotely that began in March 2008 with 30 COPD patients. This February,
NHS Lothian announced a roll-out of the pilot to 400 people across its area. [Introduction]
Laird, Sue
Living made easy.
Nursing Standard 2009; 23 (31): 18-20 (8 April 2009)
Specialist nurses are using telemedicine to transform services for patients with epilepsy in remote
rural and island communities. They provide solutions to social as well as medical problems.
[Summary]
Lowe, Charles
Beyond telecare : the future of independent living.
Journal of Assistive Technologies 2009; 3 (1): 21-23 (March 2009)
This paper is an argument for a more holistic approach to independent living. Telecare and
telehealth, as these services are being delivered in practice, risk increasing the isolation of
vulnerable people. Though undesirable in its own right, this isolation often leads to depression,
which in turn typically increases the costs of medical treatment substantially. The resultant lack of
mental stimulation also creates the conditions for earlier onset of dementia. Finally, loss of identity
exacerbates both depression and lack of stimulation. To overcome these problems, the technology
should also be used to encourage users of telecare and telehealth to maintain and grow their
engagement with wider society and to promote - rather than restrict - their mobility. 8 refs.
[Abstract]
Wakefield, Bonnie J., et al.

Outcomes of a home telehealth intervention for patients with heart failure.
Journal of Telemedicine and Telecare 2009; 15 (1): 46-50
We evaluated the efficacy of two telehealth applications, delivered by telephone and videophone, for
improving outcomes of patients following hospital discharge for an acute exacerbation of heart
failure. The outcomes measured were patient self-efficacy, satisfaction with care and knowledge of
and compliance with prescribed medications. At hospital discharge, patients were randomly assigned
to either control (usual care), telephone or videophone groups. Study nurses contacted the
intervention patients each week for 90 days after discharge. A total of 148 patients were enrolled:
49 were randomized to usual care, 52 to the videophone intervention and 47 to the telephone
intervention. At 90 days, 126 patients (85 per cent) had completed follow-up; at 180 days, 109
patients (74 per cent) had completed follow-up. There were no significant differences between the
groups in medication compliance, self-efficacy or satisfaction with care. The intervention group
patients were more likely to have had their medications adjusted during the 90-day intervention
period. Knowledge scores improved in the intervention group patients, although these scores were
lower at enrolment compared to the control group. It is possible that routine monitoring of
symptoms by the study nurses led to medication adjustments and accounted for the intervention
patients' significantly delayed time to readmission relative to the control patients. 5 tables 14 refs.
[Summary]
Faife, Dyllis
Reflections on developing an assistive technology/telecare service as a model for change
management, creative thinking and workforce development.
Housing Care and Support 2008; 11 (4): 34-41 (December 2008)
This paper explores the wider significance that the development of telecare services has for social
care in addition to supporting people to remain independent at home. It considers the impact of this
particular development as a model for change management as a model for developing a social care
workforce 'fit for the future'. The paper takes a whole systems, integrated approach to service
development and highlights important issues such as infrastructure, management, the capacity to
innovate and workforce development. The paper emphasises that the development of new skills and
new ways of thinking are even more important that the technology itself and that partnership is an
essential ingredient for success. The context and content of this paper are informed and influenced
by the experience of developing a new worker role, the assistive technology support worker, in
Norfolk; and from the experience of designing and implementing a successful county-wide
technology-based service. 6 refs. [Abstract]
Doughty, Kevin, et al.
Telecare, telehealth and assistive technologies : do we know what we're talking about?
Housing Care and Support 2008; 11 (3): 36-41 (November 2008)
The development of telecare services in the UK has been supported by grants from the respective
governments of Scotland and Wales, and by the Department of Health in England. New services are
being established, sometimes to operate alongside existing community equipment services and
community alarm services. Elsewhere they are embracing a wider range of services including
rehabilitation, intermediate care and health services designed to reduce use of unscheduled care
services. This paper discusses the difficulties in understanding the scope of telecare services, and
the definitions of services that will need to be confirmed if service users are to be able to choose
appropriately if offered direct payments. Two service models are offered, one of which uses
telehealth as an umbrella term to cover all telecare, e-care and m-care, and telemedicine, where the
former includes all such services offered in the service user's home, including those of a medical
nature. The second model views telecare alongside assistive technologies and telemedicine as one of
three technology groups designed to make people more independent, or to bring care closer to
home. There is significant overlap between the three groups, which justifies the introduction of a
new term - ARTS (assistive and remote technology services) - to describe this area of support. 2
figs. [Abstract]
Kinsella, Audrey and Doughty, Kevin

Home telehospice : new tools for end-of-life care services.
Journal of Assistive Technologies 2008; 2 (4): 47-50 (December 2008)
Hospices offer people a place to die with dignity, but their numbers are so limited that most people
die in hospital or in a care home. This paper describes the development of a telehospice toolbox
which it is believed will help to replicate hospice care in the homes of people in the community, thus
enabling many more people to be supported in the way that they want at the end of their lives. The
toolbox contains a number of different technology items that can be selected on a per-patient basis
to allow a dying patient and their family the best quality of life during their most stressful
experience. 2 figs. 1 table 1 ref. [Abstract]
Dang, Stuti, et al.

Care coordination assisted by technology for multiethnic caregivers of persons with
dementia : a pilot clinical demonstration project on caregiver burden and depression.
We evaluated a care-coordination project assisted by a screen-phone to support and educate
caregivers. A total of 113 caregivers of home-dwelling veterans with dementia were recruited to the
study: 72 were white, 32 were African American and nine were Hispanic. Caregivers were assessed
for burden, depression, coping, quality of life, knowledge and satisfaction. None of the outcome
measures changed significantly after twelve months. Forty care-recipient and caregiver dyads
responded to the twelve-month telephone satisfaction survey. The respondents were more satisfied
with the care-coordination (90 per cent) aspect of the programme than the education (77 per cent)
or the monitoring (50 per cent). The pilot project suggests that care coordination aided by screen-
phones may be a useful model for caregiver support in a managed-care setting. A systematic study
is now required. 1 fig. 2 tables 20 refs. [Summary]
21st century healthcare for vulnerable older people : Hull leads the way in telehealth.
British Journal of Healthcare Computing and Information Management 2008: (November 2008)
New and exciting technology is to help the older generation of the city of Hull in Northeast England
live longer, healthier and happier lives in their own homes through the creation of an electronic
gateway accessible through digital TV. The award-winning STREAM Personal TV project has been
formed by key partners from across Hull, including the City Council, who funded the project, and the
National Health Service. It will provide vulnerable older people with access to locally relevant and
personalised information, online support and communication through their television, providing a
platform for key services such as healthcare provision. [Introduction]
Moore, Alison
Notes from a small island.
Health Service Journal 2008; 118 (6131): 18-20 (6 November 2008)
Some islanders 'would rather be crippled than go to the mainland for an operation'. Alison Moore
reports on the goldfish-bowl world of remote island healthcare. [Introduction]
Blake, Holly
Mobile phone technology in chronic disease management.
Nursing Standard 2008; 23 (12): 43-46 (26 November 2008)
Mobile phones are being used to improve nurse-patient communication and monitor health
outcomes in chronic disease. Innovative applications of mobile technology are expected to increase
over time in community management of cancer, heart disease, asthma and diabetes. This article
focuses on mobile phone technology and its contribution to health care. 28 refs. [Summary]
Botsis, Taxiarchis, et al.

Home telecare technologies for the elderly.
There are many home telecare technologies which have been developed specifically for chronic
diseases and there are some more generic technologies that could be used as well. For home
telecare, the equipment must be certified, the operational routines must be reformed, the
infrastructure must be in place, the market must be prepared, the health authorities must be
convinced that the system will work and the cost-effectiveness must be evaluated. Organizational
and societal changes, such as cost reduction policies and an aging population, are the main driving
forces for the development of home telecare, especially for elderly patients. At the moment there is
no holistic model for scientific evaluation from different perspectives (e.g. clinical, legal, technical).
We suggest that more research on home telecare and its effects needs to be conducted, in order to
provide evidence for optimizing the use of this promising technique. 36 refs. [Summary]
Hoang, Doan and Lawrence, Elaine

An Active Grid infrastructure for elderly care.
We propose a technique in which elderly people can be monitored non-intrusively. The information is
kept in an 'active' health record which becomes alive when attention or action is necessary
concerning the condition of the elderly person. The proposed system consists of three main
components: a sensor/actor loop, sensor records and associated active services, and a Grid
middleware platform. Information is captured in realtime within a collaborative health-care Grid. The
Grid connects elderly people, caregivers and medical service providers in ways that reduce
unnecessary calls on expensive medical services through an intermediate local service centre (which
can be virtual) assisted with Internet communications and monitoring technologies. The proposal
should support preventive health-care programmes for reducing the cost of caring for the elderly. 6
figs. 10 refs. [Summary]
Paynter, Mike
Evaluating use of telemedicine within a minor injury unit.
This article outlines a pilot study using telemedicine to assess chest pain in a minor injury unit. It
discusses how the pilot was set up and the benefits of telemedicine for both patients and staff.
Bridgwater Community Hospital has recently won an award from the Community Hospitals
Association for its use of cardiology telemedicine in its unit. 5 refs. [Abstract]
King, Peter
Williams, Gareth
Individualised telecare and electronic assistive technologies to support vulnerable people.
Telecare services are now available across the UK but few have the technical expertise necessary to
prescribe and provide the bespoke solutions that may be required to support more complex cases.
This paper describes a range of innovative approaches to extending the application of existing
telecare systems to cater for the needs of people facing different physical or cognitive challenges.
They include new, easy-to-operate alarm switches, interfaces for bed/chair occupancy and property
exit alarms, and a range of hybrid arrangements that can result in automatic alarms for the
management of various environmental emergencies. Examples are provided for hypothermia,
hyperthermia, poor air quality and noise alarms. [Abstract]
Rainbow, David
Telecare services report for Herefordshire
Telecare services in Herefordshire have taken off at a considerable pace since the provision of the
Preventative Technology Grant. Over 600 people have received a service, the majority of them
having a Lifeline and a number of sensors linked to a remote alarm monitoring centre. The service
has proved popular with service users and their carers who report significant reductions in anxiety
and levels of concern across a number of areas. The service has also reduced the need for
homecare, residential and nursing home placements. Annual savings of nearly *0.5 million have
been achieved with the greatest contribution from the use of technology to improve medication self-
management without needing check calls. The service is being mainstreamed and expanded through
team expansion and improved training. 4 tables [Abstract]
Webb, Chris
Telecare puts cardiology expertise in the heart of Southampton's primary care.
British Journal of Healthcare Computing and Information Management 2008: (July 2008)
Chris Webb of Southampton Primary Care Trust outlines how how a cardiac telemedicine service
enabled the Trust to monitor patients' weight and ECGs in primary care and provide a more
accessible and timely care for the patients. [Introduction]
http://www.bjhcim.co.uk/features/2008/807002.htm
Bradbury, Pam
Improving care for patients with long-term conditions through the use of technology.
Journal of Care Services Management 2008; 2 (4): 309-314 (July/September 2008)
The author examines the use of technology in improving the care of people with chronic conditions.
The topics covered include access to self-care advice, continuity in out of hours care, remote
monitoring of patients, and providing patient information via digital television. 5 refs [BRD]
Corte Franco, Georgina

Non-invasive monitoring of the activities of daily living of elderly people at home : a pilot
study of the usage of domestic appliances.
We conducted a feasibility study of a system for non-invasive monitoring of subjects at home.
Electrical activity was recorded from room lights and from electrical domestic appliances; this was
translated into the probability of physical activity or a particular activity of daily living [ADL].
Thirteen volunteer subjects were monitored for a period of 6.4 months (range three to eight). The
mean age of the subjects was 80 years and they all lived alone at home; one had moderate
Alzheimer's disease. A one-week validation was carried out to ascertain whether the recorded
activity actually occurred. The results showed that daily and nocturnal activity could be well
differentiated. The probability of having eaten, taken a bath and going to the toilet could be
calculated each day. Eating was the most accurately measured ADL; toileting and bathing results
were less accurate. The system appears to be a promising component of home telecare. 3 figs. 2
tables 19 refs. [Abstract]
Social Care Institute for Excellence

Assistive technology for older people.
Community Care 2008; (1735): 34-35 (14 August 2008)
This article focuses on the potential use of assistive technology (telecare and telehealth) in social
care for older people. [BRD]
http://www.communitycare.co.uk/Articles/2008/08/14/109115/proven-practice-assistive-
technology.html
Willems, Danielle C. M., et al.
The effectiveness of nurse-led telemonitoring of asthma : results of a randomized
controlled trial.
Journal of Evaluation in Clinical Practice 2008; 14 (4): 600-609 (August 2008)
RATIONALE, AIMS AND OBJECTIVES: The aim of the study was to evaluate the effects on, and the
relationship between, asthma symptoms, asthma-specific quality of life and medical consumption of
a nurse-led telemonitoring intervention compared with regular care in asthma in the Netherlands.
METHODS: One hundred and nine asthmatic outpatients (56 children; 53 adults) were randomly
assigned to the treatment arms (twelve-month follow-up). The control group received regular
outpatient care, while the intervention group used an asthma monitor with modem at home with an
asthma nurse as the main caregiver. Clinical asthma symptoms and medical consumption were
measured by using diaries. Asthma-specific quality of life was measured by the (Paediatric) Asthma
Quality of Life Questionnaire. RESULTS: The study population generally represented mild to
moderate asthmatics. The results show improvement in follow-up, but no statistically significant
difference between the groups was observed. Moderate to high correlations were found within the
outcome parameters, but the most remarkable was the low and statistically significant correlation
between asthma-specific quality of life (daily functioning) and the self-reported beta-2 agonists.
CONCLUSION: Overall, the telemonitoring programme evaluated in this study did not significantly
decrease asthma symptoms or medical consumption, or improve asthma-specific quality of life. The
results showed that a telemonitoring programme on its own is not a guarantee of success. The
patients' perception of asthma-specific quality of life (daily functioning) should be a key element in
asthma telemonitoring programmes. 1 fig. 2 tables 26 refs. [Abstract]
Agomo, Chijioke
Telemedicine : improving health services through technology.
Pharmaceutical Journal 2008; 281 (7512): 103-105 (26 July 2008)
This article has looked at the clinical effectiveness of telemedicine, its acceptability to patients and
providers and the cost and relative cost-effectiveness. There is evidence to show that telemedicine
can be applied to various clinical settings with a great chance of improving the services being
provided. It is hoped that through the application of telemedicine, healthcare will be highly
decentralised, at reduced cost. Telemedicine has been found to be suitable in ophthalmology,
pathology, psychiatry, dermatology, pharmacy, the provision of medical and nursing services to
remote areas, and in situations where there are limitations of specialist services and skills. However,
in some areas it will be a complete waste of resources, particularly in cardiology, orthopaedics and
microbiology, where it is presently not cost-effective or practicable. More research, evaluation and
funding is needed if telemedicine is to be a success story. 26 refs. [Conclusion]
Botsis, Taxiarchis
Hartvigsen, Gunnar
Current status and future perspectives in telecare for elderly people suffering from
chronic diseases.
We reviewed the literature on home telecare for elderly patients suffering from chronic diseases.
Articles published between 1990 and 2007 were identified via the PubMed database. The literature
search yielded 485 papers. After reviewing the title and abstract from each, 54 were selected for
closer examination. They were published in 37 different journals. The number of papers increased
from one in 1997 to 14 in 2006. The diseases in which home telecare had been used were diabetes
(14 studies), heart failure (13 studies), cognitive impairment (dementia and/or Alzheimer's disease,
ten studies), chronic obstructive pulmonary disease (five studies), chronic wounds (four studies) and
mobility disabilities (four studies). Patients were generally satisfied with home telecare, but they
preferred a combination of home telecare with conventional health-care delivery. Health-care
professionals were positive about telecare. Users felt that on many occasions telecare led to a
reduction in costs due to time savings and avoidance of travelling. Even though there were
important benefits from home telecare, there are organizational, ethical, legal, design, usability and
other matters that need to be resolved before widespread implementation can occur. 2 figs. 2 tables
65 refs. [Abstract]
Bulik, Robert J.
Human factors in primary care telemedicine encounters.
Traditional delivery of primary care takes place in a face-to-face transaction between provider and
patient. In telemedicine, however, the transaction is 'filtered' by the distance and technology. The
potential problem of filtered communication in a telemedicine encounter was examined from a
human factors perspective. Patients with and without experience of telemedicine, and providers who
had experience of telemedicine, were asked about patient-provider relationships in interviews and
focus groups. Seven themes emerged: initial impressions, style of questions, field of view, physical
interaction, social talk, control of encounter and ancillary services. This suggests that
communication can be improved and better patient-provider relationships can be developed in a
primary care telemedicine encounter if attention is paid to four areas of the interaction: verbal, non-
verbal, relational and actions/transactional. The human factors dimension of telemedicine is an
important element in delivery of health care at a distance, and is one of few factors over which the
provider has direct control. 9 refs. [Abstract]
Powell, John, et al.

A systematic review of networked technologies supporting carers of people with
dementia.
We conducted a systematic review of the effectiveness of networked ICT interventions in supporting
carers of people with dementia. Five bibliographic databases were searched and a total of 1,456
abstracts were identified as potentially relevant. From these we identified 15 papers describing five
interventions: ComputerLink, AlzOnline, Caring for Others and two studies from the REACH project
(TLC and CTIS). The interventions reviewed were multifaceted with elements of networked peer
support. Outcomes were inconsistent but suggested that the interventions had moderate effects on
improving carer stress and depression. Treatment effects were found to vary with care-giver
characteristics such as ethnic groups, formal support and baseline burden. Further evaluation is
needed in robust trials with good follow-up. 1 table 15 refs. [Abstract]
Horton, Khim
The use of telecare for people with chronic obstructive pulmonary disease : implications
for management.
Journal of Nursing Management 2008; 16 (2): 173-180 (March 2008)
AIM: To evaluate the telecare service offered by home care teams to patients with chronic
obstructive pulmonary disease [COPD]. BACKGROUND: The use of telecare aims to support older
people in remaining independent at home, reducing hospital admissions and improving the quality of
life for older people and their informal carers. In the redesign of managed care for people with COPD
using telecare, an evaluation of the implementation process is necessary. METHOD: A focus group
with home care teams and social care staff was conducted. Six case studies identified by nursing
staff were used to examine key issues relating to telecare implementation. FINDINGS: The
experience and expectation in telecare, the usability of equipment, and changes in practice can
impact on COPD care. Case studies highlight that the rapid access to care, an increased sense of
personal safety and security, and the continuity of care are perceived as benefits. However, the
equipment was perceived as not 'user friendly' and bulky. CONCLUSION: It is important that any
service redesign to include telecare is evaluated and targeted at its specific role. IMPLICATIONS FOR
NURSING MANAGEMENT: Partnership working has to be negotiated, and leadership roles include
addressing tensions and motivation within the team. 27 refs. [Abstract]
Brennan, David M. and Barker, Linsey M.

Human factors in the development and implementation of telerehabilitation systems.
Telemedicine services must be designed and implemented with the users in mind. When conducting
telerehabilitation factors such as age, education and technology experience must be taken into
account. In addition, telerehabilitation must also accommodate a range of potential patient
impairments, including deficits in language, cognition, motor function, vision and voice.
Telerehabilitation technology and treatment environments should adhere to universal design
standards so as to be accessible, efficient, usable and understandable to all. This will result in
improved access to a wider range of telerehabilitation services that will facilitate and enhance the
rehabilitative treatment and recovery of people living with varying levels of injury, impairment and
disability. 2 figs. 27 refs. [Summary]
DelliFraine, Jami L. ane Dansky, Kathryn H.
Home-based telehealth : a review and meta-analysis.
We conducted a systematic review to identify studies on the effect of home telehealth on clinical
care outcomes. The search was restricted to peer-reviewed publications (published between 2001
and 2007) about studies conducted in home or residential settings. The search yielded 154 potential
articles and dissertations. A total of 29 articles met the inclusion criteria and were included in a
meta-analysis. The weighted mean effect size for the overall meta-analysis was 0.50, and the z-
statistic was 3.0, indicating that telehealth had a moderate, positive and significant effect (P < 0.01)
on clinical outcomes. Subanalyses also indicated positive significant effects of telehealth for some
disease categories (heart disease and psychiatric conditions), but not others (diabetes), patient
populations and telehealth interventions. Overall, the meta-analysis indicated that telehealth
positively affects clinical outcomes of care, even in different patient populations. 3 tables 32 refs.
[Summary]
Oudshoorn, Nelly
Diagnosis at a distance : the invisible work of patients and healthcare professionals in
cardiac telemonitoring technology.
Sociology of Health and Illness 2008; 30 (2): 272-288 (March 2008)
Although patients are often absent in discourses on telemedicine, many telemonitoring applications
constitute a new medical practice in which patients are expected to play an active role. The paper is
based on a study of the use of one specific telemonitoring device, an ambulatory ECG recorder
introduced to diagnose infrequent irregularities of the heart rhythm. It seeks to examine all the
invisible work it takes to produce patients who are active and responsible as participants in the
diagnosis of their heart problem. In particular, I address the question of how we can understand
that individuals who are anxious about their heart function manage to adopt the role of 'diagnostic
agent'. This research shows that, although many patients managed to become competent users of
the new technology, there are important patterns of selective use patients invented to integrate the
technology in their daily life. In conclusion, the paper suggests that most patients were able to
adopt the role of diagnostic agent not only because of their individual motivation but because of
their location in the socio-technical network of this technology, in which the invisible work of home-
care nurses and physicians at the telemedical centre made all the difference. 36 refs. [Abstract]
Finch, Tracy L., et al.

Future patients? : telehealthcare, roles and responsibilities.
Health and Social Care in the Community 2008; 16 (1): 86-95 (January 2008)
Increasing use of information and communication technologies is said to be transforming health
care. Telehealthcare enables medical consultations to be conducted between patients and health
professionals across different locations. Such technologies imply new relationships between patients
and health professionals. This study aimed to understand how policy and practice in relation to
telehealthcare suggests new conceptualisations of 'the patient'. In-depth semi-structured interviews
(n=38) were conducted with key informants from across the UK, known to have involvement or
interest in telehealthcare from a variety of perspectives: health professionals (n=eleven), patient
advocates (n=seven), telemedicine experts (n=six), policy-makers (n=four), administrators
(n=four), researchers (n=three) and technologists (n=three). Interviews were conducted either in
person or over the telephone, and were audio-recorded. Data were analysed thematically with
ongoing cross-validation of data interpretation between members of the research team. The results
indicated divergent views about the role of the patient, although accounts of patients becoming
'educated self-managers', taking on a more active role in their healthcare, were predominant. Beliefs
about the impact of telehealthcare on patients were focused on perceived 'priorities' such as access,
location of services, confidentiality and choice; however, there remains little understanding of the
trade-offs that patients are willing to make in the context of technologically mediated health care.
The results also highlight ideas around how patients relate to technologies; the extent to which
technologies might fragment care and medicine in new or unexpected ways, and participation and
absence of patients in decision-making about policies and services. The results of this study have
important implications for the ways in which relationships between health professionals and patients
are managed in practice, and raise important questions for public participation in service
development. 1 table 28 refs. [Abstract]
Saphire Consortium
Intelligent healthcare monitoring for hospital and home care.
British Journal of Healthcare Computing and Information Management 2007: (December 2007)
The Saphire Project has developed an intelligent healthcare monitoring and decision-support system
based on a 'semantic interoperability' platform that integrates wireless medical sensor data with
hospital information systems. The EU-funded project (IST-27074) is run by a consortium of eight
organisations from Turkey, France, Germany, Romania and Greece, and co-ordinated by the Middle
Eastern Technical University Software Research and Development Centre in Ankara, Turkey. The
project is designed to address the problem of the increasing workload of healthcare services due to
the increasing numbers of elderly people. This system is designed to continuously monitor patients
and deliver alarms to medical personnel whenever needed. 2 refs. [Introduction]
Saphire Project website:
http://www.srdc.metu.edu.tr/webpage/projects/saphire/index.php
Dinesen, Birthe, et al.

Telehomecare technology across sectors : claims of jurisdiction and emerging
controversies.
International Journal of Integrated Care 2007; 7: (21 November 2007)
PURPOSE: The purpose of this study was to explore and identify inter-organisational and inter-
professional controversies that emerge when telehomecare technology is implemented across
healthcare sectors. THEORY: A combined inter-organisational and inter-professional perspective
constitutes the conceptual framework for this study. METHODS: The case study approach was
applied as the overall methodology of the study. A triangulation of data collection techniques was
used in order to provide multiple sources of evidence for exploring and identifying controversies
(documents, participant observation, qualitative interviews, focus group interviews). FINDINGS:
During the design and implementation phases of a telehomecare system, several types of
controversies emerged as part of the inter-organisational and inter-professional agenda. These
controversies involved competing claims of jurisdiction, controversies over knowledge technologies,
or differences in network visions and network architecture. DISCUSSION AND CONCLUSIONS: The
identification of such controversies and differences in the design and implementation process of the
concept of home hospitalisation for heart patients by means of telehomecare technology can
contribute to the uncovering of new knowledge. These issues should be taken into account when
initiating a telehomecare project and implementing telehomecare technology. Technology in a
network and across inter-professional relations poses a challenge to this new field. There is a
particular need to precisely define the claims of jurisdiction, and the accompanying controversies
that can arise related to knowledge technologies, network visions and network architecture. 1 fig. 2
tables 33 refs. [Abstract]
http://www.ijic.org/publish/articles/000307/article.pdf
Barlow, James, et al.

A systematic review of the benefits of home telecare for frail elderly people and those
with long-term conditions.
We have conducted a systematic review of home telecare for frail elderly people and for patients
with chronic conditions. We searched 17 electronic databases, the reference lists of identified
studies, conference proceedings and websites for studies available in January 2006. We identified
summaries of 8,666 studies, which were assessed independently for relevance by two reviewers.
Randomized controlled trials of any size and observational studies with 80 or more participants were
eligible for inclusion if they examined the effects of using telecommunications technology to (a)
monitor vital signs or safety and security in the home, or (b) provide information and support. The
review included 68 randomized controlled trails (69 per cent) and 30 observational studies with 80
or more participants (31 per cent). Most studies focused on people with diabetes (31 per cent) or
heart failure (29 per cent). Almost two thirds (64 per cent) of the studies originated in the U.S.,
more than half (55 per cent) had been published within the previous three years. Based on the
evidence reviewed, the most effective telecare interventions appear to be automated vital signs
monitoring (for reducing health service use) and telephone follow-up by nurses (for improving
clinical indicators and reducing health service use). The cost-effectiveness of these interventions was
less certain. There is insufficient evidence about the effects of home safety and security alert
systems. It is important to note that just because there is insufficient evidence about some
interventions, this does not mean that those interventions have no effect. 2 figs. 2 tables 12 refs. 1
appendix [Abstract]
Davey, Julia
Telemedicine as support for chronic disease management.
British Journal of Healthcare Computing and Information Management 2007: (September 2007)
With the decline in numbers of doctors and experienced nurses and the consequent increasing
pressure on the acute sector, coupled with increasing patient expectation, Julia Davey, RGN
Community Respiratory Nurse Specialist at Central Surrey Health, asks how can the growing
problem of chronic disease management be addressed? [Introduction]
Carlisle, Daloni
Remote control.
Health Service Journal 2007; 117 (6072): 6-7 (6 September 2007 Suppl.)
Small-scale telehealth projects have made considerable savings but have never been mainstreamed.
Successful NHS and local authority pilot bidders have now been decided and providers are
tendering. Critics are concerned about the ethics and safety of giving so much of the remote care
duties to I.T. providers. [Summary]
Telehealth outomes : a sythesis of the literature and recommendations for outcome

indicators.
Journal of Telemedicine and Telecare 2007; 13 Suppl. 2: 1-38
Evaluation is a critical element in proving the value of a telehealth application, yet ironically it
remains a poorly performed activity. Within evaluation, identifying and measuring specific outcomes
of a telehealth application are also crucial and, similarly they remain poorly performed activites. This
report represents the culmination of a Canadian project called the National Telehealth Outcomes
Indicators Project (NTOIP), which was designed to provide national guidance on specific outcome
indicators in four categories (quality, access, acceptability and cost). The work was conducted in
four phases: strategic preparation, a systematic literature review, a national experts workshop and a
consensus process. The NTOIP project was the first of its kind and successfully met its goals. A total
of 34 approved telehealth outcome indicators were identified and described in an evidence- and
consensus- based manner. Twelve were thought to be most relevant for common useU.[Summary]
Hebert, Marilynne A., et al.

Analysis of the suitability of 'video-visits' for palliative home care : implications for
practice.
We conducted a retrospective chart review to estimate the extent to which palliative home care
visits could be carried out using videophones and to explore factors that might inform the eligibility
criteria for video-visits. Four hundred palliative home care health records of deceased clients from
2002 were randomly selected from the Health Records Office in one Canadian health region. One
visit was randomly selected from each of these health records. Three hundred and fifty-four visits
were coded, and based on professional nursing judgment, the coder estimated whether video-visits
could have been carried out. Approximately 43 per cent of the visits were considered appropriate for
video-visits. The results suggest that four factors may inform eligibility and decisions about a client's
suitability for video-visits: diagnosis (cancer versus non-cancer), low Edmonton Symptom
Assessment System (ESAS) score, no care-giver present, number and types of interventions
required. Patients with a cancer diagnosis were more likely to be suitable for video-visits, which
suggests that disease trajectory, rather than diagnosis of 'palliative', may be more influential in
determining the care required and appropriateness of videophone use. 1 fig. 4 tables 11 refs.
[Summary]
Dinesen, Birthe, et al.
Implementation of the concept of home hospitalisation for heart patients by means of
telehomecare technology : integration of clinical tasks.
International Journal of Integrated Care 2007; 7: (30 May 2007)
PURPOSE: To explore how the implementation of the concept 'home hospitalisation of heart patients'
by means of telehomecare technology influences the integration of clinical tasks across healthcare
sectors. THEORY: Inter-organisational theory. METHODS: The case study approach was applied.
Triangulations of data collection techniques were used: documentary materials, participant
observation, qualitative and focus group interviews. RESULTS: The clinical decision-making and task
solving became multidisciplinary and integrated with the implementation of telehomecare and,
therefore, complex in terms of the prescription and adjustment of patient medicine. Workflows
between healthcare professionals across sectors changed from sequential to collective client flows.
Pre-existing procedures for patient care, treatment, and responsibility were challenged. In addition,
the number of tasks for the district nurses increased. Integration in the clinical task-solving area
increases fragmentation in the knowledge technologies in a network perspective. CONCLUSIONS:
Implementing the concept of 'home hospitalisation of heart patients' by means of telehomecare
technology will result in a more integrated clinical task-solving process that involves healthcare
professionals from various sectors. Overall, the integration of clinical tasks between hospital and
district nursing will result in a direct benefit for the heart patients. 1 fig. 2 tables 28 refs. [Abstract]
http://www.ijic.org/publish/articles/000285/article_print.html
TeleMed and eHealth '06 : transforming the patient experience.

Journal of Telemedicine and Telecare 2007; 13 Suppl. 1: 1-67
This supplement contains papers from the Telemedicine and eHealth Forum held at the Royal
Society of Medicine in November 2006. The 27 articles focus on improving the patient experience
through telemedicine and telecare and include: 'Patient satisfaction with a nurse-led, telephone-
based disease management service in Birmingham' by P. Azarmina and J. Lewis, pp 3-4; 'The virtual
consulting room : a Web-based application to bridge the divide between primary and secondary
care' by Pasquale Berlingieri, et al.,pp 5-7; 'Understanding the implementation and integration of e-
health services' by Frances S. Mair, et al., pp 36-37; 'An economic evaluation of a Web-based
national patient record system' by T. Mladek, et al., pp 40-42; 'A trial of telecare for supporting care
to the elderly in Liverpool' by A. A. Reeves, et al., pp 48-50; and, 'Improved communication
between hospital and general practice using online patient discharge summaries' by Paul Scullard et
al., pp56-58. [BRD]
WEB RESOURCES
FAST - Foundation for Assistive Technology

http://www.fastuk.org/home.php
Telecare Local Improvement Network - DH Care Networks

http://www.dhcarenetworks.org.uk/independentLivingChoices/telecare/
Telecare Services Association

http://www.telecare.org.uk/
Telemedicine Information Exchange

http://tie.telemed.org/default.asp
TEIS: UK Telemedicine and E-health information service: all activities

University of Portsmouth - contains some telehealth projects
http://www.tkn.port.ac.uk/jsp/search/activities.jsp?field=all&sortby=alpha
WSDAN - Whole System Demonstrator (LTC) Action Network

http://www.wsdactionnetwork.org.uk/
Reading lists
Reading lists are available at:

http://www.kingsfund.org.uk/resources/information_and_library_service/readinglists ;
email library@kingsfund.org.uk ; telephone 020 7307 2568
Age discrimination Maternity services

Alternative providers in primary & community Mental health: black & minority ethnic
health services communities
Care services for older people: current issues. Mental health in London
Clinical governance Mental health services for young people
Clinician-led change NHS timeline: selected key documents
Commissioning new providers NHS workforce
Electronic patient records Older people and mental health
Encouraging healthy behaviour Partnerships & integration
End of life care Patient choice : information to enable choice
of provider and drive service improvement
Enhancing the healing environment
Payment by results
Ethnic elders
Point of care: improving patients’ experience
Ethnic health: an introduction to ethnic health
issues Practice based commissioning
Ethnic health issues for primary care Primary care and public involvement
Future of social care funding Public health in England
Health inequalities Refugee health care
Improving care for long term conditions Technology and the NHS patient
Inpatient mental health services Transforming quality, creating value
Intermediate care Workforce diversity in health & social care
Leadership in the NHS
London: an introduction to London health
issues

Telemedicine Telehealth and Telecare 2010

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Great Britain. Department of Health.

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Care Services Improvement Partnership. Integrated Care Network

Fitzpatrick, Jane and Fry, Elescha

Cooper, Kath and Doughty, Kevin

Darkins, Adam and Sanders, Jay H.

Axelrod, Lesley, et al.

Wakefield, Bonnie J., et al.

Kinsella, Audrey and Doughty, Kevin

Dang, Stuti, et al.

Botsis, Taxiarchis, et al.

Hoang, Doan and Lawrence, Elaine

Corte Franco, Georgina

Social Care Institute for Excellence

Powell, John, et al.

Brennan, David M. and Barker, Linsey M.

Finch, Tracy L., et al.

Dinesen, Birthe, et al.

Barlow, James, et al.

Telehealth outomes : a sythesis of the literature and recommendations for outcome

Hebert, Marilynne A., et al.

TeleMed and eHealth '06 : transforming the patient experience.

FAST - Foundation for Assistive Technology

Telecare Local Improvement Network - DH Care Networks

Telecare Services Association

Telemedicine Information Exchange

TEIS: UK Telemedicine and E-health information service: all activities

WSDAN - Whole System Demonstrator (LTC) Action Network

Reading lists are available at:

Age discrimination Maternity services

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