The logical end point of decentralization is to provide as much care as possible in the home. In many developed countries, telehealth services that provide a virtual link between patients and doctors are already making tentative steps into the mainstream. These hold the promise of supporting people to stay at home, rather than going into hospital or residential care. According to UK telehealth provider Appello, postponing entry into care for one year saves £26,000 (US$32,000) in non-care costs.
Such solutions do rely on a good-quality broadband infrastructure being in place to start with. Sweden is one of the world’s best connected countries, currently working towards giving 90% of its citizens a 100MB internet connection by 2020. Municipalities are now looking to capitalize on this, with digital homecare solutions that include assistive robots, smart cameras and Facetime-like video capabilities. “If you look at the cost of homecare, it’s expected to increase by 20-25% in Sweden from now to 2020,” says Christian Wictorin, manager of smart city solutions at WSP. “They are asking, how can we make this work for society?” The economic case is persuasive: ITC firm Acreo estimates that countrywide adoption would cut 53 billion kronor (US$8.2 million) from the country’s care bill by 2020. Understandably, this initially met with strong resistance from caregivers and families, suspicious that homecare is being replaced with digital services and perhaps unsettled by the idea of “Big Brother” style surveillance. But users themselves quickly adapt, says Wictorin: “It’s a big barrier before they have tested it. They say, ‘Ah, we don’t want a camera looking at us.’ But when we do evaluation afterwards, we discover that the patients find it much less intrusive than having someone that comes to them at night-time, with a key that can open their door. They actually think cameras are better.”
Another example of pioneering telecare is being trialled at the University of Manchester in the UK. Mira Rehab is a remote physiotherapy software that uses a Microsoft Kinect motion-sensor camera to transform exercises into interactive video games. By gamifying the exercises, the patient is kept motivated throughout the therapy and the clinical staff can monitor their progress remotely. “This is not intended to replace physiotherapists or practitioners, it’s to supplement them,” says Emma Stanmore, a lecturer in nursing who is leading the NHS-backed project. “Traditionally, people come to a clinic to see a physiotherapist, or the physiotherapist goes to their home, but they can’t go that often and it’s time-limited. With Mira, the physiotherapist assesses the person and decides what they need, but they are then able to remotely monitor how they’re doing, in comparison to, say, giving them a leaflet.”
Older people can be fearful of the technology, but Stanmore has found that they respond positively if they’re provided with training and given enough time to get to grips with it. Although it’s early days, feedback from patients indicates that it is already promoting independence: “One lady gave up driving two years ago and she’s now starting again. That’s life-changing for her.”
There are many digital solutions that attempt to engage patients in their own health, from wearable fitness trackers to myriad smartphone apps that monitor heart rates, blood sugar or sleep cycles, remind people when to take their medication, or simply encourage them to follow healthy eating plans or to drink enough water. “We’re becoming a culture that expects there to be an app for everything, so why wouldn’t healthcare use the same sort of technology to become part of our daily lives?” points out Simon Kydd, global lead for healthcare for WSP. Mobile technology should also improve diagnoses: “It enables long-term measurements of the body’s activity, rather than relying only on measurements taken in an anxious state at the hospital.”
For now, the majority of telehealth services make it easier for patients and their human doctors to communicate. But in the future, it’s likely that artificial intelligence will be involved at some point in the process. There are many start-ups now seeking to harness the mighty data-processing power of computers to develop new drugs or identify patterns in diagnoses. The French division of SoftBank Robotics has even developed a 140cm-tall humanoid robot called Romeo, intended to be “a genuine personal assistant and companion”, who will help with daily tasks, and learn users’ behaviour so that they can identify unusual patterns.
All of this will comprise a major transformation in healthcare, which will inevitably meet resistance and raise questions of data protection, privacy and the appropriate role of robot carers. But society has already demonstrated great capacity to adapt to technological change. And given the scale of the demographic challenge facing societies around the world, we can’t afford to dismiss possible solutions in any field, from more connected buildings to new social models and technologies. “There’s no magic bullet but we’re going to have to leverage technology to ensure that our ageing population can receive the care that they need,” as Michael Witecki, a senior healthcare engineer based at WSP’s innovation centre in Boulder, Colorado, puts it. “We can’t build fast enough, we can’t afford to keep building, and we don’t have enough doctors.”
Words by Stephen McGrath
Article originally published on www.the-possible.com