Telehealth and Telecare are both advocated as a means of delivering social health and services effectively and economically in peoples home. By using these two technologies, monitoring activities and safety, providing virtual home visiting, and activating reminder system can be done quickly. Therefore, most of the consumers are elderly people .This paper compares Telehealth and Telecare technologies and highlights the popularity of each technology. The literature review of the paper has focused on defining each technology and looking to the users satisfaction from each technology. The SWOT analysis has been used to demonstrate the strength, weakness, opportunities and threats of each technology. To find the popularity of each technology some questionnaire forms has been used which distributed between 40 elderly people of Toronto by random. The results show that people between ages 66-75 are the highest consumers of telehealth and telecare and more satisfied. The overall analysis showed that telecare satisfaction percentage is higher than telehealth satisfaction percentage however it is recommended for more advertisement for telecare products due to facing lots of people who were unfamiliar with telecare products. Future recommended research is an investigation on elderly and telehealth and telecare technology and focusing on telecare and telehealth interactions and requirements.
INTRODUCTION
1.1- Introduction
During the past few years there have been growths in possibilities of technical developments in smart environments. Developing the life quality for young, elderly and disabled people has become more and more vital task for todays societies all around the world.
What is a smart home? According to the (Smart home, 2009)
The terms smart homes, intelligent homes, home networking have been used for more than a decade to introduce the concept of networking devices and equipment in the house. According to the Smart Homes Association the best definition of smart home technology is: the integration of technology and services through home networking for a better quality of living Other terms that are related to smart homes are aware house changeable home, attentive house and ambient intelligence These terms are used to emphasize that the home environment should be able to respond and modify itself continuously according to its diverse residents and their changeable needs
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According to (Allen, 2001) Assistive technologies (AT) which can be known as a branch of Smart homes is applied to any kind of system or device, which has been designed to help disabled or elderly to overcome their individual disabilities. In other word Assistive technologies are broad range of devices and services that are designed to increase the functional abilities of disabled people. Assistive technology enables disabled and elderly people to become independent and participate more actively in their daily life.
Telecare and Telehealth are two effective extensions of smart home technology as the concern is to use of technology to monitor the health of the users. Both telecare and telehealth systems rely on telephone lines or broadband internet as means of transferring information from the source which can be house to the receiver who maybe a doctor or a nurse.
1.2 -Background
Telehealth, which is a part of information and communication technologies introduced for delivering health care services and it is considered as a way to answer lots of essential changing in healthcare systems in current years. Many of telehealth projects are taking place to targeting countryside and remote the population. So far, different kinds of telehealth applications have been implemented in developing countries and have shown the outcomes. However telehealth technologies have increased the availability of technology and telecommunication around the world.
As (Gagnon et al , 2006) argue in their research, the execution of telehealth still faces major barriers, typically barriers related to structural, organizational and finally professional imperatives. Furthermore the structural barriers related to licensure, information technology developments and settlement of telehealth. Also, issues about health care organizations are also important to ensure the telehealth adoption. More over the adoption of telehealth technology by an individual is considered to be difficult which is determined by a large set of physical factors.
According to (Perry et al, 2009) Telecare also is a part of telecommunication and technology which can provide care and support people in their homes. There are three kinds of people who can benefit most from telecare service, elderly people, disabled and those with mobility impairments. The use of this technology is determined to reduce the inappropriate or unnecessary admissions to the hospital especially for falls or any kind of accidents at home.
To increase the benefits of telecare, it is necessary to know the opinion of the users about this technology. As (Crump, 2010) discusses, telecare services provide opportunities for technology to replace people in some roles. Although it is a rapid and effective technology
for supporting services but it is necessary to have some training before using this technology. In other word this technology can be useful only if you know how to use it correctly otherwise it could be harmful.
According to Nation health executive (NHE, 2006), by increasing an ageing population and prevalence of chronic disease a challenge for the management and integration of health care is growing. The need for new care models and new technologies for long term illness is more visible and clinical partnerships and networks supports the care strategies within home Environment.
Therefore emerging telecare and telehealth have the potential to enable long term medical care in peoples own homes.
Many studies indicate that telecare and telehealth technology has a positive effect on the clinical outcomes, user independencies, reduction in emergency visits and lower admission to hospital.
However there is a lack of evidence to execute that these two technologies are cost effective-whilst there is a belief about assistive technologies exists that they should help to reduce costs in long terms and supports for faced problems.
1.3- Research
The main focus of this research is to comparing telecare and telehealth and their consequences in medical business. The aim of this paper is to find out the popularity of these two technologies between elderly and finding their good and bad consequences on people, society and business.
According to ( Sixsmith ,2000)
Many people in the field trial reported enhanced feelings of safety and security, which could help to stimulate independence and help them to remain living in their own homes The monitoring system increased the care choices available to elderly people and supported and enhanced the cares role
Technical perspective of telehealth and telecare concerns the use and development of ICT based systems. The marketplace of these technologies continues to see rapid developments. Therefore telecare and telehealth can make a real difference to the lives of elderly and disabled people.
In this research the author is going to define telehealth and telecare separately and talking about the advantages and disadvantages of each of these two technologies as well as cost analysis of them due to the several studies over the years executes that these two systems achieved a considerable cost saving. Furthermore telecare and telehealth satisfaction is going to evaluate.
1.4- Research Aim and objectives
The major significance of this study is to probe deeply in to the comments and analysis of several authors conducting their research in the subject of telecare and telehealth, to identify evidence of advantage or flaws and weaknesses that may or may not exist in the present exploitation of the services and related devices technology as well as evaluating the comments of elderly about telecare and telehealth, and finally evaluating the telecare and telehealth satisfaction between elderly. Therefore, the major objectives of these investigations are:
* To provide necessary response to questions arising from the comparisons between telecare and telehealth.
* To evaluate the popularity of telecare and telehealth between elderly and possible flow that may or may not exist in the present use of telecare and telehealth
* To criticize and analyze the results.
* To make some recommendation for future development of telecare and telehealth
REVIEW OF LITERATURE
Telecare and Telehealth ; as a part of the collection smart home play a major role in the comfort and quality of life of all people. This role is even more important when these technologies and services are contributed to a special group called elderly.
(BBC news, 2008) produces program about chronic disease patients and elderly to use telehealth and telecare products at home and monitor their health by mobile phones. As declared in (BBC , 2008)
Patients with high blood pressure and chronic lung disease will be initially recruited to test new technology that allows them to measure their blood pressure,and oxygen levels at homeThe readings will be sent via mobile phone into a central computer and collated into an online health record that can be accessed by both the patient and their GP.
As BBC announced ; it is expected that project of telehealth and telecare to be expanded between 1500 patients by 2012. However the question is that how well do elderly people know these products?
2.2 -What is meant by Telehealth?
As American (telecare, 2009) argues
Telehealth is a revolutionary medical tool that affordably expands and improves health care services for patients regardless of age, race, gender or economic status Generally Elderly patients living in remote areas and individuals suffering from a chronic disease are best suited for telehealth services
In another word telehealth plays an integral role in the management of long-term conditions.
As healthcare professionals begin their health services from pilot to mainstream provision your telehealth partner must help you step by step to go through the transition. These services are usually provided when a Tunstall telehealth projects is started. Tunstall is a founder member of the continua health Alliance. Their policy of ongoing development means that products specification and appearance could change without prior notice.
In general, telehealth is general term that includes many various activities. Many of components of telehealth integrated have been presented in the Telehealth Pyramid (figure 2.1).
Figure 2.2.1 The Telehealth pyramid, ( Elford , 2004)
Although all parts of the pyramid should be coordinated to gain the best result, each section could exist independently. On the basis of past successful telehealth experience, the components of telehealth should be placed in one physical center. In Figure 2.2.1 which has illustrated Telehealth levels in Health care system of USA, various parts of the pyramid will be delineated from the bottom to top. The size of each section could hardly present the number of people involved.
The base section is 1-800 health call center. This center is active day and night for 24 hours, 7 days a week. The staff working in this section includes: health professionals, for most parts nurses. When clients call in , the staff would respond major health questions, assist patients with minor health problems and if needed guide the patient to the proper healthcare resource.
The next layer (Medical Data and Telemetry call center). Has been set up similar to 1-800 call center, however in spite of receiving telephone calls, would also receive telemetry and medical information such as: blood pressure, EKG, Blood sugar and other types of blood chemistry, weight and pulmonary function test. This information could be sent on a daily basis or upon urgent request.
The next section, Internet Health Information and Education provides health information websites for healthcare professional and patients. The patients website includes information on different topics, response to common health questions to choice of e-mailing a health professional on a special health problem, chatting with groups for the patients with special conditions. The health professional website has more complete information for various health conditions and provides access to the health education endeavors.
The Tele-education layer is using all the telecommunication technologies and information to provide health education for both patient and health professionals. Some of the website functions of the former level could be used in this section.
According to (Elford ,2004) The next layer includes Teleconsultation, Telenursing and Telehome care.
Teleconsultation is defined as the provision of any medical services occurring between physician and patient such as: Telepsychiatry, Teledermotology, and Tele ENT
All activities mentioned involve a health professional providing a health service a patient.
Finally the last layer of pyramid (administrative center, research unit and training center) includes a number of key components that are crucial for the proper operation and long term maintenance of the telehealth. This center would manage and coordinate the following endeavors: a research unit will help in the design implementation and evaluation of telehealth project s and could also be involve d in technical test projects or evaluation. At last, a curriculum in Telehealth and a place for hands on training could be providing for the students.
( Elford ,2004) believes that Professionals (physicians, nurses, technicians) can also take non-credit courses could also take non-credit courses for education or training. Some organizations such as (Department of National Defense) contracting the training center, could provide health training to their personnel.
Whilst the telehealth pyramid of NHS (national health center) , which belongs to the UK , shows using telehealth at three levels. Looking through the pyramid from bottom to top will show that 70 -80 % of the population are supported self-care which is possible by web based- tools, and self monitoring.
At the second level which is high risk disease, some home monitoring is possible but the availability of doctors and nurses are necessary at this case.
And finally at the third level of the NHS telehealth pyramid , because of the highly complex case management , home monitoring of patient, using assistive technology and computerized decision support system can be using all together.
Figure 2.2.2 , NHS Pyramid , (Procter , Azarmina , 2007)
Telehealth can connect people with one another and by various health organizations as follow:
* Wireless mobile devices
According to (Hinz ,2010), wireless mobile devices in this study will only be utilized in the context of healthcare. these devices include: consumer mobile phones, medical devices that work in the next generation of consumer mobile
phone, and medical devices operates within a home premise and can transmit information through land-line , mobile phone or internet.
* Basic mobile phones
According to Hinz ,(2010) over the last ten years, the most accepted technology in day to day communication is the mobile phone. Even the most outdated mobile phone can make and receive both calls and text-messages .text messages and specially 3G mobile internets is a suitable media for the health system when we try to connect to patients. Also the appointment reminder alert is a very valuable tool.
* Remote care clinical devices
(Remote medical care, 2010) argues that In relation to vital signs, medical devices are different in size and complexity and the interaction with ill people. Many of these medical devices have software that could operate as a PC and mobile phone. High performance semiconductor chips which are highly integrated will expand personal medical devices. Whether these devices are a blood glucose meter, digital blood pressure meter, blood gas meter, digital plus/heart rate monitor or a digital thermometer are five system level blocks that are common for each device:
* Power battery management
* Data processing and control
* Amplification and A/D conversation of the sensor input
* Some type of Display
* The sensor element(s) itself
These devices are controlled by a handle, which are activated by battery power and using different biosensors and take measurements. The real performance topology of these
blocks is quite different with the sensing, processing and information display demands of the type of meter and the chronic condition it measures.
2.2.1 -Telehealth satisfaction
As (Ellis,2009) argued patient satisfaction influences on patients values and expectations from telehealth services therefore by measuring telehealth satisfaction more information and more positive and negative affect will be gained.
On the other hand according (Ellis, 2009) the researches on patients satisfaction about quality of interactions and telehealth services are pretty low therefore there is more requires going in depth of this topic.
According to the (Clinical evaluation, 2008) which evaluated the telehealth satisfaction from different aspects, most of the users of telehealth were between the ages of 65 to 80. The Pie chart in appendix 2 shows the age dividing in detail. The overall satisfaction level with Telehealth experience shows that 85 % of the users are very satisfied from this technology where only 15 % were satisfied and no one were not satisfied of it. The details of users satisfaction is shown in the pie chart in appendix 3. On the other hand the evaluation shows only 5% of people were disagree about the cost saving of Telehealth whilst 95% were agree about the cost saving. Appendix 4 shows the pie chart of the agreement and disagreement.
2.2.2 Consequences of Telehealth for the patients
* Immediate utilization of care specifically for the patient who live in rural environments.
* Patients receive care and health from a distance and do not have to go to doctors office to receive attention from their health provider.
* Early detection to reduce emergency room visits and hospitalizations
* To discharge early from hospital
* Patient and family can have access to care from the comfort of their home.
* Patients anxiety is reduced.
* Increased conformity and ownership to their individual health care plan
* Old patients can stay independent rather than going in to assisted living situation
* Patients feel thesaurus to take part in their care program.
* Increased patients satisfaction in received care
In general Telehealth is a very effective tool to handle patients that need the most care and attract the most cost, especially patients with chronic and terminal conditions. The following patient conditions were successful with Telehealth program:
1- Chronic disease which includes:
* HIV Aids
* Cancer
* Asthma
* Diabetes
* Congestive heart failure
2- Elderly patient cares which includes:
* Post stroke
* Therapies
* Post operative states
* Medical compliance
3- General care which includes
* High risk pregnancy
* Wound care
The Telehealth advantage for healthcare providers, administrators and institutions are:
* It can improve quality of care and clinical outcome
* It can increase productivity for healthcare provider
* It is a cost saving method that can advance profitability and business growth
There are also some other advantages for doctors and nurses can schedule for patient visits without leaving the office. In this way productivity of the number of patients that can be visited per day could increase. Clinicians can expand their office geographically. Patients can be visited regularly. Healthcare will be able to spend more time with patients and can monitor and regulate their patients care better. Healthcare providers have the advantage of attracting managed care contracts and also will be able to manage cost effective service.
(Darkins and Cary, 2000) believe that since healthcare expenses are rising, providers while maintaining good quality care and patients satisfaction .lower their costs. The related technologies help providers to produce their own effective healthcare by maximizing their human and capital resource.
2.3 -What is meant by Telecare?
Telecare is to monitor a patients real-time emergencies and his life style changes from a distance in order to manage the risks associated with independent living.
Telecare is needed since:
As (Camarinha-Matos, Afsarmanesh, 2004) argue It is a highly flexible tool which can be employed by the needs of new users. This technology can be utilized in learning disabilities, physical disabilities and mental health. Telecare can contribute to independent living and quality of life for people and their family significantly.
(Tunstall , 2007) believes that The major activity of Telecare services is to manage Telecare assets more effective to guarantee that service remain more productive.
According to (Tunestall ,2007)
Telecare overlay has been developed to allow the effective implementation of radio Telecare sensors into supported housing communities It enables the monitoring of wandering and bed occupancy as well as environmental issues such as smoke, flood and gas within a sheltered setting
(Tunstall, 2007) also argues that the telecare overlay system includes a telecare manager unit and a radio receiver, this equipment is added to the existing communicable vision system and enables staff using a variety of sensors receive alarm calls. These receivers are located around scheme. When a receiver receives the radio signals of a sensor, it will be forwarded to the communicational vision system and then raises the alarm call on the handset carried by onsite staff. Therefore, the onsite staff will be able to talk to the resident. The system can alternately sound on alarm at the responding center.
According to James Buckley, the chief executive officer of Telecare times in (Tunstall , 2007) , Telecare will make the cares able to go back to their work, will promote these services to more number of audience, and support people who have learning disabilities.
In another word Telecare describes any services that bring health and social care directly to a user, generally in their homes, supported by information and communication technology. It covers social alarms, lifestyle monitoring and Telehealth (remote monitoring of UTIA signs) for diagnosis, assessment and prevention. Telecare covers a wide range of equipment (detectors, monitors alarms, pendants and etc) and also services for monitoring call centers and response.
( Camarinha-Matos , Afsarmanesh ,2004) believes that In the UK Telecare alarms acts as a mediator through call center, however in the US you are able to purchase devices that connects directly to emergency response services.
The sample lists of Telecare devices are include:
* Safety confirmation phones
* Movement /non-movement sensors
* Fire/smoke alarms
* Food / water alarms
* Window/door sensor
* Bed/ chair occupancy sensor
* Falls sensor
* Wrist worn wellbeing monitors
* Automatic lighting sensor
* Carbon monoxide sensor
* Temperature range sensor
* Medication reminder sensor
1- Devices for predicting problem:
This prediction depends on software that receives signals from sensor and analyses the frequency and severity of monitored event such as minor falls.
2- Devices that reduce the chance if problems occurring:
For example a bad sensor can prevent falls by turning a light on when a person gets out of bed. This helps because does not need to move around and search for the light switch in the dark room. if the person does not return to bed it can raise an alarm. If the helps received quickly, problems do not rise.
3- Devices that mitigate harm
These devices send an alert signal to a call center, therefore, a help can arrive quickly before harm is done .an extreme temperature device is activated when the temperature rises quickly or reaches a low point .
4- Personal safety confirmation:
(Camarinha-Matos , Afsarmanesh ,2004) argues that The owner of this phone based device pushes a bottom on an agreed time everyday to inform the call center that they are well and alive. This considered as an alternative for independent people who are not interested in wearing a pendant alarm button or those who may fall and become unconscious and cannot pull an alert themselves.
2.3.1- Telecare satisfaction
There were two types of telecare units that were developed. One of them is based on pc setup and video conferencing and another one off- the- shelf video conferencing units. According to (Guillen et al , 2002) there is high satisfaction for the patients who used telecare devices also the medical staff were satisfied due to the improvement in quality of health services.
The result of their research shows that medical staffs believe that telecare system is a trustworthy system for patients and there is low risk for patients while using telecare system. However there are more researches needs to be done in this area because of the short duration of previous experiments.
2.3.2-Consequences of Telecare
* It can help to maintain independence for people
* Safety and confidence could be increased
* It could support careers along with traditional healthcare support and housing initiatives.
* It could ease the transfer from traditional models of residential care to supporting people at home. The pressure on the NHS can be reduced the environmental risks such as fire, flooding, carbon monoxide , natural gas , high and low temperatures and personal risks such as wandering , falling , inactivity , burglary , bogus callers and many more could protect users. (Camarinha-Matos , Afsarmanesh ,2004)
* According to the (department of health ,2010) Telecare could prevent 160.000 people from entering residential care per year, indicating potential cost saving of 20 Billion pound .
2.4 -Comparison of Telecare and Telehealth
A high increment in the cost of care or nursing homes is the main reason of inventing new methods of supporting people in their homes. Since according to (Doughty et al ,2007,p.6) the dependency ratio which is defined as( number of working people to those who are retired) is about to fall from 4:1 to 2.1:1 in the next 40 years, so the demands for the care services will increase and services that are based on technologies can replace.
(According to Doughty et al ,2007, p.7)
The term telecare was selected to cover all electronic technologies of a preventive or supportive nature because it had the necessary buzz and because it implied a modular approach and a need for a developing telecommunications infrastructure
As (Doughty et al, 2007, p.7) argued
Although the fundamental purpose of the technology is to avoid unscheduled care incidents and, in particular, the management of long-term conditions, it can support Independence because it is capable of overcoming the need for people to move prematurely into a nursing home environment Such technology would appear to be a medical application of telecare, which would be consistent with the new definition of telecare described above… However, remote and regular (but not continuous) vital
signs monitoring may be fundamentally different to existing UK telecare systems because the purpose is to collect data rather than offer an automated alarm
Whilst in the USA, the remote vital signs monitoring system are known as telehealth. The term of telehealth in the Europe has been the Umbrella term which is used for grate range of technologies which includes telemedicine as well.
The telehealth and telecare umbrella model will show the alternatives for adoption or rejection.
As the figure 2.4.1 shows there are three components of telehealth exist which shows a growing range of assistive technologies. Also there are some disabled facilities has covered .covering number of comparatively expensive fixed assistive technologies like level access showers can be known as effective versions. However consequent removal while the service user moves on is more difficult with the result that the venture is left in the property. This means that following architects to follow the lifetime homes and using free access for the standards is necessary. Telehealth somehow has higher weight than telecare because health is necessary for everyone but maybe not everyone need care.
Figure 2.4.1 Telehealth Umbrella model (Doughty et al ,2007, p.9)
As figure 2.4.2 shows telecare is term which is used for all defensive technologies which are using electronics, telecommunication and information system. Thats why they can cover some applications such as alarms through monitoring the vital signs either in the home or on the move thus when a term such as Telehealth covers all forms of information and medical monitoring then the advanced form which is telecare could be expanded from environmental to medical areas. In another word According to (Doughty et al ,2007,p.8)
the use of community / social alarm system to support independent living as a form of telecare was both a consequence of change in community care but also it produced a valuable service that did not have doctors and nurses as the gatekeeper
Figure 2.4.2 umbrella model of telecare (Doughty et al ,2007,p.9)
2.5 -Impact of telecare and telehealth on cost saving
There are lots of comparative studies in telehealth and telecare which demonstrate the economic benefits of these technologies. These studies show that improved access to suitable healthcare services, increased patients satisfaction and cost savings. Many of pre- reviewed researches consistent in finding that telehealth and telecare saves the patients, providers and payers money in compare of traditional healthcare system.
According to (Jennett et al, 2003), Cost saving of telehealth services can be done by reduction in use of hospitals, nursing home services and transport costs. In other word reduction in transporting patients to emergency departments and therefore to physician offices will cause a reduction in cost of emergency department visits.
4.5- SWOT Analysis
Since in primary data , the author couldnt noticed the presented data completely relevant to the research questions and couldnt answer all the objectives of the research therefore she decided to do the SWOT analysis .SWOT Analysis is a kind of evaluation by defining the Strengths, weakness, opportunities and threats of the defined subject.
4.5.1- Telehealth SWOT Analysis
The SWOT analysis of telehealth is focusing on what the strength of the telehealth are, what can be known as the weaknesses, what opportunities telehealth has and finally what are the threats o
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