Telecare Development

1. Telecare Development Meduse Conference 20th September 2007 Nigel Barnes BT Group Chief Technology Office

2. Telecare Definition The use of Information and Communication Technology (ICT) to support independent living for older, frail and disabled people

3. 3 Generations of Telecare • 1st generation • Social alarms - dispersed panic alarm with pendant and pull cords • Addition of passive sensors for auto alerts • An existing care intervention package • 2nd generation • Telecare systems - adaptive, personalised but event driven • Exhibits aspects of reasoning • An emerging care intervention package • 3rd generation • Well-being analysis - pre-emptive, long term trend analysis • Migrates telecare from a crisis safety net to an assessment tool • Will enable intervention outcome measures and optimisation

4. Our research • Intelligent alarms • Proactive alarm to immediate situations • Personalised to individual behaviours/profiles • Wellbeing analysis • Determination of performance of ADLs • Trend analysis of ADLs • Use for preventative care strategies • Holistic care management • Fusion of social and health + ambient and worn • Continuous contextual analysis for preventative care • Pervasive living • Whole population wellbeing strategies • Promotion of healthy living and self management Liverpool Pilot DTI Care in the Community DTI SAPHE

5. 1st Generation Telecare There are now 1.5 million alarm support systems in the UK which use simple technology to provide support to vulnerable people ... … but systems using new technology could provide much better support.

6. Call Centre 2nd Generation Carer Automated alarm escalation to carer Non-invasive home monitoring Automated alerting to client Data capture and intelligent analysis

7. Activity monitoring

8. Event Based Algorithms Door Open Alarm Time • Configurable Event Timings • Currently non-adaptive Front Door

9. Behaviour based algorithms No Room Change or No Activity Lounge Hall Time Kitchen • - Based on Individual’s Profile • Dynamic & Fixed Thresholds Front Door

10. Adaptive Thresholds Inter-event time value Threshold alert • Example using actual client data • Bedroom threshold from 0 to 2 am • Varies between 3.3 and 8.5 hours over 40 week period • Tracks changing client sleeping pattern

11. Liverpool Direct call centre Carer Carer Firewall Telecare platform Voice call (PSTN) Daily summaries Daily summaries Management interface Data server Broadband Encrypted Internet Alert messaging Back office Voice call (PSTN) Messaging server Voice server Monitoringdata Broadband Encrypted Monitored residence RMU Automated Voice Call (PSTN)

12. Example showing typical activity • Client in bed between 11pm and 8:30am

13. Example showing cause for concern • Client leaves dwelling at 10pm and does not return till 3am

14. 3rd Generation Telecare • 3rd generation Telecare is a tool for providing the carer with activity information enabling them to identify significant changes in the general well-being of their client. • Its aim is to enable carers to prevent incidents from occurring in the home. • Shift from response (r-mode) to prevention (p-mode)

15. DTI Centre for Care in Community Led by BT this Centre, by focusing on Telecare, aimed to design and prove a system for continuous monitoring of client health and social well-being in the home.

16. Focus for MEDUSE • Design process and stakeholder engagement • Four groups: • Academics • Technologists • Carers • Service users • Parallel projects: • Domain Specific Modelling (DSM) • Sensor Networks • Intelligent Data Analysis (IDA) • Demonstrator – note not a pilot.

17. Longitudinal Trend Analysis Sense Analyse Display …combining a multiplicity of instrumented data with known human intervention to generate a sophisticated well-being indicator and assessment aid…..

18. Well-being INDEX: HISTORY REGION PREDICTIVE REGION 1st FALL MEDICATIONCHANGE 2nd FALL 100 80 (Without Intervention) 50 20 CAREINTERVENTIONSTARTS STAIR LIFTINSTALLED 10 04 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 00 PERIOD TODAY INTERVENTION LEVEL: None X PREDICTIONTYPE: Without Intervention Mild Medication Change Moderate Accommodation Change Major CALCULATEOPTIMISATION: X Care Well-being Index X Cost (£ per Week) Av Err: 12%

19. What is wellbeing? • Conceptual model development • Led by Andrew Sixsmith • Verhoven model • World Health Organisation (WHO) • Jill Jepson (OT, UEA) • Initial focus on physical conditions • Incorporation of mental state • Socialisation of model with peers and care managers • Positive feedback

21. Person factors Activity Experience Well-being outcome Context factors Well-being concept model

22. Well-being concept model

23. Activities monitored

24. Sensors “tool box” • Wireless connectivity • Self powered, battery and scavenged • Jiffy-bag deployment • Water flow • Gas flow • Power usage • Vibration • Pressure • PIR • Active IR • Telephone usage • Gait analysis • others ….

25. Kitchen sink drainer Back door Master bedroom Double bed Wardrobes Gas Cooker Bath Fridge/ freezer RMU Basin cupboard Lounge Coffee table Landing Bathroom ‘Radio’ chair W.C. Spare bedroom Fireplace Draws ‘TV’’ chair Pile of various objects Sofa & armchairs TV Wardrobes Window sill Sensor locations Client 1 Downstairs plan view 24 sensors installed

26. It’s all a bit fuzzy… • Wellbeing is a fuzzy concept • ADLs and routines are not prescriptive or regimented • Changes and trends are not absolute • Need for easily understandable output • All lends itself to fuzzy data analysis and simple output reporting • Use of “plain English” questions to query the analysis

27. Sleeping Patterns Question: • Are the locations of the sleep-periods within the house changing?

28. The Silence of the Lounge

29. No such thing as too much data…

30. Intelligent Data Analysis interface

31. However, need for simple overview… • RAG rating • Busy-ness index • Is the service user as activity as usual? • Is there any unusual behaviour? • Is there a change that needs looking at? • Ability to drill down in data.

32. Sample ‘Wellbeing’ interface Q3. Sleeping Habits Q4. Eating Habits

33. The mobile care worker

34. Issues • Parallel projects • Each heads in own direction • Diversions of design and ambitions • Academic/technologist led • Need for strong carer input - champion • Technology understanding • Time • Short term pressures vs. long term research • Alarm conditions – liability • Funding

35. Pervasive ICT for wellbeing • Holistic Well-Being Monitoring: • Integration with health monitoring (SAPHE) • Chronic disease management • Enabler for joined up care • Many questions still to be answered: • Low cost ubiquitous sensor devices • Scalable intelligent data analysis • Seamless links to ICRS • Privacy and ethics • Opportunity for continuous objective measurement and support: • Peace of mind for clients and carers • Optimisation of home care services • Timely intervention ahead of crises

36. SAPHE

37. By sensing under normal physiological conditions combined with intelligent trend analysis, SAPHE opens up new opportunities for the UK ICT and healthcare sectors in meeting the challenges of demographic changes associated with the aging population DTI Technology Programme Project Overview • To develop a novel architecture for unobtrusive pervasive sensing to link physiological/metabolic parameters and lifestyle patterns for improved well-being monitoring and early detection of changes in disease.

38. Activity monitoring Social care Home setting Fixed deployment Technology led Activity & physiological monitoring Social care & healthcare Holistic data analysis and intelligence Home & mobile settings Flexible deployment Technology & business drivers Firewall From Telecare…to holistic care NHS Central systems Family Social care providers Health care providers wireless sensor Internet Telecare Platform hub GSM/GPRS/3G OpenZone Wi-Fi

39. £3.3M Collaborative research project co-funded by the DTI Technology Programme • Commenced March 2006 for three years • Liverpool care economy – trial partner • PCT, Social Services, Liverpool Direct Ltd • Trial in 2008 • To increase efficiencies within the PCT • “To be able to do more with what we have.” Chronic condition management Wellbeing and Independence • Combined health and social monitoring • Contextual understanding • New intelligence that adds value to care processes • Trend analysis • Prediction • Support • Reassurance Monitoring in context: Correlation of physiology and daily activities Continuous risk assessment: preventative care and early change detection Information dissemination: Appropriate and timely to carers Ubiquitous non-invasive monitoring infrastructure

40. High Intensity Users (HIUs). Those requiring repeated admission to acute care. 5% Use pervasive healthcare to prevent this group becoming HIUs and move them down the pyramid… Service users Professionals • Non invasive monitoring of activity and physiology • Continuous monitoring – home and away • Reassurance • Independence • Self management • Medication / regime reminders • Education ‘Unwell’ patients. Worsening symptoms and whose condition may require more professional care. 5-10% • Continuous evidence based risk assessment • flagging of early changes in disease state • Reduce acute admissions • Support earlier release • Monitoring in context • Trend analysis • Improve compliance …and better support this group to prevent them moving up. ‘Nearly well’. Managed throughcontact with GPs, community matrons, etc. 70-80% ‘Well’. Self-management. 10% Informal carers Call Centre • Reassurance • Support • Access to wellbeing summaries • Alerted to problems • Manage alerts • Access to monitoring data • Access to records • Escalation to professionals

41. Thank you – any questions? nigel.barnes@bt.com research.bt.com/pict