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Author: Yi-Shin Chen, Yeh-Liang Hsu, Chia-Che Wu, Yen-Wei Chen, Ju-An Wang (2010-04-25); recommended: Yeh-Liang Hsu (2011-04-25).
Note: This paper is presented at the 9th International Conference on Smart Homes and Health Telematics (ICOST 2011), Montreal, Quebec, Canada, June 2011.

Development of the “Care Delivery Frame” for senior users

Abstract

The “Care Delivery Frame (CDF)” presented here integrates two distinctly different applications, the home telehealth system and the remote photo sharing service of digital photo frame, to create a unique information channel for senior users who are not familiar with the operation of computers and Internet. In addition to health data monitoring, children or caregivers can “deliver care” to their seniors not living together by warm messages and thoughtful reminders on the CDF, as well as sharing their feelings, joy, and life experience through photos and video clips. CDF is positioned as the software for providing care and positive emotion to senior users, with the emerging new class of computers – the “Pad PC”, as its major target platform. CDF is the smallest possible home telehealth system that can be established between a single user and his/her care giver. It is our answer to the current difficulties and challenges of home telehealth systems.

Keywords: Gerontechnology, Home Telehealth System, digital photo frame.

1. Introduction

Most developed countries are facing the problem of increasing number of elderly population. The need of health care and management for the elderly is an urgent issue. Home has become the centerpiece of health delivery system today. Intensive monitoring of health parameters in the home environment is necessary for health care and management. Telehomecare, or the more modern term home telehealth, can be defined as “the use of information and communication technologies to enable effective delivery and management of health services at a patient’s residence” [1]. Home telehealth allows patients the dignity of remaining in their own home for as long as possible by providing care that is equal to or superior than approaches that rely solely on health providers coming into the home for scheduled visits [2]. Most home telehealth systems adopt the following sequence for health data monitoring: measurement of various health data, health data transmission, data storage and analysis. Finally medical actions will be taken if necessary. The technical emphasis is on establishing an information channel for health data transmission between homes and hospitals or other home healthcare service providers. The “care” in such systems often refers to professional health care [3]. Although the usefulness of the home telehealth system has been recognized in many studies, and all technologies required are readily available, expectations for its widespread adoption have not been realized. Coughlin also pointed out that, there is a growing awareness of the need for new ways to improve the well-being of older people at home as well as the availability of increasingly affordable technology and computational power, consumer and clinician adoption has been slow [4].

Aging is associated with an increasing risk of isolation [5]. In U.S, there were 27.39% of the 65 years old and over population who lived alone [6]. In addition to transmitting health monitoring data, the essence of “care” to the senior should emphasize more on the care from people in the forms of warm messages, thoughtful reminders, and sharing feelings, joy, and life experience. We need to establish an information channel so that the love ones, children, family members, and care givers can easily “deliver care” to the seniors not living together.

To those users who are familiar with computers and Internet, the PC is the most important and irreplaceable information channel. Information access, interpersonal communication, audio-visual entertainment, shopping, distance learning, and health care, can all be achieved on a PC connected to the Internet. However, there is still no proper information channel for those people who are not familiar with computers and Internet, such as the seniors.

The “Care Delivery Frame (CDF)” presented in this paper integrates two distinctly different applications, the home telehealth system and the remote photo sharing service of digital photo frame, to create a unique information channel for senior users who are not familiar with the operation of computers and Internet. In addition to health data monitoring, children/caregivers can “deliver care” to their seniors not living together by warm messages and thoughtful reminders on the CDF, as well as sharing their feelings, joy, and life experience by displaying photos and video clips remotely on the CDF. Even more applications can be imagined once this information channel to the seniors at home is established, such as entertainment, displaying life information or even commercial ads.

Figure 1. The 4 main functions of the Care Delivery Frame

As shown in Figure 1, CDF provides the following 4 main functions:

(1).    Home telehealth: The basic function of CDF is the home telehealth system. All technical functions of a home telehealth system are built in the CDF. Currently the vital sign sensors that can be connected to CDF are blood pressure meter, blood glucose meter, and weight scale.

(2).    Remote photo sharing: CDF provides a platform for children and caregivers to upload photos and videos clips remotely, and manage the display sequence and timing on the CDF for their seniors not living together.

(3).    Caring messages and reminders: Children/caregivers can send warm caring messages and thoughtful reminders to their seniors to display on the CDF.

(4).    Entertainment and life information: Collaborating with information service companies, CDF can also be a platform to display life information such as weather, shopping, as well as music and other entertainment information.

2. Information Structure for CDF

Figure 2 shows the information structure of the “decentralized home telehealth system” proposed by Gerontechnology Research Center (GRC), Yuan Ze University [7]. In this structure, a single household is the fundamental unit for sensing, data transmission, storage and analysis. The core of the system is the “Distributed Data Server (DDS)” inside a household, which can be a hardware thin server or software running on a PC. Health monitoring data is stored in the DDS within the household, instead of transmitting the health monitoring data to a centralized database in a home healthcare service provider.

Figure 2. Information structure of the decentralized home telehealth system

This is the smallest possible home telehealth system, which makes it economically viable and acceptable to the end-users. However, all technical functions of a centralized system, such as health monitoring data storage and display, health event alert, regular report etc., can still be achieved. Monthly service fee is not necessary, as the caregivers of the senior users (not the home healthcare service provider) take the responsibility of providing necessary care based on the health monitoring information. The DDS can still be connected to a centralized database when more complicated health management services are needed.

The emerging of a new class of computers – the so-called “Pad PC”, is also a very important driver of CDF. Pad PC was called “tablet PC”, “slate PC” or “screen PC”. The industry is starting to consolidate its name into “Pad PC” after the successful launch of iPad by Apple Inc. in April 2010. Pad PCs are often small in size, equipped with a touch screen, and they are less expensive, more mobile than laptop PCs. Pad PCs usually possess less computation power than laptop PCs, and are designed to be used for specific purposes such as digital day planners, Internet surfing devices, project planners, music players, and displays for photos, video, live TV, and e-reading. Many PC manufacturers have planned to introduce new pad PCs after iPad in early 2011. Derived from DDS of the decentralized home telehealth system, CDF can be a hardware thin server or software. CDF is set up as PC software in this first stage. Pad PC is the major target platform for CDF. A dedicated CDF hardware device is also being developed.

Figure 3. The Information structure of CDF in 3 different versions

As illustrated in Figure 3, CDF software is offered in 3 versions. The “basic version” uses the simplest “stand-alone” information structure involving only two PCs on the Internet. CDF software is installed (in a pad PC) as software DDS in the home telehealth system for the senior user. Children/caregivers communicate with the senior user remotely by installing “CDF-Remote” program. The senior user uses vital sign meter at home. The measurement data can be transmitted to the pad PC, and saved in the storage unit. Children/caregivers can login into the senior user’s pad PC using CDF-Remote program to track the health monitoring data of the senior user, and perform the 4 main functions of CDF described in the previous section. In the “advanced version”, the users register in the application server shown in Figure 2 to perform the 4 functions of CDF from any browsers without installing the CDF-Remote program, and receive advanced services such as User name/IP convert, email/SMS event message, regular report etc. The “professional version” connects the CDF to the centralized database of a hospital or home healthcare service provider for users who need professional health care.

3. Software design of CDF

Table 1 shows the 4 core functions of CDF, their sub-functions and descriptions. For designing the CDF software, the operation flow chart of CDF was first developed in Figure 4. Figure 5 shows the interface of the CDF, which incorporates mostly large, graphical buttons. Designed as an information display channel, normally CDF works like a digital photo frame displaying photos and video clips managed by the remote children/caregivers. Message box pops up when there is a caring message or reminder. The button at the lower left corner provides a one-touch operation for importing data from vital sign measurement devices, which is the only occasion the senior user has to operate the CDF. The button at the lower right corner leads to the management pages of the 4 main functions (Figure 6) for proximal users/caregivers who have more computer skills.

Table 1. The Definition of Four Core functions

Category

Function

Description

A. Digital Photo Frame

A1. Display photos

To display the photos of the specific folder.

Support the JPG, BMP, PNG 640 * 480dpi format of pictures.

Use timer to set up the play time.

A2. Photos management remotely

Via the Internet, remote computer management software uploads pictures to the system’s memory card.

B. Home telehealth

B1. Blood Glucose/pressure device data access

Through the transmission line, System connected with device and use the related protocol commands (provided by vendors) to get the physiological measurement data and stored in the system memory card.

B2. Data browsing and analysis

Displayed the physical measurement data on the screen and demonstrated its historical curve, mean, standard deviation, etc.

B3. Data browsing and analysis remotely

Through the management software, remote users can login to the system (must have account privileges) to browsing and analysis.

B4. Data exception warning

When the data exceed the normal range, system will automatically send the event alert messages by e-mail or phone message service (SMS) to the contact person (need to pay the fees).

C. Caring Messages and Reminders

C1.Caring messages and reminders checking

Users are able to choose the type of event reminder and the time, which including 1. Medication reminder 2. Measurement reminder 3. Revisits reminded. When the time approached, the system will send a warning to user.

Remote users can also login to the system management software (must have account privileges) to set the event to remind user.

C2. Reminding sound

Sound of the reminder alert increase user's attention.

C3. Leave the message/reminder remotely

Remote users can login to the system through the management software (must have account privileges) to leave the message.

D. Entertainment

D1.Music playback

Enable to play the music in the specific folder.

Audio format support for MP3 and other popular formats.

Figure 4. Flow chart of CDF operation

Microsoft Visual Studio 2008 is chosen as the CDF development platform. In order to facilitate system expansion and maintenance, all functions are written in modules. Currently, there are 10 modules in CDF program. Digital photo frame module, multimedia module, remote connection module, device communication module, drawing module, data access module, print module, message module, reminder module and network communication module.

Figure 5. The Interface of CDF

 

 

Figure 6. Management pages of the 4 main functions

4. Discussion and conclusion

Although the usefulness of the home telehealth system has been recognized in many studies, and all technologies required are readily available, expectations for its widespread adoption have not been realized. In our observation, there is not a commercially successful home telehealth system in Taiwan.

Current models of home telehealth systems often involve in integration of different businesses and very complicated infrastructure. A monthly fee is required to cover the cost of maintaining such systems. However, the difference between the cost and “willingness to pay” for the current centralized service oriented model is huge. It is difficult to close this gap if the “customers”, including the patients, medical doctors, caregivers, do not have enough motivation to use such systems.

Competition in home telehealth system has moved from technical competition to finding the best business model. The CDF presented in this paper is actually our answer to the difficulties and challenges of home telehealth systems. The characteristics of CDF are summarized as follows:

(1).    CDF is the smallest possible home telehealth system that can be established between a single user and his/her care giver without subscribing services and paying monthly service fee to a service provider.

(2).    In addition to health data monitoring, children or caregivers can “deliver care” to their seniors not living together by warm messages and thoughtful reminders on the CDF, as well as sharing their feelings, joy, and life experience through photos and video clips.

(3).    CDF is positioned as the software for providing care and positive emotion to elderly users, with the emerging new class of computers – the “Pad PC”, as its major target platform.

(4).    CDF creates a unique information channel for senior users who are not familiar with the operation of computers and Internet.

(5).    With the different versions, CDF can still be used as a home station of the centralized home telehealth systems.

The development of the software version of CDF has been completed and is now under usability study. The interface has been examined from ergonomics point of view by inviting senior users to the lab to use the CDF interface. In order to be able to draw a significant conclusion on the acceptance of CDF, we are going to conduct an evaluation by the real users (senior, caregivers, and children) in their home environment, to evaluate criteria such as cost, utility, response time, flexibility etc., to compare with other existing telehealth systems. The basic version of CDF will be made available for free download after the preliminary user evaluation is completed.

References

[1]     Office of Health and Information Highway, Health Canada, “International Activities in Tele-homecare: Background paper,” September (1998).

[2]     American Telemedicine Association, http://www.americantelemed.org.

[3]     Koch, S., “Home telehealth – Current State and Future Trends,” International Journal of Medical Informatics, article in press, (2006)

[4]     Coughlin, J., Pope, J., “Innovations in Health, Wellness, and Aging-in-Place: Development of a Consumer-Centered Approach to Intelligent Home Service”, IEEE Engineering in Medicine & Biology, Vol.27, Issue 4, pp. 47-52, (2008)

[5]     Coughlin, J., “Technology Needs of Aging Boomers”, Issues in Science and Technology, Vol.16 (1), pp.53-60, (1999).

[6]     U.S. Census Bureau, http://www.census.gov.

[7]     Hsu, Y. L., Yang, C. C., Tsai, T. C., Cheng, C. M., Wu, C. H., “Development of a decentralized home telehealth monitoring system”, Telemedicine and e-Health, Vol. 13, No.1, pp. 69-78, February, (2007).