Author: Yi-Shin Chen, Yeh-Liang Hsu, Chia-Che
Wu, Yen-Wei Chen, Ju-An Wang (2010-04-25); recommended: Yeh-Liang Hsu
Note: This paper is presented at the 9th International Conference on
Smart Homes and Health Telematics (ICOST 2011), Montreal, Quebec, Canada, June
Development of the “Care Delivery Frame” for senior users
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
Keywords: Gerontechnology, Home Telehealth System, digital photo frame.
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”
. 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 . 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 . 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 .
Aging is associated with an increasing risk of isolation . In
U.S, there were 27.39% of the 65 years old and over population who lived alone .
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
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.
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
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 . 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
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
Figure 3. The Information structure of CDF in 3
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
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
A. Digital Photo
To display the
photos of the specific folder.
JPG, BMP, PNG 640 * 480dpi format of pictures.
Use timer to
set up the play time.
Via the Internet,
remote computer management software uploads pictures to the system’s memory
Glucose/pressure device data access
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.
browsing and analysis
Displayed the physical
measurement data on the screen and demonstrated its historical curve, mean,
standard deviation, etc.
browsing and analysis remotely
management software, remote users can login to the system (must have account
privileges) to browsing and analysis.
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).
Messages and Reminders
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.
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
can login to the system through the management software (must have account
privileges) to leave the message.
Enable to play
the music in the specific folder.
support for MP3 and other popular formats.
Figure 4. Flow chart of CDF operation
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
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.
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
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:
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.
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
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.
CDF creates a unique
information channel for senior users who are not familiar with the operation of
computers and Internet.
With the different versions,
CDF can still be used as a home station of the centralized home telehealth
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.
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