Research Challenges and Further Work
From Capsil Wiki
Telehealthcare is recognised as a development that could have a hugely positive impact on this very serious problem facing all healthcare providers. It has also been noted that despite large enthusiasm for the concept of telehealthcare, relatively little of any significance or scale has happened to date, despite the technology being available for quite some time. The underlying causes of these barriers must be dealt with if telehealthcare is to fulfil its true potential. Much work is needed at the policy, and legislative level and issues of data ownership, accountability, privacy etc are paramount. From the technical point of view while remote monitoring devices have been available for quite some time, these devices need to be more intuitive, user-friendly and engineered with the end user in mind.
In summary the areas needing further work include the following;
| Recomendation | Detail |
| 1 | Reimbursements and Cost Mitigation – It is imperative that mechanisms are brought on board to mitigate the cost of a home monitoring solution as data shows that people are not inclined to bear an out-of-pocket expense here. Healthcare insurers need to come on board with incentivisation programs and risk management schemes that motivate people to get involved. How to match telehealthcare with insurance premiums is a challenge and involves financial supply chains, modelling tools and risk management techniques. How to accurately charge for clinical time, how to ensure compliance to the program and how to share data across borders is indeed a challenge. A major research effort around data ownership and accountability across borders is needed i.e. recommending policies and procedures that can be adopted by member countries and states. Unfortunately until these issues are addressed and involvement in a telemonitoring effort is ‘made safe’; very little will happen area as fear of consequences (being sued) will always cause people to ‘err on the side of safety’ i.e. keep doing things the way they were always done. |
| 2 | Security and Privacy – Evidence shows that security and privacy are major concerns for people adopting telemonitoring solutions, particularly for older people. The idea of a person’s confidential health information being accessible by parties other than those authorised, is a major concern. The inappropriate use of this data highlights one of the main concerns around pervasive technology in general, i.e. ‘trust’. “How can I trust you when you tell me everything is secure and private..?” It would be very helpful here to conduct large scale pilots (at a national level) perhaps under a chronic conditions program (Diabetes for instance) where trust would be built up piece by piece. In fact, building up the profile of telehealthcare in this fashion is the only way that to engender this trust. |
| 3 | Perceptions and Attitudes – It has been reported that this is a bigger issue than might be imagined at first. The psychology of adoption of a telehealth solution needs to be looked at very closely i.e. what does it mean for the person (particularly an older person)? Factors such as perceived loss of control, role reversal (with kids for example), fears of social network decline, suspicions of the technology, fears of privacy being reduced and user friendly technology are important here. This work is complicated by demographics and ethnographics in that for instance what may work in Germany may be culturally unacceptable in Turkey, or what would be acceptable in California may not be workable in Bulgaria. Thus this work will involve much ethnography, psychology and human-machine interface work. |
| 4 | Interoperability – Interoperability of devices and systems is being driven by various standards organisations such as The Continua Alliance. This work needs to continue further and be supported to its conclusion. Currently the telemonitoring ‘solutions’ available (as described in section 1.3.1) operate proprietary networks. They are ‘stove piped’ to the extent that they don’t (and cant) share data freely between different networks and health record systems. This needs to be changed. The ideal scenario is completely compatible systems that can share data across networks and also across disparate medical record systems and databases. More work is needed around the Personal Health Record and its ability to share data across networks. |
| 5 | Technology Development – It has been pointed out that particularly among elderly people there can exist a mental barrier to technology and devices such as PCs and medical devices can be viewed as overly complex and not very user friendly. Design of the home monitoring devices needs to be very user-centric and in fact not resemble anything like a computer device. More effort in the human machine interface and in the ethnographics of device design is needed. |
| 6 | Development of Body Sensor Networks – Ideally sensor devices should be pervasive and operate in the background with little or no human intervention. Body Sensor Networks offer huge potential in this regard and sensors woven into garments and furniture look quite promising. There are of course a lot of challenges in developing these devices including practicality, reliability, robustness, biocompatibility and usability and much further research is needed to bring these devices to market. |
| 7 | Broadband Proliferation – A more obvious area of focus is the area of Broadband proliferation. By proliferation it is meant ‘affordable’ broadband at reasonable quality and speed. This area is being primarily driven by the telecommunications industry however cost of provision still prohibits deployment in rural and remote areas. Government policy needs to step in in these cases to subsidise this deployment. It may even be a sound policy to provide free broadband to socially disadvantaged areas and for people with chronic conditions as the return of investment from the healthcare services provision would certainly outweigh the broadband costs involved. |
| 8 | Condition Monitoring of Sensor Nodes and Networks - Much further work is required also on the area of detection and correction of sensor node and network failures. For example the so called ‘Sticky Values’ problem that may be caused by a combination of sensor failure, sensor-skin interface or biocompatibility failure due to sensor –fouling. Techniques such as Games theory should be looked at in this context. |
- Back to Home and Mobile Systems
- Back to Main Page
