Telecare Development

Telecare DevelopmentMeduse Conference 20th September 2007

Nigel BarnesBT Group Chief Technology Office

© British Telecommunications plc

Telecare Definition

The use of Information and Communication Technology (ICT) to support independent living for older,

frail and disabled people


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


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


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.

1st Generation Telecare


Non-invasive home monitoring

Data capture and intelligent analysis

Automated alerting to client

Automated alarm escalation to carer

2nd Generation Call Centre

Carer


Minute

Hour

Day< >

< >

< > 0 30

0

0 30

1

0 30

2

0 30

3

0 30

4

0 30

5

0 30

6

0 30

7

0 30

8

0 30

9

0 30

10

0 30

11

0 30

12

0 30

13

0 30

14

0 30

15

0 30

16

0 30

17

0 30

18

0 30

19

0 30

20

0 30

21

0 30

22

0 30

23

4 April 1998

FALSE TRUE

AWAKE ASLEEP

ON OFF

IN OUT

Temp (Lounge)22.0

24.0

PIR (Bedroom)257

PIR (Lounge)231

PIR (Kitchen)324

PIR (Hall)21

PIR (Bathroom)10

Closedoor (Entrance Door)8

Closedoor (Fridge Door)15

Activity (CDEFGI)865

Activity monitoring


Event Based Algorithms

Time

Front Door

Door Open Alarm

- Configurable Event Timings

- Currently non-adaptive


Behaviour based algorithms

Time

Lounge

Kitchen

Hall

Front Door

No Room Change

or No Activity

- Based on Individual’s Profile

- Dynamic & Fixed Thresholds


Inter-event time value

• 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

alert

Threshold

Adaptive Thresholds


Carer

Voice call(PSTN)

Liverpool Direct

call centre

Alert messaging

BroadbandEncrypted

Voice call(PSTN)

Monitoringdata

Internet

Back office

Managementinterface

Data server

Telecare platform

Firewall Messaging server

Voice server

Monitored residence

RMUAutomated Voice Call (PSTN)

BroadbandEncrypted

Carer

Daily summaries

Dailysummaries


• Example showing typical activity

• Client in bed between 11pm and 8:30am


• Example showing cause for concern

• Client leaves dwelling at 10pm and does not return till 3am


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)


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.


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.


Minute

Hour

Day< >

< >

< > 0 30

0

0 30

1

0 30

2

0 30

3

0 30

4

0 30

5

0 30

6

0 30

7

0 30

8

0 30

9

0 30

10

0 30

11

0 30

12

0 30

13

0 30

14

0 30

15

0 30

16

0 30

17

0 30

18

0 30

19

0 30

20

0 30

21

0 30

22

0 30

23

4 April 1998

FALSE TRUE

AWAKE ASLEEP

ON OFF

IN OUT

Temp (Lounge)22.0

24.0

PIR (Bedroom)257

PIR (Lounge)231

PIR (Kitchen)324

PIR (Hall)21

PIR (Bathroom)10

Closedoor (Entrance Door)8

Closedoor (Fridge Door)15

Activity (CDEFGI)865

Sense Analyse Display

…combining a multiplicity of instrumented data with known human intervention to generate a sophisticated well-being indicator and assessment aid…..

0 2 4 6 8 10 12 14

0.0

0.2

0.4

0.6

0.8

1.0

Inter-event Time (ln[seconds-10])

Pro

babi

lity

Den

sity

Ref Client: 23s3BHKLT.txt

Event Count: 134285

ExponentialLog-GammaLognormalGammaWeibull

Longitudinal Trend Analysis


Av Err: 12%

38 39 40 41 42 43 44 45 46 47 48 49 50 51 52PERIOD

TODAY

2nd FALLMEDICATIONCHANGE

1st FALL

PREDICTIVE REGION

Well-being INDEX:

100

80

50

10

00

20

04

(Without Intervention)

HISTORY REGION

STAIR LIFTINSTALLED

CAREINTERVENTION

STARTS

MajorModerateMildNoneINTERVENTION

LEVEL:Accommodation Change Medication ChangeWithout InterventionPREDICTION

TYPE:X

Care Well-being IndexCALCULATEOPTIMISATION:

XCost (£ per Week)X


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


C O N D I T I O N S T E C H N O L O G I E S

Activity Problem

Sen

sor i

dent

ified

Num

ber o

f pro

blem

/con

ditio

n hi

ts

Par

kins

on's

dis

ease

Stro

ke

Rhe

umat

oid

arth

ritis

Dem

entia

Res

pira

tory

dis

ease

Ost

eo-a

rthrit

is (O

A) -

low

er li

mb

Dia

bete

s

Ana

emia

Dep

ress

ion

Ost

eo-a

rthrit

is (O

A)

Isch

aem

ic h

eart

dise

ase

& M

I

Per

iphe

ral a

rtery

dis

ease

Ost

eo-a

rthrit

is (

OA

) – h

ip

Ost

eo-a

rthrit

is -

knee

Hea

rt fa

ilure

Ost

eo-a

rthr

itis

- spi

ne

Cat

arac

t

Gla

ucom

a

Mac

ular

deg

ener

atio

n

Ost

eo-a

rthrit

is (O

A) -

upp

er li

mb

CO

PD

Car

diov

ascu

lar d

isea

se

Ost

eopo

rosi

s

Anx

iety

dis

orde

rs

Ver

tigo

Dea

fnes

s

Ost

eo-a

rthrit

is -

hand

Can

cer

Problem

PIR

Ligh

t bea

m

Pre

ssur

e m

ats

Stra

in g

auge

load

cel

l

Pie

zo e

lect

ric

Pre

ssur

e se

nsiti

ve re

sist

or

Forc

e se

nsiti

ve s

witc

h

Wat

er fl

owm

eter

Tilt

switc

h (fl

ush

sens

or)

Doo

r sw

itch

(ree

d re

lay)

Tag

and

read

er

Ther

moc

oupl

e

App

lianc

e C

urre

nt S

enso

r

Cen

tral P

ower

Mon

itor

Aco

ustic

ene

rgy

Ele

ctric

al s

ubsy

stem

Lock

sen

sor

Vib

ratio

ns/S

hock

Sen

sor

Com

men

ts

Opening front door Time taken 16 Time taken Time taken from the moment the bell is rung to when the door is opened

Bed Sleep 11 Sleep Need to identify quality of sleep. Proposed solution is to monitor the amount of movement I.e. tossing and

turning

Walking Trips/falls 7 Trips/falls Monitor seismic eventy caused by slip or fallGeneral (non activity specific) Weight loss/gain 7 Weight loss/gain Use chair leg sensor to gauge weight

Bed Standing up from bed 6 Standing up from bed Pressure mat signal indicates standing - no load on

bed indicates end of activity. Time taken gives quality of activity

Chair/Sitting Standing up 6 Standing up Pressure mat signal indicates standing - no load on

chair indicates end of activity. Time taken gives quality of activity,

Walking Speed 6 Speed Chair/Sitting Time spent sitting 7 Time spent sitting

Bed Lifting legs into bed 4 Lifting legs into bed Pressure mat signal indicates standing - increased and steady load on bed indicates end of activity. Time taken gives quality of activity.

Walking Incidence / mobility patterns 4 Incidence / mobility patterns Chair/Sitting Sitting down heavily 4 Sitting down heavily Bed Getting up frequently (pain) 4 Getting up frequently (pain) Bed Moving around in bed / turning 3 Moving around in bed / turning Bed Sitting up 4 Sitting upWalking Gait 3 Gait Chair/Sitting Difficulty maintaining posture 5 Difficulty maintaining postureWalking Gait pattern 2 Gait patternToilet Frequency 2 Frequency Bed Getting up frequently (toilet) 1 Getting up frequently (toilet) Bed Laying down 1 Laying downWalking Wandering 1 Wandering Chair/Sitting Moving away from chair 1 Moving away from chair Chair/Sitting Sleeping in chair at night 1 Sleeping in chair at night Opening front door Not closing/locking 1 Not closing/locking

Number of related 'problems' 12 10 11 7 7 5 5 5 4 4 3 3 3 3 3 3 2 2 2 2 2 2 2 1 1 1 1 1

Walking Bumping into things 6 Bumping into things Feeding (and drinking) Cutting food 5 Cutting foodToilet Inability to manage clothes 5 Inability to manage clothesFeeding (and drinking) Amount eaten 4 Amount eatenFeeding (and drinking) Gripping cutlery 4 Gripping cutleryFeeding (and drinking) Speed 4 SpeedFeeding (and drinking) Swallow 4 SwallowToilet Cleaning self 4 Cleaning selfToilet Sitting down heavily or slowly/carefully 4 Sitting down heavily or slowly/carefully Toilet Standing up -speed,poor balance, increasing reliance on support. 4 Standing up -speed,poor balance, increasing reliance on support.Opening front door Manipulating knob/locks 4 Manipulating knob/locks Bed Managing bedclothes 3 Managing bedclothesOpening front door Not responding to bell 3 Not responding to bell Feeding (and drinking) Lifting food/cup to mouth 2 Lifting food/cup to mouthChair/Sitting Pulling dining chair up to table 2 Pulling dining chair up to tableChair/Sitting Unsteadiness on standing up 2 Unsteadiness on standing upToilet Moving around in small space 2 Moving around in small spaceFeeding (and drinking) Effort 1 EffortFeeding (and drinking) Loading fork/spoon 1 Loading fork/spoonToilet Losing way 1 Losing wayOpening front door Not closing/locking 1 Not closing/locking Toilet Inability to manage clothes 0 Inability to manage clothes


Preparing hot food/drink Accessing low shelves/oven/fridge 3 Accessing low shelves/oven/fridgePreparing hot food/drink Carrying items 2 Carrying itemsPreparing hot food/drink Dropping items 2 Dropping items Preparing hot food/drink Gas/electricity safety 2 Gas/electricity safetyPreparing hot food/drink Heat sensitivity 5 Heat sensitivityPreparing hot food/drink Leaving pans on/filling kettle etc. 2 Leaving pans on/filling kettle etc.Preparing hot food/drink Lifting utensils/saucepans/kettle etc. 3 Lifting utensils/saucepans/kettle etc.Preparing hot food/drink Opening packaging 3 Opening packagingPreparing hot food/drink Preparing food to cook 7 Preparing food to cookPreparing hot food/drink Preparing food to drink 1 Preparing food to drinkPreparing hot food/drink Response to timers/alarms etc 3 Response to timers/alarms etcPreparing hot food/drink Storage of food 1 Storage of foodDressing Fastenings (buttons, zips etc) 3 Fastenings (buttons, zips etc)Dressing Inappropriate dressing 2 Inappropriate dressing Dressing Lower garments 3 Lower garmentsDressing Not dressing 2 Not dressing Dressing Shoe laces 3 Shoe lacesDressing Speed and effort 4 Speed and effortDressing Task sequencing 2 Task sequencingDressing Upper garments 2 Upper garmentsWashing/Grooming Effort 1 EffortWashing/Grooming Flooding bathroom 1 Flooding bathroomWashing/Grooming Hair 3 HairWashing/Grooming Managing taps 2 Managing tapsWashing/Grooming Not washing 2 Not washingWashing/Grooming Reaching parts of body 4 Reaching parts of bodyWashing/Grooming Shaving 4 ShavingWashing/Grooming Teeth 3 TeethTelephone Making calls 3 Making callsTelephone Speaking 3 SpeakingTelephone Time to answer 12 Time to answerTelephone Understanding 3 UnderstandingBath/Shower Drying self 1 Drying selfBath/Shower Flooding bathroom 1 Flooding bathroomBath/Shower Getting in and out 4 Getting in and outBath/Shower Managing taps/plugs/shower 2 Managing taps/plugs/showerBath/Shower Reaching parts of body 2 Reaching parts of bodyBath/Shower Sensing temperature 3 Sensing temperatureBath/Shower Standing balance (shower) 2 Standing balance (shower)Stairs/Steps Gait pattern 3 Gait pattern Stairs/Steps Resting 4 Resting Stairs/Steps Slips/trips 6 Slips/trips Stairs/Steps Speed 4 Speed Managing medication Opening bottles / packs 3 Opening bottles / packsManaging medication Reading instructions 5 Reading instructionsManaging medication Remembering medication 3 Remembering medicationManaging medication Swallowing 2 SwallowingHousehold tasks Lifting & bending 6 Lifting & bendingHousehold tasks Manipulating equipment e.g. plugs 5 Manipulating equipment e.g. plugs Household tasks Motivation 1 Motivation Household tasks Recognition of need 2 Recognition of needHandling money Cognitive ability/understanding 2 Cognitive ability/understandingHandling money Losing money/purse 4 Losing money/purseHandling money Manipulation of money 6 Manipulation of moneyWriting Ability to write 1 Ability to writeWriting Accuracy of writing 3 Accuracy of writingWriting Gripping pen 2 Gripping penWriting Size of script 4 Size of scriptGeneral (non activity specific) Continence 2 ContinenceGeneral (non activity specific) Social withdrawal 11 Social withdrawalGeneral (non activity specific) Speech alteration 6 Speech alterationGeneral (non activity specific) Standing 4 StandingGeneral (non activity specific) Volume of sound 1 Volume of sound


Activity Problem

Sen

sor i

dent

ified

Par

kins

on's

dis

ease

Stro

ke

Rhe

umat

oid

arth

ritis

Dem

entia

Res

pira

tory

dis

ease

Ost

eo-a

rthrit

is (O

A) -

low

er li

mb

Dia

bete

s

Ana

emia

Dep

ress

ion

Ost

eo-a

rthrit

is (O

A)

Isch

aem

ic h

eart

dise

ase

& M

I

Per

iphe

ral a

rtery

dis

ease

Ost

eo-a

rthrit

is (O

A) –

hip

Ost

eo-a

rthrit

is -

knee

Hea

rt fa

ilure

Ost

eo-a

rthr

itis

- spi

ne

Cat

arac

t

Gla

ucom

a

Mac

ular

deg

ener

atio

n

Ost

eo-a

rthrit

is (O

A) -

upp

er li

mb

CO

PD

Car

diov

ascu

lar d

isea

se

Ost

eopo

rosi

s

Anx

iety

dis

orde

rs

Ver

tigo

Dea

fnes

s

Ost

eo-a

rthrit

is -

hand

Can

cer

Poss

ible

s

Cum

ulat

ivel

y - a

ll co

nditi

ons

cove

red

No

tech

nolo

gy s

olut

ion

/ not

des

irabl

eTh

ird p

arty

influ

ence

and

/ or

not

app

licab

le to

all

clie

nts


Well-being concept model

Person factors

Context factors

Activity Experience Well-being outcome


Well-being concept model


Activities monitored

Well-beingelement

Activity type

Activities

Physical ADL’s Preparing food & eating

Sleeping

Social Social Interaction

Leaving & returning home

Visitors

Mental Personal goals

Personal appearance

Leisure activities


Sensors “tool box”

• Water flow• Gas flow• Power usage• Vibration• Pressure• PIR• Active IR• Telephone usage• Gait analysis• others ….

• Wireless connectivity• Self powered, battery and scavenged• Jiffy-bag deployment


Sensor locations

Client 1Downstairs plan view24 sensors installed Kitchen

Lounge

cupboard

Back doorTV

Coffeetable

‘Radio’chair

Fire

plac

e

Fridge/freezer RMU

Gas

Cooker

Sofa &

armchairs

Window sill

sink drainer

‘TV’’chair

Spare bedroom

Master bedroom

Bath

W.C.

Basin

BathroomLand

ing

Double bed

War

drob

es

War

drob

es

Draws

Pile of various objects


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


Sleeping Patterns

Question:

• Are the locations of the sleep-periods within the house changing?


The Silence of the Lounge


No such thing as too much data…


Intelligent Data Analysis interface


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.


Sample ‘Wellbeing’ interface

Q4. Eating Habits

Q3. Sleeping Habits


The mobile care worker


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


Pervasive ICT for wellbeing

Holistic Well-Being Monitoring:• Integration with health monitoring (SAPHE)• Chronic disease management• Enabler for joined up care

Opportunity for continuous objective measurement and support:

• Peace of mind for clients and carers• Optimisation of home care services• Timely intervention ahead of crises

Many questions still to be answered:• Low cost ubiquitous sensor devices• Scalable intelligent data analysis• Seamless links to ICRS• Privacy and ethics

www.saphe.info

Supported by DTI Technology Programme

SAPHE

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.

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


From Telecare…to holistic care

• 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

NHS Central systems

hub

wirelesssensor

Internet Telecare Platform

Firewall

OpenZone

Family Social care

providers Health care

providers

GSM/GPRS/3G

Wi-Fi


Chronic condition management

Wellbeing and Independence

Mon

itorin

g in

con

text

: C

orre

latio

n of

phy

siol

ogy

and

daily

act

iviti

es

Con

tinuo

us ri

sk a

sses

smen

t: pr

even

tativ

e ca

re a

nd e

arly

ch

ange

det

ectio

n

Info

rmat

ion

diss

emin

atio

n:

App

ropr

iate

and

tim

ely

to c

arer

s

Ubiquitous non-invasive monitoring infrastructure

• £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.”

• Combined health and social monitoring

• Contextual understanding– New intelligence that adds value to

care processes

• Trend analysis

• Prediction

• Support

• Reassurance


…and better support this group to prevent them moving up.

• Non invasive monitoring of activity and physiology

• Continuous monitoring – home and away

• Reassurance

• Independence

• Self management

• Medication / regime reminders

• Education

• 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

High Intensity Users (HIUs).Those requiring repeated admission to acute care. 5%

‘Unwell’ patients. Worsening symptoms and whose condition may require more professional care. 5-10%

‘Nearly well’.Managed through contact with GPs, community matrons, etc. 70-80%

‘Well’. Self-management. 10%

Use pervasive healthcare to prevent this group becoming HIUs and move them down the pyramid…

• Reassurance

• Support

• Access to wellbeing summaries

• Alerted to problems

• Manage alerts

• Access to monitoring data

• Access to records

• Escalation to professionals

Service users

Informal carers

Professionals

Call Centre

Thank you – any questions?

[email protected]

research.bt.com/pict

Telecare Development

Documents

Transcript of Telecare Development