Telehealth – Ensuring The Guardian Angel Doesn’t Become Big Brother


Over the past few weeks I have been undertaking some research as part of the initial stages of a design project that my colleagues and I are involved in. The challenge is to find solutions that will enable people with a limiting long-term illness (LLTI) to remain healthy and supported within their own homes and communities. One objective of the work is to reduce hospital admissions, ensuring that people with LLTI’s only get admitted into acute care when they really need to be. I’m a Service Designer and as such I’m clear in my own mind that the only way to approach this piece of work is by taking a design based approach. There is a danger with this kind of work that commissioners simply look at solutions to address a current problem, but of course as designers we understand that to find a truly innovative solution you need to step back and take a holistic approach to any given challenge.

In Scotland a Public Audit Committee consisting of MSP’s recently produced a report which urges the Scottish Government to do more to address the huge difference in heart disease rates between rich and poor areas. The committee convener Ian Gray was quoted by the BBC as saying that “many simply do not expect to enjoy good health and have an almost resigned acceptance that ill-health, including heart disease, is what life brings”. “The powerful but deeply disturbing message was ‘people like us die of heart disease, and that’s how it is’”. Further desktop research throws up similar findings across the UK and I find this fascinating. For me, this is where the key focus of our research should be. Understanding why people take such a fatalistic approach to their health is essential if we hope to design sustainable solutions which reduce hospital admissions in the long term. Rather than fire fighting, where possible we need to prevent people from developing a LLTI in the first place. The difficulty for the public sector is that changing people’s beliefs, behaviours, and even values takes time, and that is something that politicians don’t always have, favouring a quick win over a long term solution which might take a generation or two before it starts yielding results. To address this challenge effectively there therefore has to be a multi tiered approach. The first tier to be addressed in the short term, is the need to co-design solutions for people who are currently living with a LLTI, and those that will unavoidably develop a LLTI in the future. The second being addressed over a longer term, is the need to understand why people have certain beliefs and behaviours around health, in particular those with a fatalistic approach to ill health, and co-design solutions which prevent them from developing a LLTI in the future. Service Design has a huge role to play in this.

Over the past few weeks the research that my colleagues and I have been conducting has lead me to think a little more about the short term solution, and as you might imagine I’m picking up quite a lot about Telehealth. Simply following twitter feeds such as the recent #telehealth2012 hash tag highlights that commissioners are becoming increasingly interested in Telehealth; and perhaps they should be. I met a patient recently who likened their home-based Telehealth solution to a guardian angel watching over them. For the patient, the comfort they found in having the monitoring equipment in their home, and the clinicians at the end of a phone line if anything was wrong, meant that their confidence grew, they became more resilient and started to own their condition. The evidence appears to back this up with one health authority seeing a 40% reduction in admissions from those using Telehealth. But I’m also conscious that with the growing public sector interest in Telehealth and the growing popularity of smart phones, and the public’s willingness to use them, the manufactures of traditional Telehealth have a vested interest in proving their technology works and securing their share of the market. Tech savvy developers are creating a growing number of mobile apps which they hope will take the Telehealth market by storm. In the US some hospitals and medical centres recently began testing apps which rely on technology that is increasingly standard on smartphones such as global positioning systems and accelerometers to track location and movement. The thought behind the apps are that you are less likely to be at the park or out shopping when you are ill, with changes in behavioural patterns often acting as an early warning system, likened by the developer to the body’s ‘check-engine light’. It certainly appears that technology, in some shape or form, will play some part in the management of our own health in the future. I have a feeling though that both the manufactures of Telehealth and health apps, and the commissioners simply purchasing a Telehealth package to slot into an existing service framework are missing the point. I’m concerned that design hasn’t yet got a foothold in the Telehealth industry or the public sector which commissions it. It sometimes feels like there is ‘Field of Dreams’ mentality at play: If we build it, they will come.

Let’s look first at the aesthetics. Like it or not we are all consumers. We spend varying degrees of our life carefully selecting the products we furnish our homes with, from white goods, to furniture, accessories to essentials, all are carefully chosen as part of a conscious (or unconscious) attempt to design the environment around us. Quite a bit of the Telehealth I have seen is really clunky; beige and grey boxes that whilst practical, are devoid of aesthetic appeal. However companies such as Cambridge based Equivital create aesthetically pleasing and well designed Telehealth to monitor athletes such as Felix Baumgartner during his recent space jump, so why can’t we adopt this type of design in the health sector? If we want to move into an era where people own their own health then why not give them a say in the design of the equipment they need to manage it; I have a feeling that before long people will be demanding this kind of choice. For me however the most important facet of design currently missing from the Telehealth market is Service Design. Telehealth can only work effectively if it is part of a solution which has been co-designed with the people who will be using it. On the face of it the health app which monitors people’s movements and reports back changes in behavioural pattern sounds useful and utilises smartphone technology already available to the many of the people who will benefit from it, but as a service designer something really concerns me about this. As individuals so many of us value our privacy, so will people really want to give that up just because they get ill? When does the guardian angel become big brother?

The research into Telehealth is compelling, and my research to support the design project I am involved in continues. However I would urge all manufactures and commissioners to engage more with design, and co-design the technology, and the services, with the people who will use them. Telehealth needs good design!


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