The background considers the situation of telecare, traditionally funded and regulated by the social care entities, vital signs remote telehealth monitoring, as well as new clinical and technological solutions and concepts, including IoT-Med.
Standard Telecare is support and assistance provided at a distance using information and communication technology. Advanced Telecare is the continuous, automatic and remote monitoring of users by means of sensors to enable them to continue living in their own home, while minimising risks such as a fall, gas and flood detection and relate to other real-time emergencies and lifestyle changes over time. Telecare still relies predominantly on analogue telephone lines to communicate. Many service providers wish to prepare their equipment park for the digital world, not only because the telecommunications companies are planning to phase out analogue lines, but also because it is perceived that new value-added and more varied services could be offered via an “always on” broadband connection.
In Spain, an additional dimension has been added to the standard and advanced telecare services, called Proactive Telecare, where the control centre runs outbound call programmes, tackling isolation, depression, and with targeted and themed campaigns such as flu vaccination reminders and measures to take in adverse environmental circumstances such as heat waves or high pollen counts, which crosses over into the realm of telehealth by providing direct health benefits to telecare users.
In its broadest sense telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies. Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Among them, Remote vital signs monitoring is the use of biometric sensors in the home to gather biometric data such as blood pressure, temperature, blood oxygen level, and rapid weight fluctuations in relation to prevalent chronic conditions or for monitoring for other medical purposes such as post-operative in-community monitoring. Though there are some standards that define the terminology or the formatting of some of these measurements, no common standard in place for the format and governance of all of the data involved.
IEEE's defintion of Internet of Things: “The Internet of Things (IoT) is a network of physical devices and other items, embedded with electronics, software, sensors, and network connectivity, which enables these objects to collect and exchange data”. There are multiple “Things” or devices that can be useful for measurement, monitoring and decision-making within the health and social-care sectors, especially when networked. There is, however, a lack of a standard framework for dealing with this information in a structured way. As a result, health and social care professionals and organisations have opted for the conservative safe approach of only utilizing conventionally assured information such as those from CE marked medical devices.
Taken together the above digital data types from IoT sources (which includes traditional telecare and telehealth categories) can be used to cross validate each other allowing for more comprehensive and trusted data outputs than has ever previously been possible. As above, for IoT-Med, telecare and telehealth it is important that there is transparency of analytics that will allow for auditing, and validation. It is the vision of the Ensom founders that the creation of the framework will mark the first step towards this future integration allowing for highly scalable and cost-effective digital systems to be widely implemented and deployed to the benefit of European citizens, industry and overall global health.
The above provides background on the multiple and compelling reasons for utilising new and combined data. However, there are strict rules in Europe about which data can be used for health or social care purposes, and how such data is gathered, transmitted, and stored, to ensure citizens’ rights are protected. With the May 2018 implementation of the General Data Protection Regulation (GDPR) citizen rights are being put foremost in the handling of such data.
Ensom proposes to provide a dynamic framework of Information Governance guidance to assist public health and social care authorities to define minimum governance standards for services. This approach will also ensure technology and service providers are aware what practical standards are required for compliance with the regulations.