CAPSIL Strategic Recommendations

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The overall strategic recommendations from the CAPSIl project are listed here by individual chapter.

Contents

Background and Common Clinical Requirements Strategic Recommendations

  • To implement large scale pilot studies to assess and optimize monitoring technology that targets disease and other common conditions affecting older adults. See section on International Pilot Activity.
  • To increase the involvement of the private sector in studies of home monitoring technology toward the development of deployable systems.
  • To standardize electronic and personal health records as repository of information gathered using monitoring technology. See section on Digital Health Records.
  • To create and maintain accessible databases containing information concerning pilot testing and trials focused on monitoring technology.
  • To leverage monitoring technology to address modifiable risk factors such as unhealthy diet and lack of exercise.
  • To support mechanisms that provide incentives to individuals who make healthy choices (e.g. decrease in health insurance premium).

Intervention Systems Strategic Recommendations

  • Intervention technology should coordinate care that addresses multiple protocols - Most older adults have more than one chronic disease, more than 5 medications.
  • Incorporate quality of life: Need to address cognitive functioning, sleep management, socialization, stress, and depression.
  • Usability: Technology interfaces must be simple and easy to use (also easy to learn),vision and hearing issues. See section on Useability.
  • Privacy and Security - Need for easier unobtrusive authentication. See section on Privacy & Security.
  • Home monitoring data and intervention action plans need to be integrated into personal health record systems (PHRs) and EHRs.
  • Government needs to promote policies to encourage proactive holistic care for older adults. See section on Government Policy.
  • Remote home health interventions should be reimbursed.
  • Remote home health intervention systems should be tailored to fit cultural needs, languages, and local preferences.
  • Pilot studies and larger evaluations are required to demonstrate the efficacy and cost-effectiveness of remote home health interventions

Monitoring Systems Strategic Recommendations

  • Computational Models - Development of representations and models relating raw data to unobtrusively observed quantities Examples, Gait variability and Cognitive Function, Linguistic constructs, verbal fluency and memory.
  • Inference Algorithms - Statistical characterization of observed data. System characterization including, e.g., nonlinear dynamics. Computational approaches, e.g. particle filtering using event input sequences. Fusion algorithms: Combining diverse sources of stochastic processes.
  • Operation - Maintainability; Economically feasible installation process and self-monitoring of the devices’operational state.
  • Workflow integration - Integrate with existing processes and EHRs, PHRs.
  • Standardization - Interoperability standards beyond HL7. Plug and Play design. See section on Standards.

Wireless Body Sensor Networks Strategic Recommendations

  • Pilots and Results Dissemination - No significant WBSN pilots performed to date (with publication of results).Commercial Telehealth pilots to date are too small in scale. More emphasis required on Assistive Living pilots and building compelling business case with demonstrated return on investment. Improved results dissemination and longitudinal updates from existing and historical projects. See section on International Pilot Activity.
  • Research Focus - Move from technology centric to use case centric research grounded in an understanding of end user needs. Far too much 'me too’ research. Focus needs to shift to service orientated solutions. Increased focus required on commercialization of research, product and services development. Eliminate ‘islands’ of technology. From inception WBSNs outputs must be integrated into existed or modified clinical pathways.
  • Privacy and Data Ownership - Concerns such as ‘Big Brother’ and ‘One Big Database’ need to be addressed proactively. Legislative issues that arise as data crosses boundaries (national and international) need to be addressed and guidelines/directives drafted. Low-cost high-security schemes needed to demonstrate robustness in large scale. See section on Privacy & Security.
  • Practicality and Usability - More emphasis needs to be placed on user and application-oriented design, compliance and biocompatibility. See section on Design Aspects of BSNs.
  • Technical - Power Sources – Alternative sources such as small form factor, fuel cell, solar, piezo and RF-coupling. Adaptive firmware designs e.g. resource and goal directed decision making. RF Effects need further work e.g. De-tuning and attenuation effects of skin on RF signals. Further work needed on High Level Development Environments as these will open up sensor networks to ‘non-technical’ people. See section on Design Aspects of BSNs and BSN Operating Systems and Development.

Software and Interfaces Strategic Recommendations

  • Interfaces - User Centred and Participatory Design of devices (particularly for acceptability of technologies). Research on elder users needs/abilities with a specific focus on meaningful presentation of data, Customisation and personalisation of interfaces for users with specific health requirements, Standardised interoperability and communication: ideally ‘plug and play’ interfaces, Reliable and robust indoor and outdoor location tracking.
  • Shared Software - Benchmark/guidelines, i.e., testing for robustness and fault tolerance. Where do Consumer and Healthcare standards meet e.g. HL7 and Continua? Automatic measurement of human behaviour and qualities of movement (e.g., for fall prevention and monitoring of cognitive decline).
  • Networking - High speed context aware 'intelligent' computer networks, current Internet vs. future 3-D Internet. Access to broadband connectivity is key
  • Networked Media - Work needed on areas such as; Mobile/Ubiquitous healthcare, Outdoor/mobile use: cross network compatibility, Management of data interchange between providers (network, devices, bandwidth throttling, etc), Security and privacy policies across providers and networks, Social networks for elderly and medical staff.
  • Data reduction, retrieval, and mining - Research focus here includes; Customisation of data for use for mobile devices, Round trip clinical validation of data inference, Effective techniques to manage large archives of data in distributed databases, Multimodal content-driven information retrieval.
  • Security and privacy - Focus of research needs to include; Health data management e.g. Privacy and Security policies between networks, countries and states, there is a need for international standard for FDA/CE type compliance – critical for telehealth.

Visioning Scenarios - Gaps and Areas of Research Focus

  • Adaptive unobtrusive monitoring – systems need to weave seamlessly into person’s life.
  • Privacy issues need to be paramount and addressed proactively i.e. not added on later.
  • Social networks will be very important going forward. See section on Social Connectedness.
  • Important that the business model is proven and incorporates legal issues.
  • Perceptions and attitudes to technology need to be considered proactively and must include cultural effects.
  • Reimbursement schemes need to be available widely also to facilitate take up. See section on Business Models.

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