myhealth product and service critique deliverable 4.2 v2.d…/file/d4.2... · appendix 3 –...

DELIVERABLE 4.2

2010‐11‐3

1 (140)

Deliverable 4.2

Product and Service Critique Authors:

Jonathan Wallace (University of Ulster)

Brendan Galbraith (University of Ulster)

Elin Breivik (NST)

Lennart Issakson (Lulea)

Revision: Release Version 2

Version Date: 30/11/2010

DELIVERABLE 4.2

2010‐11‐3

2 (140)

INTRODUCTION

This purpose of this Deliverable 4.2 Product and Service Critique is to develop a structured approach including detailed questionnaires and questions for focus group meetings with the stakeholders (Clients, HWOs and Companies) to critique the product and service solutions being piloted within the MyHealth@Age project, in relation to the development of an opportunity for commercialisation roadmap of these, which will be outlined within the Deliverable 4.3 Market Design and Evaluation Report. This report is complimentary to the evaluation reports in relation to usability, functionality etc. that are being produced within WP2, WP3 and WP5 of the project.

This second updated version of the report contains the synopsis of the results of the questionnaires and focus groups within the 3 Member States / trial site locations.

This document contains the following Appendices:

Appendix 1 – Product and Service Critique Questionnaire Background

Appendix 2 – Product and Service Critique Questionnaire for Service Provider – HWO / Municipality / Alarm Centre

Appendix 3 – Product and Service Critique Questionnaire for SME / Technology Providers

Appendix 4 – Product and Service Critique Questionnaire for Patient / Client

Appendix 5 – Results from Sweden

Appendix 6 – Results from Norway

Appendix 7 – Results from Northern Ireland

APPENDIX 1

Product and Service Critique Questionnaire Background

Product and Service Critique Questionnaire Background

Authors:



Revision: Release Version 1a


INTRODUCTION

This “Questionnaire Background” document will set out the rationale behind our adoption of a multidisciplinary Living Lab approach for the development of the MyHealth@Age products and services as well as outlining the Business Model Framework adopted which informs the stakeholder questionnaire and focus group discussions that you will be completing with the MyHealth@Age representative.

RATIONALE FOR AN OPEN INNOVATION & LIVING LAB METHODOLOGICAL APPROACH

The enormous sustainability issues associated with the provision of healthcare across the EU is a broad and growing arena for innovators. A reflection of this, from a policy perspective, is that the healthcare sector features prominently in the EC Lead Market initiative (2007) that states: “eHealth can help to deliver better care for less money within citizen-centred health delivery systems.”

Evidence from industry and Health and Welfare organisations confirm the exploitation opportunities that assistive technology solutions can provide, as anecdotally there have been many examples of successful implementation (2008, Hamilton). However, for all of these successes, there is an increasing body of evidence that illuminates the array of problems that have been experienced with the implementation of assistive technology solutions in a healthcare setting (Galbraith et al, 2008).

Empirical research has shown that the health sector has been particularly prone to product development problems including unanticipated technical, human or organizational issues (Southon et al, 1999).

Moreover, design flaws have been found to affect the ease of use and reliability of systems and may even be dangerous, creating ill-feeling and reducing clinicians’ willingness to use emerging systems, software, and hardware in practice (Dumay and Freriks, 2004). Even seemingly minor problems with usability or conceptual fit can destabilize the implementation of otherwise highly engineered and valid technologies (Pagliari, 2007).

Figures 1a, 1b and 1c below show from the Euro Health Consumer Index 2008, that there are significant disparities across Europe in relation to comparative healthcare measures. The UK and Ireland in particular are not doing very well comparatively with Sweden for example. Yet, whilst UK, Ireland, Sweden and Norway are expending nearly as much as the best providers with Norway expending the most. The UK, Ireland and particularly Norway are not getting great value for money.

Figure 1a

Figure 1b

Figure 1c

Many of these problems have been experienced as a resulted due to an adherence to a linear technological model of innovation that is not sensitive to the complexities of the user community and multi-stakeholders. The MyHealth@Age project clearly stated from the outset that we would adopt a multi-stakeholder, trans-national and user-driven methodology to ensure that market, technical and user needs are balanced. This open and inclusive innovation methodology is in contrast to the failed linear technological models that have gone before. In fact, the MyHealth@Age project methodology has been guided by current innovation practices including open innovation and living labs. Figure 2 below summarises the difference between the old closed and new open and inclusive innovation approach.

Progress versus Innovation

Source: based upon presentation from

• Linear, slow• Proprietary knowledge• Ideas as strategic advantage• Mentors• Learn by reverse-engineering• Progress by “Shoulders of Giants”• Wisdom of experts

• Exponential, networked, quick• Shared knowledge• Ideas “paid forward”• Micromentors• Lessons-learned benefit all• Progress by “The Mash Pit”• Wisdom of crowds

New (Open)Old (Closed)

• Linear, slow• Proprietary knowledge• Ideas as strategic advantage• Mentors• Learn by reverse-engineering• Progress by “Shoulders of Giants”• Wisdom of experts

Figure 2

1.1 OPEN INNOVATION

Open innovation has been defined as the antithesis of the traditional vertical integration model where internal research and development activities lead to internally developed products that are then distributed by the firm. It assumes that firms can and should use external ideas and internal and external paths to market, as the firms look to advance their technology (Chesbrough, 2003). The difference between a closed and open innovation system is presented in Figures 3a and 3b below.

In this apparently new paradigm, successful innovation is about the effective management of the flows of knowledge and activity across complex networks. This seems to sit well with the diverse characteristics of the healthcare area. Indeed, the breadth and complexity of healthcare in terms of the stakeholders, technologies, objectives and disciplines involved, increases its heterogeneity and the necessitates the use external ideas and knowledge (Galbraith et al, 2008). Maximising the potential of assistive technology in healthcare requires the involvement of a wider constituency of disciplinary experts, including social scientists, management, intellectual property and legal experts, financial managers and management accountants, [in addition to product design, healthcare and computing] (Pagilari, 2007). The collaborative nature of MyHealth@Age project consortium and work processes ensures that the high complexity of the resultant new innovation services have been enriched by crucial external sources of knowledge. This includes leveraging multi-disciplinary academics (healthcare, ICT, business etc), SMEs, Health and Welfare Organisation (multi-disciplinary professionals) and end users from each national location.

Figure 3a

Figure 3b

Table 1 below depicts the multi-level, multidisciplinary, multi-stakeholder, trans-national collaboration - symptoms of the ‘openness’ of the Connected Health sector.

Multi-level Scope for Openness in Connected Health (Galbraith et al, 2008)

Level Examples

Trans-national To create open innovation-friendly market conditions, regulatory conditions (data protection, liability, trade certification and accreditation) and cross-border health services

Regional Develop global policies that exploit local capabilities and opportunities (especially regions that have market deficiencies)

Technological Open standards, open source systems, modularity and interoperability

Firm To disband the closed paradigm of innovation and develop open organisational routines, absorptive capacity and dynamic networking capabilities in order to create and capture value

User communities (citizen/customer/healthcare worker)

Adopt user-led, living lab co-creation processes in the innovation activities of new, and improved products, services and processes

Table 1

The final theoretical and evidenced-based rationale for the MyHealth@Age methodology is to highlight the growing moving in Europe and amongst large multinational corporations toward a living lab method of working. Living Labs have been interpreted as an open and user-driven method (or tool), intermediary or network.

The growing European Network of Living Labs (www.openlivinglabs.eu) now represents 129 regions and includes a strong thematic network of healthcare living labs and multinational corporations such as Nokia, IBM, Telefonica, BT and SAP. This is a further representation towards a shift towards new open, inclusive, user-centric models of innovation.

The advantages of utilising a Living Lab approach include:

• User-centered

• Real user feedback and ideas

• Balance design versus engineering

• Avoiding technological determinism

• Openness and active communities drive innovation

• Vital tool in developing service & business innovations

• No company can do it alone

• Shorter time to market

Figure 4 below indicates the differing layers of Living Lab and Figure 5a below shows the the Triple Helix approach (Academia, State and Industry) afforded by adopting a Living Lab approach whilst Figure 5b instantiates this in a Connected Health context.

Layers of Living Lab

Source: Modified from presentation by VP Niitamo Research Director Nokia, Chair of European Living Labs Portfolio, February 2009, Malta.

Human LevelOrganic

Usage LevelTest beds and trials

Local-Regional LevelInnovation Service Provider

Thematic LevelThematic Networks

European LevelENoLL

Global LevelGlobal Networks

Figure 4

Triple Helix

State Academia

Industry

Users

Figure 5a

Triple Helix Instantiation

11

Figure 5b

SELECTION OF BUSINESS MODEL FRAMEWORKS

As reflected in the EC Lead Market Initiative (2007) and Table 1 (above) the implementation and scalability of eHealth solutions has often been hindered by legal, organization and technical factors. The MyHealth@Age project aims to manage the potential impediments. To that end we have adopted a business model framework from a wide range of those reviewed that will facilitate commercialisation of the product and service solutions being trialed in MyHealth@Age.

1.2 BUSINESS MODEL FRAMEWORKS

As a precursor to this discussion, it is important to reflect on the key aims of a business model. Namely, a business model should clarify:

1. How value is created (i.e. articulate the value proposition) and; 2. How value is captured (how do you get paid)

(Chesbrough, 2006).

It was important to identify a business model framework that was appropriate to critique and guide the development of business models for all three MyHealth@Age services.

Since MyHealth@Age involves the development of three new innovative services it was determined that each service will need to develop individual business models.

The Business Model Framework we have adopted is based upon the Nine Building Block Business Model Framework as well as using aspects of a SLEPT Analysis.

1.3 BACKGROUND TO NINE BUILDING BLOCKS MODEL

Conceptualisations of business models try to formalize informal descriptions into building blocks and their relationships. While many different conceptualizations exist Osterwalder proposed a synthesis of different conceptualizations into a single reference model based on the similarities of a large range of models, and constitutes a business model design template which allows enterprises to describe their business model:

Infrastructure

Core capabilities: The capabilities and competencies necessary to execute a company's business model.

Partner network: The business alliances which complement other aspects of the business model.

Value configuration: The rationale which makes a business mutually beneficial for a business and its customers.

Offering

Value proposition: The products and services a business offers. Quoting Osterwalder (2004), a value proposition "is an overall view of .. products and services that together represent value for a specific customer segment. It describes the way a firm differentiates itself from its competitors and is the reason why customers buy from a certain firm and not from another."

Customers

Target customer: The target audience for a business' products and services.

Distribution channel: The means by which a company delivers products and services to customers. This includes the company's marketing and distribution strategy.

Customer relationship: The links a company establishes between itself and its different customer segments. The process of managing customer relationships is referred to as customer relationship management.

Finances

Cost structure: The monetary consequences of the means employed in the business model.

Revenue: The way a company makes money through a variety of revenue flows. A company's income.

Figure 6 below provides a schematic of the Nine Building Block Model.

DistributionChannel

CoreCapabilities

PartnerNetwork

ValueConfiguration

ValueProposition

CustomerRelationship

TargetCustomer

CostStructure

RevenueStreams

INFRASTRUCTURE OFFER CUSTOMER

FINANCE

Business Model Design Template: Nine Building Blocks

and Their Relationships - Osterwalder 2004

Figure 6

1.4 SLEPT ANALYSIS

SLEPT is a commonly used tool that is deployed to conduct an environmental scanning of the macro factors that surround a new product or service innovation. In marketing terms, SLEPT is more widely known as a PEST (Political, Economic, Social & Technological) Analysis. However, both are very similar.

A SLEPT analysis is an investigation of the Socio-Cultural, Legal, Economic, Political, and Technological influences on an organisation.

Social factors relate to pattern of behaviour, tastes, and lifestyles. A major component of this is a change in consumer behaviour resulting from changes in fashions and styles. The age structure of the population also alters over time (currently we have an ageing population). An understanding of social change gives business a better feel for the future market situation.

Laws are continually being updated in a wide range of areas, e.g. consumer protection legislation, environmental legislation, health & safety and employment law, etc. Businesses need to take a pro-active approach and be ahead of these changes, rather than hurriedly making alterations to products and processes in a reactive way.

Economic changes are closely related to social ones. The economy goes through a series of fluctuations associated with general booms and slumps in economic activity. In a boom nearly all businesses benefit and in a slump most lose out. Other economic changes that affect business include changes in the interest rate, wage rates, and the rate of inflation (i.e. general level of increase in prices). Businesses will be more encouraged to expand and take risks when economic conditions are right, e.g. low interest rates and rising demand.

Political changes relate to changes in government influence. In recent years these changes have been particularly significant because as members of the European Union we have to adopt directives and regulations created by the EU which then become part of UK law. Political changes are closely tied up with legal changes.

Changes in technology have also become particularly significant in the post-millennium world. This is particularly true in terms of modern communication technologies. The creation of databases and electronic communications have enabled vast quantities of information to be shared and quickly distributed in a modern company enabling vast cost reductions, and often improvements in service. Organisations need to be aware of the latest relevant technologies for their business in order to keep up with the rapid changes that are occurring in this field and benefit from these changes.

All industries are influenced by SLEPT factors.

CONCLUSION

This “Questionnaire Background” document has set out the rationale behind our adoption of a multidisciplinary Living Lab approach for the development of the MyHealth@Age products and services as well as outlining the Business Model Framework adopted which informs the stakeholder questionnaire and focus group discussions that you will be completing with the MyHealth@Age representative.

Many thanks once again for taking your time for your participation and answering this questionnaire.

APPENDIX 2

Product and Service Critique Questionnaire for Service Provider – HWO / Municipality /

Alarm Centre

Product and Service Critique Questionnaire for Service Provider – HWO / Municipality /

Alarm Centre Authors:





Section 1 (Respondent Details)

Q1. What country were you based in, in relation to your involvement as a Service Provider – HWO / Municipality / Alarm Centre in the MyHealth@Age project? (please tick)

Northern Ireland Norway Sweden

Section 2 (Infrastructure)

Q2. In your opinion what capabilities and competencies are necessary to deliver the business model of each of the services? (Please comment on each service)

Social Networks ‐ End User / Patient / Client

‐ Carer

‐ Health & Welfare Organisation

‐ SME / Technology Provider

Prescribed Self Care ‐ End User / Patient / Client

‐ Carer



Mobile Safety Alarm ‐ End User / Patient / Client

‐ Carer



Q3. Describe the necessary partners and business alliances needed to compliment aspects of the business model for each of the three services (this can be technical, social, logistical or other).

Social Networks ‐ Technical

‐ Social

‐ Logistical

‐ Other

Prescribed Self Care ‐ Technical

‐ Social

‐ Logistical

‐ Other

Mobile Safety Alarm ‐ Technical

‐ Social

‐ Logistical

‐ Other

Q4. What are the biggest obstacles (technical, social, logistical, financial, ethical or other) in collaborating with each partner in delivering this service and how can they be addressed?

Social Networks Technical

Obstacles

Solution

Social

Obstacles

Solution

Logistical

Obstacles

Solution

Financial

Obstacles

Solution

Ethical

Obstacles

Solution

Other

Obstacles

Solution

Prescribed Self Care Technical

Obstacles

Solution

Social

Obstacles

Solution

Logistical

Obstacles

Solution

Financial

Obstacles

Solution

Ethical

Obstacles

Solution

Other

Obstacles

Solution

Mobile Safety Alarm Technical

Obstacles

Solution

Social

Obstacles

Solution

Logistical

Obstacles

Solution

Financial

Obstacles

Solution

Ethical

Obstacles

Solution

Other

Obstacles

Solution

Q5. Explain how each service offers value to both the organisation (i.e. Health & Welfare Organisation) that is providing the service and the customer (end user) that is receiving the service?

Social Networks Organisation

Customer / End User / Patient / Client

Prescribed Self Care Organisation


Mobile Safety Alarm Organisation


Section 3 (Offering)

Q6. Does each service work effectively (i.e. fully functional, usable, improve quality of life / independence etc)? Please comment on the best aspects.

Social Networks ‐ Functionality

‐ Ease of Use

‐ Improvement on Quality of Life / Independence

‐ Other

Prescribed Self Care ‐ Functionality

‐ Ease of Use


‐ Other

Mobile Safety Alarm ‐ Functionality

‐ Ease of Use


‐ Other

Q7. Do these services fully meet the needs of the Health & Welfare Organisation and the end user? If not, please outline the key criticisms of each service.


‐ Ease of Use


‐ Other


‐ Ease of Use


‐ Other


‐ Ease of Use


‐ Other

Q8. How resource intensive is the delivery of the service in comparison to the current provision? Overall is it more efficient to warrant introducing this new service?

Social Networks

Prescribed Self Care

Mobile Safety Alarm

Q.9 Will the service integrate with other products / platforms and is it scalable to other regions and countries?

Social Networks


Mobile Safety Alarm

Section 4 (Customer)

Q10. Describe the characteristics of each customer for each service?

Social Networks Service Provider – HWO / Municipality / Alarm Centre

End User / Patient / Client

Prescribed Self Care Service Provider – HWO / Municipality / Alarm Centre


Mobile Safety Alarm Service Provider – H&WO / Municipality / Alarm Centre


Q.11. What are the customer reactions to each service?





Mobile Safety Alarm Service Provider – HWO / Municipality / Alarm Centre


Q.13 How is this service different from other competitive services?

Social Networks


Mobile Safety Alarm

Q.12 If the service is not special, why would someone buy the service from you? (i.e. what is your competitive advantage?)

Social Networks


Mobile Safety Alarm

Q14. Describe the distribution channel for each service? The means by which the company delivers the service to the customer i.e. the marketing and distribution strategy (i.e. how will the services be commissioned / rolled out by the Health & Welfare Organisations / State ?)

Social Networks


Mobile Safety Alarm

Q15. Where will the service be sold and how will it be sold?

Social Networks


Mobile Safety Alarm

Section 5 (Finance)

Q.17. Describe the cost structure of each service? i.e. start-up costs, installation costs, purchase price etc.

Social Networks


Mobile Safety Alarm

Q.16 How much will each customer pay for each service?

Social Networks


Mobile Safety Alarm

Q.18 What is the model of payment for each service (fixed annual fee, price per interaction, combination or other)?

Social Networks


Mobile Safety Alarm

Q.19. Would customers (end users) pay for it if it was not paid for by the Health & Welfare Organisations / State? If yes, how much?

Social Networks


Mobile Safety Alarm

Thank you for your time in completing this questionnaire.

APPENDIX 3

Product and Service Critique Questionnaire for SME / Technology Providers

Product and Service Critique Questionnaire

for SME / Technology Providers Authors:






Q1. What country were you based in, in relation to your involvement as an SME / Technology Provider in the MyHealth@Age project? (please tick)





‐ Carer




‐ Carer




Social Networks ‐ Technical

‐ Social

‐ Logistical

‐ Other

Prescribed Self Care ‐ Technical

‐ Social

‐ Logistical

‐ Other

Mobile Safety Alarm ‐ Technical

‐ Social

‐ Logistical

‐ Other



Obstacles

Solution

Social

Obstacles

Solution

Logistical

Obstacles

Solution

Financial

Obstacles

Solution

Ethical

Obstacles

Solution

Other

Obstacles

Solution






‐ Ease of Use


‐ Other


‐ Ease of Use


‐ Other


‐ Ease of Use


‐ Other


‐ Ease of Use


‐ Other

Q8. How resource intensive is the delivery of the service in comparison to the current provision? Overall is it more efficient to warrant introducing this new service?

Social Networks


Mobile Safety Alarm

Q.9 Will the service integrate with other products / platforms and is it scalable to other regions and countries?

Social Networks


Mobile Safety Alarm



Social Networks Service Provider – H&WO / Municipality / Alarm Centre


Prescribed Self Care Service Provider – H&WO / Municipality / Alarm Centre








Social Networks


Mobile Safety Alarm

Q.12 If the service is not special, why would someone buy the service from you? (i.e. what is your competitive advantage?)

Social Networks


Mobile Safety Alarm

Q14. Describe the distribution channel for each service? The means by which the company delivers the service to the customer i.e. the marketing and distribution strategy (i.e. how will the services be commissioned / rolled out by the Health & Welfare Organisations / State ?)

Social Networks


Mobile Safety Alarm


Social Networks


Mobile Safety Alarm

Section 5 (Finance)

Q.17. Describe the cost structure of each service? i.e. start-up costs, installation costs, purchase price etc.

Social Networks


Mobile Safety Alarm

Q.16 How much will each customer pay for each service?

Social Networks


Mobile Safety Alarm

Q.18 What is the model of payment for each service (fixed annual fee, price per interaction, combination or other)?

Social Networks


Mobile Safety Alarm

Q.19. Would customers (end users) pay for it if it was not paid for by the Health & Welfare Organisations / State? If yes, how much?

Social Networks


Mobile Safety Alarm

Section 6 (The Process)

Q.20. Describe how the process of working with other SME / Technology Providers, Health & Welfare Organisations, end users and the universities / research organisations has (if at all) benefited your innovation efforts in the development and delivery of the MyHealth@Age products and services. Please provide examples / details.

Working with End User / Patient / Clients

Working with other SME / Technology Providers

Working with Health & Welfare Organisations

Working with the Universities / Research Organisations

Q.21. What have been the biggest challenges in working with end users, other SME / Technology Providers, Health & Welfare Organisations and the universities / research organisations, in furthering your innovation efforts in the development and delivery of the MyHealth@Age products and services?

Working with End User / Patient / Clients

Working with other SME / Technology Providers

Working with Health & Welfare Organisations

Working with the Universities / Research Organisations

Q.22. As a result of working on the development and delivery of the MyHealth@Age products and services, have you made any unintentional/unplanned improvements to your product portfolio? If yes, please explain?

Q.23. As a result of working on the development and delivery of the MyHealth@Age product and services, what did you learn in relation to the involvement of the end user in the innovation process? Please provide details.

Q.24. Regarding the involvement of end users in the innovation process, can you comment on the

advantages of involving the end user in each of the following stages. Please provide details.

Idea Generation / Understanding of Needs

Concept Development

Prototyping / Product & Service Development

Piloting of Services

Q.25. Regarding the involvement of end users in the innovation process, can you comment on the limitations of involving the end user in each of the following stages. Please provide details.

Idea Generation / Understanding of Needs

Concept Development

Prototyping / Product & Service Development

Piloting of Services

Q.26. What were the biggest advantages and disadvantages in working with external partners in creating the three new innovative services, rather than developing this internally?

Advantages

Disadvantages


APPENDIX 4

Product and Service Critique Questionnaire for Patient / Client

Product and Service Critique Questionnaire

for Patient / Client Authors:






Q1. What country were you based in, in relation to your involvement as a patient / client in the MyHealth@Age project? (please tick)





‐ Carer




‐ Carer





Obstacles

Solution

Social

Obstacles

Solution

Logistical

Obstacles

Solution

Financial

Obstacles

Solution

Ethical

Obstacles

Solution

Other

Obstacles

Solution






‐ Ease of Use


‐ Other


‐ Ease of Use


‐ Other


‐ Ease of Use


‐ Other


‐ Ease of Use


‐ Other








Social Networks


Mobile Safety Alarm

Section 5 (Finance)

Q.10 Would you as a customer (end user) pay for it if it was not paid for by the Health & Welfare Organisations / State? If yes, how much?

Social Networks


Mobile Safety Alarm


APPENDIX 5

Results from Sweden

WP4 SERVICE CRITIQUE - SWEDEN

Revision: PA1

Author: Lennart Isaksson, eHealth Innovation Centre,

Luleå University of Technology

Content

INTRODUCTION

QUESTIONNAIRE RESULTS MOBILE SAFETY ALARM

QUESTIONNAIRE RESULTS MOBILE PRESCRIBED HEALTHCARE

QUESTIONNAIRE RESULTS SOCIAL NETWORK

INTRODUCTION

The responders to the questionnaire have been:

End users: A group of 15 elderly field trial participants

Healthcare staff; A general practitioner and a physiotherapist from the Sanden healthcare centre

Welfare staff: Three homecare workers from municipality of Boden and two people working at Fyren alarm centre, city of Luleå.

Healthcare decision makers: General practitioner with medical responsibility for all healthcare centres in Boden and Luleå.

Welfare decision makers: General manager for ordinary care and a manager for a homecare group, Municipality of Boden. Process developer at City of Luleå.

Manager and technicians at the technology providers Tieto and Arctic Group.

The data collection has been carried‐out through focus meetings where the responders have discussed the

questions. But some of the responders have also filled‐in the questionnaire individually.

The answers in black colour is answers from elderly end‐users.

Answers in green colour is made by healthcare and welfare staff.

Answers in red colour bold italic style is made by healthcare and welfare decision makers.

Answers in blue colour is made by technology providers (“SME”).

Mixed colour = same answer for the categories with actual colours.


Q3. IN YOUR OPINION WHAT CAPABILITIES AND COMPETENCIES ARE NECESSARY TO DELIVER THE BUSINESS MODEL OF THE SERVICE?

End-User

Inclusion criteria:

Cognitive capability, arability to understand instructions.

Mental and some physical capability is required.

Shall be able to use the smart phone.

Shall be able to make alarms through the different means of generating an alarm.

Shall be knowledgeable about how the safety alarm works and the service level provided by the alarm centre and the assistance staff. For example, will it be supported 24 hr 365 days/year? How fast will the alarm centre manage alarms? Which alarms will the assistance staff provide assistance for? Different service levels at daytime/night time? At which geographical area will assistance be supported? What happends if alarms is made outside that area?

Exclusion criteria:

Mobile safety alarm is not aimed for people with dementia.

End‐users need enough vision in order to be able to manage the smart phone.

The user can’t have too shaky hands (For example parkinson patients with “shaky hands”.

Health and Welfare Organization

Welfare staff - Alarm centre

Time available to manage mobile safety alarms.

All alarm centre operators needs to be trained on managing mobile safety alarm calls.

Routines that describes how to manage mobile alarm calls.

Good manuals.

Be able to turn on the computer, log‐in and start the alarm centre application. Then use the alarm centre application.

Welfare staff – Assistance staff

Time available to manage mobile safety alarms.

Not to strong need of control

Need to be self‐going.

Good manuals.

All healthcare workers that shall assist mobile safety alarm calls has to be properly trained on receiving and managing alarm calls.

Routines on how to manage mobile alarm assistance calls.

ICT knowledge needed to some extent.

Be able to start the Smart‐phone and start and use the I‐Traks handset application.

Welfare organisation

More flexible organisation.

Shall “assistance need” based on the law of SOL be applied?

Mature to manage mobile alarm customers.

If not paid through “assistance need” decision, how to finance?

SME

The mobile safety alarm system has to be working reliable.

Provide easy to understands manuals/help guide.

The application and equipment shall be easy to use.

Understand the real working situation for the alarm and assistance operation.

Cost/efficiency both for elderly end‐user, municipality and the manufacturer.

Competence to develop mobile safety alarm applications för the Smart‐phone. Bluetooth competence, GPS knowledge ant knowledge how to integrate the solution with the alarm centre application through web‐services.

Q4. DESCRIBE THE NECESSARY PARTNERS AND BUSINESS ALLIANCES NEEDED TO COMPLIMENT ASPECTS OF THE BUSINESS MODEL FOR EACH OF THE THREE SERVICES (THIS CAN BE TECHNICAL, SOCIAL, LOGISTICAL OR OTHER).

Technology

The Mobile Safety Alarm has to be integrated with the conventional safety alarms already in use for the municipalities. That makes it necessary with co‐operation with vendors of conventional safety alarms like Tunstall, Caretech and STT Condigi.

Coperation with alarm receiver organizations lika SOS Alarm and Tunstall.

Technology provider, service provider and alarm receiver.

A more easy to use mobile phone. A more suitable alarmcentre application. The mobile alarm application has also to be integrated with the alarm centre application. It is also valuable to support existing standards for the integration.

Social

Provide the alarm customer the possibility to create an alarm chain. Make it possible to first send the alarm to for example the person the alarm customer lives together with. If that person don’t confirm that the alarm have been received, send it to the next receiver at the alarm chain. That could be alarm central or directly to the assistance staff.

Welfare organization and alarm central.

A change is needed if the customers will become mobile.

Logistical

Co‐operation with distribution chains/support organizations that are easy to access for the customers. For example network operator stores like Telia in Sweden.

The mobile application has to be easy enough to use for the end‐user. The end user shouldn’t need to make any configuration himself.

Other

Other healthcare service providers.

Safety guard companies like Securitas and Falk that can provide safety against crime.

Emergency Service for support to lift heavy persons etc. during assistance. This kind of co‐operation is already established between the homecare organization and the Emergency Service.

Police.

Financial partners that could provide leasing of mobile safety alarm equipment.

Q5. WHAT ARE THE BIGGEST OBSTACLES (TECHNICAL, SOCIAL, LOGISTICAL, FINANCIAL, ETHICAL OR WITH EACH PARTNER IN DELIVERING THIS SERVICE AND HOW CAN THEY BE ADDRESSED?

Technology

Obstacle: Need mobile coverage.

Solution: Don´t know how to improve.

Obstacle: Need GPS coverage.

Solution: Make it possible to inform the system when I am indoors at frequently visited places as

home, relatives etc.

Obstacle: Can the fall sensor work well also when I am taking a shower? Many fall accidents occur

in the bathroom.

Solution: Make the fall sensor waterproof.

Obstacle: The smartphone is cumbersome to learn how to use. Not everyone can use the alarm.

Some capabilities is needed to use it.

Solution: Make it easier to use. Provide education/training. Adopt functionality to other user

groups like people with dementia.

Obstacle: Shall work with all mobile phones.

Solution: Develop web‐application that support all common smartphones.

Obstacle: Shall always be connected with internet.

Solution: Extended mobile network coverage…

Obstacle: Longer battery time needed. Hard to remember to charge the device.

Solution: Improved batteries, more power efficient wireless connections etc.

Obstacle: Shall manage to identify geographic position indoors.

Solution: Provide easy to use functionality where the alarm customer can click on icon that he/she

is home and other frequent visited places.

Obstacle: Make it easy for assistance staff to support the person when the alarm customer has

made an alarm from own home and the door is locked.

Solution: Electronic locks at the alarm customers doors.

Obstacle: All parts of the mobile safety alarm has to work for complete safety ness.

Solution: Access to technical support 24 hours 365 days/year.

Obstacle: Mobile safety alarm support should be provided 24 hours 365 days/year.

Solution: Alarm centre and assistance staff should should always be on duty.

Social

Obstacle: None, only positive effects.

Obstacle: Lack of integrity.

Solution: Alarm customer position shall only be possible to see when an alarm is made.

Obstacle: The assistance staff wear cloths that show which organization they work for.

Solution: Many times it is important that the alarm customer and other can see who the

assistance staff is. Not good to wear ordinary cloths. Especially if they need to open

locked doors to make the assistance.

Obstacle: Change work method..

Solution: Adopt work methods/processes to manage mobile customers.

Logistical

Obstacle: The assistance staff have limited time available for assistance (supporting other

customers with ordinary homecare services). They also have limited availability to cars

necessary for outdoor assistance.

Solution: Can be necessary to extend the assistance staff workforce and acquire more cars. Can

also be necessary to establish dedicated team for safety alarm assistance.

Obstacle: Assistance can only be provided at the municipality area.

Solution: Co‐operation between municipalities.

Obstacle: If the phone is lost or damaged, how to get access to a working phone? Problem both

for alarm customers and assistance staff.

Solution: Provide easy access to replacement equipment.

Obstacle: Need to be integrated with existing business support systems and alarm central system.

Solution: The systems has to “talk with each other”.

Financial

Obstacle: No‐one wants to pay the cost!

Solution: Make it possible to get large part of the costs paid by the municipality.

Obstacle: Who shall pay? Shall it be subsidised through “need” decision based on the law SOL or

shall the alarm customer pay the equipment and alarm assistance service by

herself/himself???

Solution: The welfare organization has to decide how the mobile safety alarm shall be offered and

financed.

Obstacle: The municipalities have limited budget.

Solution: Develop alarm system solution that won’t cost more than 500‐700 SEK/month. That is

what some municipalities in the southern part of Sweden already invoice for traditional

safety alarm. More than that isn’t economical possible to charge the customers. If the

alarm customers want pay that much, their children might pay.

Obstacle: Is the customers willing to pay large/whole cost for the mobile safety alarm including

the alarm centre and assistance service?

Solution: Not more that 500‐700 SEK/month. Is it possible to get sponsoring from companies?

European community economical support? Deductible cost for income tax?

Ethical

Obstacle: Integrity “big brother see you”.

Solution: Make it only possible to track the end‐user position when an alarm is initiated.

Obstacle: Religious or other reason that makes it not possible to get assistance from the opposite

sex.

Solution: Include the assistance application with support to make sure that suitable assistance

staff is allocated for the safety alarm assistance work.

Obstacle: Manage to support alarm customers that can’t speak the national language.

Solution: Provide the assistance staff with mobile translation service.

Obstacle: How to manage communication between alarm centre and alarm customer when the

alarm customer have hearing disability?

Solution: Support video calls through the mobile phone?

Q6. EXPLAIN HOW EACH SERVICE OFFERS VALUE TO BOTH THE ORGANISATION (I.E. HEALTH & WELFARE IS PROVIDING THE SERVICE AND THE CUSTOMER (END USER) THAT IS RECEIVING THE SERVICE?

End-User

Improved freedom with high personal security.

Extended freedom to be outdoors and visit friends and still feel safe.

Be able to keep frequent social contacts also when the health becomes more fragile.

Be able to remain physical active.

Better health.


Welfare staff

Learn new technology.

Improved appreciation from the alarm customers.

Increased workload => lower risk that the workforce will be downsized.

If people remain with good health, the need for healthcare services will be reduced.

Q7. DOES EACH SERVICE WORK EFFECTIVELY (I.E. FULLY FUNCTIONAL, USABLE, IMPROVE QUALITY OF LIFE / INDEPENDENCE ETC)? PLEASE COMMENT ON THE BEST ASPECTS.

Functionality

It works well, but remove the 1 minute delay before the alarm is transferred to the alarm centre. It is better that the alarm is transferred directly. It is always possible to tell the alarm centre staff that it was a false alarm I there isn’t a need for assistance..

The alarm that was used in the field trial is considered to have complete functionality.

Yes.

Easy to use

Yes, if the complexity of the smart phone itself is not considered. The menus for the mobile alarm application is easy to use, but the phone itself is to complicated to use.

Alarm centre staff

Picture of the alarm customer is popping‐up all the time. Not necessary. Enough that the picture is possible to view.

Delay until the SMS is received. Since the alarm centre staff not always is at the alarm centre control room, it is important to get the sms without unnecessary delay. That can be achieved bi national SMS service for all alarm centres. Now the SMS is sent from Northern Ireland to Sweden.

The alarm assistance staff and the alarm centre staff shall be the ones that can deactivate the alarm when the assistance is completed, not the alarm customer. If the alarm centre staff can decide that there is no need for the assistance staff to be involved, it is the alarm centre that shall deactivate the alarm. In other case, the assistance staff.

The alarm centre staff shall be able to turn of the alarm sound for a specific alarm even if the work to manage the alarm isn´t completed. But if a new alarm is received, the alarm sound shall begin for the new alarm.

Assistance staff

Shall be able to turn off the alarm. It shall be registered who turned off the alarm.

Sometimes hard to hear when an alarm is received. For example when the staff is using bicycle with loud sound from cars passing by. Also when using car for transport and when making vacuum cleaning.

Better sound quality talking with alarm customers through the mobile phone. Some alarm customers have hearing disabilities and need high volume.

The mobile phone live it’s own life, but the service works well.

The map isn’t very good. Google Map works better and is more detailed.

Improved quality of life / independence

Should improve quality of life if the alarm customer can move more independently. Participate in social life, visit friends and relatives.

Yes, the alarm customer becomes more mobile/gets opportunities to socialize more.

Q8. DO THESE SERVICES FULLY MEET THE NEEDS OF THE HEALTH PLEASE OUTLINE THE KEY CRITICISMS OF EACH SERVICE.

Functionality

The reliability of the service needs to be improved. Shall always work, not only work days / hours.

Speech recognition for people with vision limitation.

Yes.

Easy to use

The alarm centre application has to become easier to use and more reliable.

Healthcare staff

The smart phone should be easier to use.

The mobile safety application should be easier to use.

The communication between assistance staff and the alarm centre staff should be easier and faster. Can’t wait 20 minutes until they call back!

More visible symbols.

Larger text size and larger screen.

Improved Quality of Life

Targeted to the customer. Generate more work/responsibility for the welfare organization. At least short turn.

Yes.

Q9. HOW RESOURCE INTENSIVE IS THE DELIVERY OF THE SERVICE IN COMPARISON TO THE CURRENT PROVISION? OVERALL IS IT MORE EFFICIENT TO WARRANT INTRODUCING THIS NEW SERVICE?

More alarm customer => more alarm to assist.

The homecare organization at Municipality of Boden has to be changed since all homecare teams only work in their own area in the municipality.

The assistance staff that shall manage safety alarms need to have access to cars.

Need more cars for assistance.

Added value for the alarm customer (improved freedom to move).

Everything new require effort from the staff. The most efficient introduction of the mobile safety alarm application is through the existing alarm centre application.

Q.10 WILL THE SERVICE INTEGRATE WITH OTHER PRODUCTS / PLATFORMS AND IS IT SCALABLE TO OTHER REGIONS AND COUNTRIES?

Yes.

Have a docking‐station at home where the mobile phone is placed. When it is placed in the docking station, it shall be connected to the existing alarm systems at home. That could be traditional home‐based safety alarm, fire alarm, burglary alarm etc.

Time will tell… Co‐operation needed with existing providers of safety alarms.

Q11. DESCRIBE THE CHARACTERISTICS OF EACH CUSTOMER FOR EACH SERVICE?


Lack of money!

Flexible organization.

Engagement to prevent health problems.

Improved knowledge about where the customer is if the customer have left the home and need support.

Cost-sensitive. Require reliable and easy to use applications.

Alarm customer

Rather good physical and mental shape.

Better health than customers of conventional safety alarms.

Social and physical active life.

Flexible.

Ready to pay the cost.

The customer would like to be more mobile than today. Many young people have functional limitations.

Request easy to use and reliable solution.

Q.12. WHAT ARE THE CUSTOMER REACTIONS TO EACH SERVICE?

Alarm customer

Mobility offers improved safety ness.

Will use the service if the price is right.

Can I really trust the alarm when I really need to initiate an alarm?

Can I trust that the position that is transferred is correct?


Welfare staff – Alarm centre

Will we have time to support mobile alarms?

Afraid that it would cause many extra alarms => significant extra work volume. But the extra workload was very small.

Always cumbersome to learn something new. Especially for this workforce that isn’t technically oriented.

Welfare staff – Assistance staff

Will we have time to support mobile alarms?

Afraid that it would cause significant extra work. Could be problem to manage ordinary homecare appointments when mobile assistance calls needs to be done.

Always cumbersome to learn something new. Especially for this workforce that isn’t technically oriented.

Healthcare decision makers

Who will pay???

Q.13 HOW IS THIS SERVICE DIFFERENT FROM OTHER COMPETITIVE SERVICES?

Provides the alarm customer with increased freedom. Very much appreciated.

More flexible and with more functions.

Mobile connection, GPS and fall sensor.

Q.14 IF THE SERVICE IS NOT SPECIAL, WHY WOULD SOMEONE BUY THE SERVICE FROM YOU? (I.E. WHAT IS YOUR COMPETITIVE ADVANTAGE?)

The welfare organization in City of Luleå with a dedicated alarm group secure fast response when alarms is received. Not busy with other work which is common for the homecare workers.

It is reliable.

Q15. DESCRIBE THE DISTRIBUTION CHANNEL FOR EACH SERVICE? THE MEANS BY WHICH THE COMPANY DELIVERS THE SERVICE TO THE CUSTOMER I.E. THE MARKETING AND DISTRIBUTION STRATEGY (I.E. HOW WILL THE SERVICES BE OMMISSIONED ?)

Political question

What is a reasonable living condition? Does it include mobile safety alarm to feel safe?

If partly subsidy by the municipalities, it would be provided at the alarm centre or by the welfare teams.

Complementary service for citizens.

Education should be provided by the technology provider or by the alarm staff.

1st line support through alarm centre staff or homecare staff.

Who will provide advanced support???

Municipalities and private alarm companies offer the customers their alarm service. The alarm equipment/applications are delivered by companies that compete with each other to get their specific product on the market for the alarm customers. The alarm operators market their offerings directly to the alarm customers (end-users, elderly with fragile health). The alarm product vendors market themselves instead towards the alarm service operators (municipalities and private alarm service operators like Tunstal and SOS Alarm).

Q16. WHERE WILL THE SERVICE BE SOLD AND HOW WILL IT BE SOLD?

Probably at private stores or by the municipality.

Through municipalities and private alarm service operators.

Q.17. DESCRIBE THE COST STRUCTURE OF EACH SERVICE? I.E. START-UP COSTS, INSTALLATION COSTS, PURCHASE PRICE ETC.

Subsidy by the Municipality. A monthly service charge should be invoiced to the customer. Not higher than 500‐700 SEK/month.

If offered by commercial company, everything has to be paid by the customer.

Cost for smart phone and mobile subscription. Monthly cost for the alarm assistance service.

Q.18 HOW MUCH WILL EACH CUSTOMER PAY FOR THE MOBILE SAFETY ALARM SERVICE?

Based on the service content. Will it only provide social service assistance or will also personal safety be included? Shall the mobile phone communication cost be included in the monthly subscription charge?

Today, the alarm customers are invoiced about 15 Euro/month. Absolutely not more than 500‐700 SEK/Month för Mobile Safety Alarm.

Probably an up‐front cost of 100‐200 Euro. Then a mobile safety alarm assistance subscription cost of 10‐20 Euro/month. The mobile subscription for the mobile phone communication will then be added and depend on how much voice and data communication the end‐user will use.

Q.19 WHAT IS THE MODEL OF PAYMENT FOR EACH SERVICE (FIXED ANNUAL FEE, PRICE PER INTERACTION, COMBINATION OR OTHER)?

Monthly subscription charge. Don´t cover the whole cost. Tax financing has to be applied to some extent.

Initial cost and a monthly subscription cost.

Q.20. WOULD CUSTOMERS (END USERS) PAY FOR IT IF IT WAS NOT PAID FOR BY THE HEALTH & WELFARE ORGANISATION / STATE? IF YES, HOW MUCH?

Could be possible. The customer could pay the whole cost. But not more than 50‐70 Euro/month.

10‐20 Euro/month. They pay for increased safety.

Q.21. DESCRIBE HOW THE PROCESS OF WORKING WITH OTHER SMES, HEALTH & WELFARE ORGANISATIONS, END USERS AND THE UNIVERSITIES / RESEARCH ORGANISATIONS HAS (IF AT ALL) BENEFITED YOUR INNOVATION EFFORTS IN THE DEVELOPMENT AND DELIVERY OF THE MYHEALTH@AGE PRODUCTS AND SERVICES. PLEASE PROVIDE EXAMPLES / DETAILS.

Co-operation with End-Users

Decision of which alarm functionality to include and the design for the alarm application.

Co-operation with ICT companies

Integration with systems from other ICT companies.

Co-Operation with Health- and Welfare Organization

Most broad co‐operation between the municipalities. That is very positive.

Should have been better. At least regarding the alarm centre application.

Co-operation with Universities/Research institutes

A well working co‐operation was already in place. This has been strengthen even more during the project.

Unsure if the research level at this project is high enough for co‐operation with researchers?

Q.22. WHAT HAVE BEEN THE BIGGEST CHALLENGES IN WORKING WITH END USERS, OTHER SMES, HEALTH & WELFARE ORGANISATIONS AND THE UNIVERSITIES / RESEARCH ORGANISATIONS, IN FURTHERING YOUR INNOVATION EFFORTS IN THE DEVELOPMENT AND DELIVERY OF THE MYHEALTH@AGE PRODUCTS AND SERVICES?

Co-operation with end-users

Has worked‐out well.

To get all requirements specified and to understand the requirements specified by the end‐users.

Co-operation with other ICT companies

The technology and the vocabulary can be a challenge to manage for healthcare staff that is unused with that.

To adapt towards existing solutions.

Co-operation with Health and Welfare Organization

Has worked‐out well.

To get the trust from the welfare organizations to really use the new applications.

To get the welfare staff to really use the new technical support tools.

Co-operation with University/research institutes

The technology competence have increased.

To find the research part and the research level.

Q.23. AS A RESULT OF WORKING ON THE DEVELOPMENT AND DELIVERY OF THE MYHEALTH@AGE PRODUCTS AND SERVICES, HAVE YOU MADE ANY UNINTENTIONAL/UNPLANNED IMPROVEMENTS TO YOUR PRODUCT PORTFOLIO? IF YES, PLEASE EXPLAIN?

More knowledgeable than expected to use the Smart phone.

No.

Q.24. AS A RESULT OF WORKING ON THE DEVELOPMENT AND DELIVERY OF THE MYHEALTH@AGE PRODUCT AND SERVICES, WHAT DID YOU LEARN IN RELATION TO THE INVOLVEMENT OF THE END USER IN THE INNOVATION PROCESS? PLEASE PROVIDE DETAILS.

The end‐users knows best what they need.

The importance to collect the end‐users requirements at an early stage.

To focus on usability.

Q.25. REGARDING THE INVOLVEMENT OF END USERS IN THE INNOVATION PROCESS, CAN YOU COMMENT ON THE ADVANTAGES OF INVOLVING THE END USER IN EACH OF THE FOLLOWING STAGES. PLEASE PROVIDE DETAILS.

Idea generation/need understanding

The co‐operation with end‐users are positive, it don’t raise constrictions.

Ideas can easily run far away from what is relevant. It is then important to help the end‐users to get back on track without making them to forget the initial idea.

Consider that it shall be easy to use already at the beginning. This can however itself reduce the creativity. It is a hard balance to manage.

Concept development

Again – try to find the core of the services the end‐users request and make it as easy as possible. Focus shall always be on usability.

Prototype development

Important to get feedback – especially regarding the graphical user interface.

Pilot trial

At this phase, it is hard to make extensive changes. The focus is mainly on improvement of the details.

Q.26. REGARDING THE INVOLVEMENT OF END USERS IN THE INNOVATION PROCESS, CAN YOU COMMENT ON THE LIMITATIONS OF INVOLVING THE END USER IN EACH OF THE FOLLOWING STAGES. PLEASE PROVIDE DETAILS.

Idea generation / understanding of needs

The end‐users engagement is really positive. They don´t limit the innovation process at all.

Sometimes, lack of knowledge about what is technically possible to achieve makes the end‐user to wish for unrealistic solutions.

Consept development

Hard to get everybody in the end‐user group to agree about what is good for everybody. Different people have different conditions and therefore different requirements.

Prototype development

Focus on details that don’t really are product related. Difficult to see the whole picture.

Pilot trial

Sometimes lack of understanding about what is really possible to change.

Q.27. WHAT WERE THE BIGGEST ADVANTAGES AND DISADVANTAGES IN WORKING WITH EXTERNAL PARTNERS IN CREATING THE THREE NEW INNOVATIVE SERVICES, RATHER THAN DEVELOPING THIS INTERNALLY?

Advantages

More competences contribute.

Learn to know new partners. Establish relationships with companies that might evolve to new business relationships.

Disadvantages

Sometimes, the time is running out… It takes more time to co‐operate (at least short turn).

Integration with existing systems. Hard to get another company to adopt their solution. Weak engagement from some companies to contribute. Resistance to change. Especially regarding companies that build their solution on an existing product.

QUESTIONNAIRE RESULTS PRESCRIBED HEALTHCARE


End-User

a) Own interest to learn how to use the technology.

b) Basic knowledge on how to use the equipment and the application.

c) Some experience on how to use computer or smart phone is valuable, but not a requirement.

d) Good vision and not shaky hands.

e) Cognitive capability, not dement.

f) Capability to understand instructions.

g) The patient need to be self‐going.

h) Be able to write.


a) Ready to change work methods and leave how things have been done earlier.

b) Enough experience to use computer.

c) Some basic computer and internet experience.

d) Access to staff.

e) Forgiving attitude from the management.

f) Access to interested patients.

Healthcare staff

g) Time available for prescribed healthcare.

h) Not to strong control need.

i) Time to learn and use the Prescribed Healthcare application.

SME

a) Listen to the needs of the end‐users and the staff.

b) Not to many technology thoughts.

c) Competence, both technical and logistical.

d) High service level.

e) High availability.

f) The technology provider need experience to offer reliable ICT environment in order to secure high availability to the application.

g) The technology provider has to be able to provide scalability. That is to be able to expand the number of users significantly and make sure that all users get fast response times. It is also important to be able to manage integration with other related ICT systems used by the healthcare organization.


Technology

a) Integration with healthcare systems.

b) Telephone operators.

c) Software providers.

d) Co‐operation with medical journal providers for integration between the computer systems.

e) A larger company is needed that is ready to manage the whole ICT responsibility for the solution. This technology provider should provide the most extensive technology part of the implementation. It is also necessary that the other ICT providers are ready to sell and guarantee their parts of the solution on reasonable economical terms.

f) Select as flexible and scalable solutions as possible in order to make it possible to expand functionality and exchange hardware when needed as the total solution evolves.

Social

g) Co‐operation between Healthcare and Welfare organizations. The district nurses are often employed by the municipalities in Sweden.


Technical

Obstacle: Need to learn how to use the equipment and the application.

Solution: Make the equipment and application user friendly and intuitive to use. Easy to

understand manual/guide.

Obstacle: People with for example Parkinson that have hard to control the pen (shaky hands).

Solution: Visual aids and alternative interaction with the device.

Obstacle: Menues needs to be easier to understand.

Solution: Develop the menus together with the end‐users. Make it easy to change them when

needed.

Obstacle: Open tendering procedure to purchase mobile phones and diagnose equipment.

Solution: Knowledgeable purchase staff. Good requirement specifications.

Obstacle: VAS cooperation (the health record system used by County Council of Norrbotten)

Solution: Political support.

Obstacle: Can be a problem to scale‐up the solution to many users.

Solution: The architecture of the solution need to be scalable. The implementation need to be

developed with scalability and high availability in mind. The ICT operational environment

need to be scalable.

Obstacle: Lack of integration with Healthcare providers ICT systems.

Solution: It is important that it is possible to easily integrate the application with already existing

ICT systems at the healthcare provider.

Obstacle: Future proof offering.

Solution: The system implementation has to be based on a flexible architecture making it easy

and economical to enhance and expand the functionality.

Obstacle: In order for Healthcare providers to introduce the new application on larger scale, they

need to trust the technology provider.

Solution: A large ICT provider has to be responsible for the whole solution for the Healthcare

organization. That is market, sale and support. The other ICT providers has to co‐operate

with that company and offer their parts of the solution at reasonable terms.

Social

Obstacle: Users that are singles with no or few social contacts don´t get any support.

Solution: End‐user groups that supports “Super‐users”.

Financial

Obstacle: If I make the work for the healthcare centre, they shall finance the equipment.

Solution: The healthcare centre shall provide Prescribed Healthcare equipment.

Obstacle: Have the County Council money to finance prescribed healthcare? More elderly people => higher

cost but reduced income.

Solution: High cost limit ad for medication could be one possibility.

Obstacle: Cost for diagnose equipment that needs to be paid by the elderly end‐users.

Solution: Develop an attractive “package” that the end‐user feel give value for their money.

Obstacle: Shall the customer pay?

Solution: Political support.

Obstacle: Open source software?

Solution: Agreement with the software providers.

Ethical

Obstacle: Personal integrity.

Solution: Enough high data security. Protection against virus and hackers.

Obstacle: Mostly security/integrity issues.Which information can be sent/received

electronically?

Solution: Increased availability to healthcare staff.

Obstacle: Secure data connection.

Solution: Secure authorization of users.

Other

Obstacle: Who is responsible if my medical diagnose measurements are not correct and cause

health problems due to wrong treatment?

Solution: The healthcare organization is always medically responsible. The healthcare organization

has to educate the patient and make sure that the patient can perform prescribed

healthcare before they approve the patient to use it.

Q6. EXPLAIN HOW THE PRESCRIBED HEALTHCARE SERVICE OFFERS VALUE TO BOTH THE ORGANISATION (I.E. HEALTH & WELFARE IS PROVIDING THE SERVICE AND THE CUSTOMER (END USER) THAT IS RECEIVING THE SERVICE?

End-User

Better knowledge about my own health and when I should contact the healthcare centre.

Better knowledge about my health can motivate me to take better care of my own health through more healthy diet and regular physical exercises.

Possibility to communicate with his/her caregivers without need to travel.

Improved availability to healthcare.

It is easier to get contact with my doctor, even at time of day/week when the doctor isn’t available directly, through the messaging service.

Improved knowledge about own health.

More secure treatment through more frequent contacts.

Can manage my chronicle disease with greater trust. Don’t need to worry as much as before.

More satisfied patients that feel that they are seen by the healthcare staff.

Fast availability to information when something happens.

Possibility to perform physical exercises on distance.


Healthcare staff

The patients perform part of the healthcare centre work.

Fewer patients in the waiting room.

More healthy patients reduce the workload at the healthcare centres.

Easier to communicate with patients.

Save time for personal contacts.

Strengthen the healthcare providers market position against other healthcare providers.


Functionality

More attractive and easy‐to‐use user interface is requested.

Support users with physical disabilities. Reduced vision, shaky hands etc.

Support more efficient work process.

The functionality has to be enhanced to be easier to use.

The application has no known errors at this point. It might be needed to expand the functionality for larger scale usage in order to manage large number of patients for the healthcare staff. Integration with the Healthcare providers other ICT systems etc.

Easy to use

Seem to be easy to use for the patients. But all functions will probably don’t be used. The user will only use the most important ones.

Generally it is easy to use for the healthcare staff, but some parts of the implementation needs to be made even more easy to use for the healthcare staff.

The Prescribed Healthcare application has to be integrated with VAS, the medical record system.

Improved Quality of Life

a) Makes life more safe. Improves the knowledge of the own health condition.

b) The mobility improves the quality of life for most people.

a) Yes, due to the Mobile Safety alarm and easier access to welfare staff.

Other

c) The mobile network isn’t always working.


Functionality

Would like to be able to use computer since it is easier to interact with the prescribed healthcare application through a full‐size keyboard and a large screen (Patient functioinality).

The web-application for the healthcare staff should be made more intelligent.

The palette can be made broader. Develop more functions.

Better user interface. Provide better overview.

Easy to use

Yes.

Integrate with VAS.

More modern smart phone.

Integrate solution with home‐PC.

Improved Quality of Life and Independency

Yes.

Should be offered to patient that recently received diagnose when the motivation to change lifestyle is large.


The efficiency can be improved with this tool. At the end, available time will be provided/prioritized.

Prescribed Healthcare won’t replace but complement existing work methods.

Traditional (unsecure) e-maiul contact between patients and healthcare staff is already commonly used.


Yes, that is very likely.

Has to be designed to be integrated with several medical record systems.

Yes, in order to make the application attractive for the healthcare staff it is important that this won´t be a new “extra system”. It should therefore be integrated.

For the patient it is valuable that this application is provided on the web at a portal for other related health applications and information services.


Patient

Willing to learn.

Would like to learn more about the diagnose/health condition.

Wish to change to healthier lifestyle.

Secure that they have Cognitive capability.

Healthcare staff

Willing to learn.

Overloaded with work/patients. Need to get smart short‐cuts.

Computer literacy very much.

Ready to be more coach oriented and not focus on control.


End-User

Initially eager, then will the enthusiasm be reduced.

Only part of the functionality will be frequently used.


Healthcare staff

More work.

Work time conflict?

Initial resistance in parts of the organization.

Early adopter teams/units.

Patient

Complicated technology.Can I manage to use the equipment/application???


There are no similar services offered today. My Healthcare Contacts application will soon be launched. They should be integrated to provide prescribed healthcare.

Contact with my doctor and my physical therapist, not to an anonymous care giver.


It provides additional value for the customers. Both for the patients and the health organization.

Probably not.


The County Council has to be involved as service provider. Provide medical experience.

Two alternatives:

a) Healthcare organization offer the Prescribed Healthcare service to selected patients with special needs.

b) Patients purchase smart phone, diagnose equipment and application for co-operation with his/her healthcare service provider.

For both cases, education is provided by the healthcare organization.


Through the healthcare centres (County Council).

On the internet.


To a high extent, financed by the patients. The offering has therefore to be attractive and include demand on the Healthcare Staff/Service.

The smart phone can be rented at the healthcare centre if the patient don’t have his/her own phone.

The application/software should be provided for the patient for free.

The diagnose equipment can be rented at the healthcare centre or purchased by the patient based on recommended specifications from the healthcare centre..

Q.18 HOW MUCH WILL EACH CUSTOMER PAY FOR EACH SERVICE?

Mobile phone and eventual computer together with end‐user diagnose equipment has to be financed by the patients. All other costs has to be paid by the healthcare organization.

Can’t be to expensive. 10‐20 Euro/month.


Up‐front cost when equipment is purchased.

Patients should buy or rent the smartphones.

Medical diagnose equipment should also be purchased or rented by the patients.

A monthly fee should be payed to the healthcare provider. If the patient have reach the maximum cost level/year = 90 Euro/year, the cost should be free.


Mobile phone and eventual computer together with end‐user diagnose equipment has to be financed by the patients. All other costs has to be paid by the healthcare organization.

End-User


Co-operation with patients

Many technology based ideas have been created, but no new solutions.

The co‐operation with patients have been necessary in order to develop an user‐friendly application for them. Example on questions that the patients have provided answers to is what is complicated when the application is used at a Smart phone? Answer: The text is to small. How should medical diagnose results be managed? Answer: Not automatic. Prefer manual typing through the keyboard. Appreciate to have own control of the measurement results that are stored.

Co-Operation with Unioversity/Research institutes

Very limited.

Arctic Group have provided with important competence regarding Windows Mobile. The co‐operation between Tieto and Arctic Group have made the calander functionality with alarms for the end‐users when new messages have been received etc. from the GP possible to provide.

Healthcare staff

Discussions with the General practitioner that used the application have generated enhancements regarding for example how it should be marked when a patient request is completely answered.



Healthcare staff

To get technical solutions that really works.



Expanded the prescription of physical exercises and patient performed diagnose measurements at home for patients.

Restarted off-care.



Healthcare staff

It is necessary to stimulate patient’s use of the services and provide active response. If the healthcare staff won’t give response, the end‐usage decreases. It is a large interest here as well as a large development potential.


Idea generation and understanding of needs

Ideas have been created, but the technology includes restrictions.

The patient can think more freely since they don’t know what is possible/impossible to implement easily/with large effort/impossible.

Prototype development/product and service development

Larger screens and keyboard. Easier to use manuals.

Field-trial of new services

Larger screens and keyboard. Easier to use manuals.


Idea generation / understanding of needs

No.


Advantages

New ideas and “viewing angels” have been generated. Move the process forward.

Input from other healthcare organizations.

Other views on patient responsibility, autonomously etc.

The total available competence is larger.

It is easier to identify innovative solutions when ideas are discussed with other people.

Disadvantages

Easier to develop “My own solution” without considering the partners.

If one partner haven´t time available, it can delay another partners work.

QUESTIONNAIRE RESULTS SOCIAL NETWORK


To be able to use the mobile phone and the social network application.



The group is to small with people from different geographical area and with different interests. Don’t make sense to use it in this context.

The application is also to cumbersome to use and provide to little functionality to be really valuable. Facebook is a much more attractive alternative.

Q6. EXPLAIN HOW EACH SERVICE OFFERS VALUE TO BOTH THE ORGANISATION (I.E. HEALTH & WELFARE IS PROVIDING THE SERVICE AND THE CUSTOMER (END USER) THAT IS RECEIVING THE SERVICE?

The only value in this context is information sharing regarding project information.


Cumbersome to use. Not easy to use interace. Lack of functionality. Facebook is a better alternative.


To limited user group.

To limited functionality.


This is a service that should be self‐going without need to be actively supported by healthcare or welfare staff.


No.


It could be valuable if a wider user group would be involved. It need to be enough people that share common interests.


Why shall I use it???

Why shall the healthcare or welfare staff be actively involved using this service?


To limited functionality.


It will probably not be used in Sweden after the project.


Not actual.


Not actual.


Need mobile interconnected phone. No other cost.

Q.18 HOW MUCH WILL EACH CUSTOMER PAY FOR EACH SERVICE?

Should be offered for free (like Facebook).


Should be offered for free (like Facebook). Advertise financed.


No.


Requirements have been specified. The SME have made requested changes.


See the same answers for the other products/services.











APPENDIX 6

Results from Norway

Product and Service Critique – HWO

Mobile Safety Alarm None of the HWOs (employed in home care services and sheltered houses/retirement homes) had participated in the trial. Capabilities and Competencies The home care services have implemented a new safety alarm service for its users and the carers now receive alarms on a mobile phone. Some of the health personnel find it hard to use any kind of technology, even mobile phones, but state that it is possible to learn new systems if they are trained properly. The Functioning of the Services The healthcare workers didn´t participate in the Norwegian trials and are not able to comment on the functioning of the services. Obstacles Many of the end users are old and in bad health. They are not comfortable with operating any kind of technical device. The healthcare workers recognise that the mobile alarm makes the users feel secure. At present, the home care workers respond to alarms in the users´ homes, but they will not be able to assist users outside their homes. The service will have to be reorganized if the mobile alarm is implemented. The management of the mobile alarm service would demand more resources than the present security alarm. Benefits Users of the present safety alarms often forget to press the alarm or are unable to reach it if they find themselves in a situation when assistance is needed. Many users don´t carry the alarm because they are afraid of accidentally pressing the alarm button. The HWOs think that an alarm with an automated fall sensor will be positive, as situations like this can be avoided.

Prescribed Self Care The healthcare workers didn´t participate in the trials Capabilities and Competencies The healthcare workers report that many of the users of the home care services, especially those over the age of 80, are not comfortable using mobile phones or sensors for measuring blood pressure etc. and will need help in operating phones and sensors. They expect that health care workers will be able to operate this service if they receive sufficient training. Many users are not capable of employing the devices. The health care workers think they can aid the users in making and transmitting measurements as well as guide them in interpreting feedback from the GP. As nurses, they are also trained in handling the condition of chronic patients and may receive measurements and manage for instance the blood sugar level in diabetics without involving the GP. The Functioning of the Services The healthcare workers didn´t participate in the Norwegian trials and are not able to comment on the functioning of the services. Obstacles Many of the end users are old and in bad health. They are not comfortable with operating any kind of technical device. The measurements have to be integrated in the GPs´ EPR in order to get the GPs to offer this service to their patients.

At present, the GPs are not reimbursed for offering these kinds of services, neither are the home care services. The healthcare workers don´t consider this an obstacle to the municipal participation in the implementation of this service, since they already take/do a lot of tests without getting extra payment (the GPs get paid, however) and the service probably will result in savings and other benefits for the home care services. They apprehend however that the GPs will not engage in routine services without reimbursement. Benefits The home care services often accompany users to the GP or take test ordered by the GP in the patient´s home and carry it to the GPs office or the lab. They strongly believe that this service will contribute to more efficient use of their time as well as improving the quality of the follow-up of patients with chronic diseases. They therefore think that the municipalities may want to finance the service for users of home care services.

Social Networks The healthcare workers haven´t participated in trying out this service. They report that many of those in need of nursing don´t use a mobile phone – they still use the home telephone. They don´t think the municipality will participate in supplying this service.

Product and Service Critique – End Users Capabilities and Competencies To employ the services, the end users have to be trained in using mobile phones. The users state that it is important that the software/services can be installed on their private mobile phone, as they don´t want to carry two phones. They want to keep their private phone because it is difficult to learn to use an unknown mobile phone. The end users think that the health personnel participating in the trial have the necessary competencies to deliver the Prescribed Self Care service. The Functioning of the Services Functionality:

The end users are not satisfied with the design of the fall sensor. They think alternatives to carrying it on the belt must be developed.

The end users find that the mobile phone is not user friendly; battery time is to short and the keypad is too

small (see chapter above: they prefer to use their own, private phones).

The social networks service is not user-friendly: the end users find it difficult to log on and use the service. Organizational Issues: The end users need to trust that the quality of their measurements are adequate and therefore stress the importance of getting feedback from the health personnel each time measurements are transmitted. They suggest that the health personnel must be alerted each time a message is sent. Response times must be specified, so the users know when to expect feedback. Benefits The end users emphasize that the services (safety alarm and prescribed self-care) make them feel secure and safe. They know that they will get the assistance they need – at the time they need it. They feel more in charge of their own lives. The access to these services also reassures relatives and friends. Safety Alarm: It is reassuring that they will get assistance if something happens to them when outside.

Prescribed Healthcare: In addition to feeling safe, the end users point out that they save time as well as travel costs because they don´t have to go to their GP for tests and controls. This is especially appreciated by end users living far from the GPs office or the hospital. They can even go abroad on holiday and still transfer test measurements to the GP. Some of the end users think that they get more time with the GP and that the quality of the time has improved by employing this service. Others feel that this service doesn´t affect the quality of the health services provided to them: they always get excellent treatment by their GP, while others fear that the service may result in less contact with health personnel. Social Networks: The users did not really feel the need for another ICT-based service in this area. They all use mobile phones and SMSs; many also keep in touch with family and friends on Facebook. Financing The end users recognize that the public health service will probably not be able to finance AAL-services for all in the target group. The end users suggest that services provided by the public health service should be means tested. The end users state that they value the feeling of safety and security associated with the mobile security alarm and the prescribed self-care service. If the services were not provided to them by the public health service, they would be willing to pay themselves to access them. They recommend that the costs should be considered a part of the existing free-pass system, which implies that all personal health service costs (user fees etc.) above a certain threshold are covered by the public health service. Another proposal suggests that the costs should be tax-deductible. The-willingness-to-pay for the prescribed self-care service applies to the software part of the service. As the users normally only pay small fees to get public health services, they are not willing to pay extra for health services. The end users emphasize that it must be possible to buy the services separately; they are not willing to pay for more services than feel the need for. The end users also discussed how the services should be priced: Should they pay for having access to the services, or should the price be related to how many times they use any of the services - or a combination of both pricing models?

APPENDIX 7

Results from Northern Ireland

WP4 - PRODUCT & SERVICE CRITIQUE – NORTHERN IRELAND

Revision: Version 1 amended

Date: 20th November 2010.

Authors: Brendan Galbraith, Jonathan Wallace, University of Ulster

Melanie Mc Clements ‐ SHSCT

Content

Introduction

Questionnaire results Mobile Safety Alarm

Questionnaire results Prescribed Healthcare

Questionnaire results Social Network

INTRODUCTION

The responders to the questionnaire have been:

End users:

Healthcare staff;

Welfare staff:

Healthcare decision makers:

Welfare decision makers:

The data collection has been carried-out through focus meetings with end users and one-to-one meetings with Health and Welfare staff where they have filled in the questionnaire with the interviewee.


Q3. In your opinion what capabilities and competencies are necessary to deliver the business model of the service?

End User

The End user needs to feel safe and secure, knowing that a system is built around them in the event of a fall /personal safety threat. The biggest issue with falling is the fear of falling, which could be reduced by this service.

The Mobile Safety Device needs to be user friendly so that it can clip onto a pocket or belt and it was found that this is easier for males, but for females they would need an alternative version e.g. wristwatch.

The Myhealth@age sensor was a product of the Swedish company. There are other devices on the market which may be preferable but currently may not interface with the Myhealth@age software. We would need the device to be interoperable with other products on the market.

Carer

If the system is in place it will potentially free up time for the carer, who will have ‘peace of mind’ knowing the service is in place when they are for example working. It would have added benefits for patients who live in rural areas. No identified additional capabilities or competencies are required from the carer’s perspective.

Health and Welfare Organisation

The HWO organisation is assured that if someone is feeling unsafe in their environment that they can receive the appropriate response by raising an alarm. Most times this is out of the role/remit of the HWO because the responses come from the families, carers or users. Occasionally, the HWO are involved with being the responders if there are no social contacts for the patients - in that case the HWO employ home helps or volunteers. If they are frequent fallers, having an appropriate service in place, the HWO organisation are assured of a timely response to avoid associated health risks. Most or all alarms in Northern Ireland are resourced by clients or families. The Health Trust funds falls alarms if there is a particular need identified. Therefore, Myhealth@age would have to be considered by the Commissioners of telehealth / telecare services and potentially become part of the range of products commissioned for older peole.


Technical

Alarm Monitoring Centre

Social

Responders – family/carers/neighbours/volunteers and on rare occasions statutory services

Logistical

Good communication is required. For example if there is deterioration in family relationships, there would need to be an alternative support system put in place.


Falls alarms are currently available from HWO, where eligible need is identified. Personal alarms are currently purchased by older people themselves or their carers. Full implementation of this service was not possible in the Field Trial.

Q6. Explain how each service offers value to both the organisation (i.e. Health and Welfare Organisation) that is providing the service and the customer (end user) that is receiving the service?

HWO: is assured that if someone is feeling unsafe in their environment that they can receive the appropriate response by raising an alarm. Most times this is out of the role/remit of the HWO because the responses come from the families, carers or users. Occasionally, the HWO are involved with being the responders if there are no social contacts with the patients. In that case the HWO may use home helps or volunteers.

If they are frequent fallers the HWO organisation are assured of a timely response to avoid further health risks.

End user: The end user needs to feel safe and secure, knowing that a system is built around them in the event of a fall or personal safety threat. The biggest issue with falling is the fear of falling – which this system could potentially reduce. However, the device needs to be more user friendly, particularly for females.

Carer: If the system is in place it will potentially reassure the carer, who will have ‘peace of mind’ knowing the system is in place when they are working/living away from the older persons home. It is particularly helpful for clients who live in rural areas.

Q7. Does the service work effectively (i.e. fully functional, usable, improve quality of life/independence etc)? Please comment on the best aspects.

We were only able to proceed with demonstrations in Northern Ireland.


The main beneficiaries are the older persons and their families/carers. However the HWO is assured of a more preventative approach if the system is operating effectively to reduce personal safety and falls risks.

Q9 How resource intensive is the delivery of the service in comparison to the current provision? Overall is it more efficient to warrant introducing this new service?

The Mobile safety alarm seems expensive compared to those that are currently available on the market

Q10. Will the service integrate with other products/platforms and is it scalable to other regions and countries?

c.f. WP3 outcomes and companies


Service Provider – H&WO/Municipality/Alarm Centre

Within the HWO, patients/clients need to be meet agreed criteria to be deemed eligible to receive this service, following a professional assessment – this currently includes older people with health conditions and personal safety / falls risk. These are currently only funded for patients who are prone to falls. Older people who require a personal safety alarm mainly organise and fund this independently.

End User/Patient/Client

c.f. WP2/WP5 report NI information

Q12. What are the customer reactions to each service?


We did not fully test the Personal Safety Alarm in Northern Ireland.



Q13. How is this service different from other competitive services?

This trial was about “proof of concept” - the other services currently available on the market are tried and tested and falls alarms are funded by the commissioners. Therefore this would need to be included in the range of funded services available or affordable for older people to purchase. Service model is similar to those currently available so needs to offer something extra or be more cost effective.

Q14. If the service is not special, why would someone buy the service from you? (i.e. what is your competitive advantage?)

Potentially, it can be an integrated solution (with social networks and prescribed healthcare) but needs to prove its usability.

Q15. Describe the distribution channel for each service? The means by which the company delivers the service to the customer i.e. the marketing and distribution strategy (i.e. how will the services be commissioned/rolled out by the Health & Welfare Organisation/State?)

This service could offer an integrated model that meets the holistic needs of older people but needs to be affordable from the Commissioner/older people’s perspective. It would then need to be assimilated with other technological solutions available to address the totality of older peoples needs. It would need to be purchased as part of Regional Supplies Procurement Services and thus may require further testing/development.


Currently the integrated service has not been fully tested in Northern Ireland, so we would need the learning outputs from other partner countries to develop it to the next stage for Northern Ireland. Other state-of-the-art products need to be competitively assessed to prove Myhealth@age as a viable product.

Q17. Describe the cost structure of each service? i.e. start-up costs, installation costs, purchase price etc

Detail not available

Q18. How much will each customer pay for each service?

Current funding model - Self-funded for personal safety alarm and if eligible under falls criteria, service and equipment is funded by the Health Trust.

Q19. What is the model of payment for each service (fixed annual fee, price per interaction, combination or other)?

It is approximately £200 to purchase a similar device and monitoring fee is approximately £50 per year.

Q20. Would customers (end users) pay for it if it was not paid for by the Health & Welfare Organisation/State? If yes, how much?

If it proved to be more effective than current service models, users would be happy to consider paying for it, if not within the range of services provided via HWO.

QUESTIONNAIRE RESULTS PRESCRIBED HEALTHCARE



Potential benefits include empowerment/self management of long terms conditions, better health status in terms of control of the specific health condition and reduction of the impact of poor control or management of long-term conditions. In Northern Ireland Telehealth currently utilises Bluetooth, so it easy for the client to use. Myhealth@age device is seen as regressive as it requires manual entry which introduces risk i.e. with entry of wrong data or deliberate manipulation of data, so this capability would need to be developed. There are programmes (Northern Ireland-wide) that are run by clients for clients with long-term conditions, with associated technological support built into their care plan to effectively manage their condition. Any new services need to be competitive in terms of capabilities.

Carer

The benefit is they will have peace of mind that conditions are managed on an appropriate and timely manner – meaning less knock on effect on the carer, e.g. the patient having to be admitted to hospital recurrently because the condition is out of control or poorly managed.


The benefit is better management of health conditions i.e. respiratory/diabetes etc plus more timely responses, as opposed to relying on retrospective blood results and patient reports. This would give a daily picture, to in a timely way manage patient condition. However, as there is a Northern Ireland Telehealth Strategy, any developments related to prescribed healthcare would have to be well aligned, to enable resourcing. Also, it has to be in line with the associated criteria and agreed conditions (i.e. diabetes, stroke etc) for inclusion in Telehealth monitoring, unless the device is self-bought by the client. In Northern Ireland, currently these devices are 100% funded by the HWO. Some clients, who meet the criteria for the service to be implemented, prefer not to uptake the service.


Technical

Devices connect to the Health Trust systems in Northern Ireland and in particular to the Specialist Nurses (not General Practitioners – GP’s). Nurses communicate to GP’s and the wider Primary Care if there is a need for medical intervention. If Myhealth@age was widely used the data would need to be clinically triaged through a monitoring centre with onward referral to the Specialist Nurse teams, if outside of the normal parameters. This is in line with the current NI Telehealth service model, whereas the current Myhealth@age system required staff to proactively screen data on a daily basis which would not be appropriate on a wider scale.

IT partners need to be on board to assist with identifiable patient data and appropriate data protection.

Social

There is a need for improved co-working with the wider Primary Healthcare team, so that support can be mobilised form the appropriate professional. Family and friends also need to be considered social partners in effective management of long-term conditions.

Logistical

Interoperability. The current Telehealth systems and Myhealth@age need to have the potential to interface.


Technical Obstacle

Systems need to be able to interface with each other. Protection of identifiable patient data.

Solution

Interoperability.

Appropriate data protection, storage and access.

Social Obstacle

Poor communication potential across primary healthcare team and older person/carers.

Solution

Commitment and improved communication pathways.

Financial Obstacles

Device is currently not included within the specification for Telehealth in NI.

Solution

Needs to be integrated into Telehealth packages and considered appropriate by Commissioners

Ethical Obstacles

Ensure there are no issues with transfer/access of data as per Health Trust policy.

Solution

Safety of data needs to be assured. Consent is required before participation in the service either by older people or their main carer if more appropriate.


End User/Patient/Client The benefits empowerment/self management of long terms conditions, better health status in terms of control of the long-term condition and reduction of effects of poor control/poor management.

Carer

The benefit is they will have peace of mind that conditions are managed on an appropriate and timely manner.


The benefit is better management of health conditions i.e. respiratory/diabetes etc plus more timely responses, as opposed to relying on retrospective blood results and patient reports. This should have a knock-on effect in terms of reduced readmissions to hospital, better management of long-term conditions and reduced costs as a result should reduce unnecessary attendances in outpatient/GP clinics.


This service was not tested with a live pilot in Northern Ireland.


This service was not tested with a live pilot in Northern Ireland.


This is not integrated with other services available within Telehealth in NI and appears to be more resource intensive by frontline staff as they need to source the data sets daily. Other current service models are clinically triaged by an alarm centre and reported by exception. This element would need to be part of the Myheath@age specification.





The HWO who will carry out professional assessments in line with agreed eligibility criteria for older people with long-term health conditions. Currently only certain conditions are applicable e.g. Stroke, Diabetes, Chronic Obstructive Pulmonary Disease (COPD). An appropriate system would be inbuilt into the care plan for these clients, in line with the NI Telehealth Strategy. Contractual agreement would need to be developed for alarm Centre monitoring.


Older people with long-term conditions including Diabetes, COPD & Stroke



Function was not tested live in NI


Potential for better control of long term condition but not fully tested.


Similar to current prescribed health care services but potential of integrated solution is attractive for Myhealth@age.


Potentially, it can be an integrated solution (with social networks and prescribed healthcare) but needs to prove its usability and the current Myhealth@age device needs further development.


As an integrated model that meets the holistic needs of older people, it would be included as part of the care package (subject to eligibility criteria). It would therefore be funded by the Commissioner, in line with the Telehealth regional specification. There would also be potential for clients to purchase the system and monitoring independently if not considered eligible for funded services but further discussion would be necessary with the Health Trust staff if they were to receive data reports.


Currently the integrated service has not been tested in Northern Ireland, so we would need the learning outputs from other partner countries to develop it to the next stage for Northern Ireland. The other state-of-the-art products need to be competitively assessed to prove Myhealth@age as a viable product.


Unable to comment


It will be funded by the Commissioner if it meets the criteria and is considered good value for money following tendering of similar specification services. Currently if eligible need is identified, it is free to the client/patient.


It is free to the patient at the moment and funded by the Commissioner if it meets the criteria.



QUESTIONNAIRE RESULTS SOCIAL NETWORKS


End User/Patient/Client Older people would be in control of their social health and well being and have increased choices. However, in NI, mobile phones and social networking are not the social norm for these user groups - a large percentage of users in the field trial didn’t use a mobile phone or only used it for emergency calls. Thus they limited their use of this service opportunity. They would need to develop competencies in using mobile phones and social networking and be persuaded of the potential benefits.

Carer

The benefit is that they will have more flexibility and ‘peace of mind’ when leaving elderly for a couple of hours, as they are reassured they have other social contacts. Carer could also be part of the social network. This should not require new capabilities or competencies.


As an integrated model with the other service (prescribed healthcare and mobile alarms) this is an added benefit to clients to prevent inappropriate use of services due to social isolation or early access to use of services. No additional capabilities /competencies required.


Technical

Providers of social network services and platforms.

SMEs – Swarmteams/Bluetree services

Social

A user group of older people and their contacts - big enough to merit using it and who want to use it. Then it would become a social norm and more acceptable.

There is potential for carers to be more actively involved in this network so that they can continue with work or have time-out and still be able to contact with the family or patient, or be reassured they have other social contacts.

Other

There needs to be extended access to the system with improved usability, to make it attractive to the elderly. Young people use facebook/bebo etc automatically, but this is not the case for the elderly.


Technical Obstacle

Not easy to use on current mobile phone platform

Solution

More appropriate for younger user groups in Northern Ireland or adapt to a different mobile platform/computer access.

Social Obstacle

Not a social norm for older people

Solution

Increase mobile phone and computer literacy of older peer groups.

Financial Obstacles

Client needs to purchase their own smart phone – it is not provided by the Trust. This would make it harder to access for disadvantaged elderly people.

Solution

Cheaper technology or as a result of an integrated solution, it could be an additional service built into the with the commissioners specification, which would make it more competitive/appropriate.

Ethical Obstacles

Older people in control of this element so should not be ethical issues. Just need increased awareness re invited guests, closed groups etc.


End User/Patient/Client The benefit is that they are in control of their social well being and have increased choices and reduced social isolation / increased social inclusion.

Carer

The benefit is they will have more flexibility and ‘peace of mind’ when leaving elderly for a couple of hours, as they know they are less isolated and less dependent on sole carers.


As an integrated model with the other service (prescribed healthcare and mobile alarms) this is an additional benefit for clients which could prevent inappropriate use of and/or early access to use of services, which often arises to meet a social need rather than a need for health care.


For those who were more receptive to social networking, it functioned reasonably well and opened up social opportunities. It could have benefited form improved usability.


This element is of less relevance to HWO but may have spin off benefits in terms of social isolation being addressed.


Older people n NI were not accessing similar services. Currently social networking is not funded by HWO’s in Northern Ireland so no comparisons possible.





Not relevant to HWO





This element is of less relevance to HWO but good to see a social networking opportunity for older people which could be further accepted/developed




Because of the integrated potential. Otherwise it appears similar to other services of similar nature.


Potentially, it can be an integrated solution (with personal safety alarm and prescribed healthcare) but needs to prove its usability and appropriateness to the client group.


Would generally be accessed by the older person directly, unless it formed part of an integrated solution at no extra cost. In the later case, it could potentially be included in the telehealth/telecare solutions.


Currently the integrated service has not been tested in Northern Ireland, so we would need the learning outputs from other partner countries to develop it to the next stage for Northern Ireland. The other state-of-the-art products need to be competitively assessed to prove Myhealth@age as a viable product.


Unable to comment


Social networks are free on the internet so this would only be attractive as a resource neutral element within an integrated solution.


Available on the Internet open source.


No - as it is currently free on the Internet and not seen as a high priority by older people in NI.

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