Page 263 - Handbook of Electronic Assistive Technology

252 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

funding was secured the focus of the study changed from whether the devices worked,
which all did to differing degrees, to the implementation and cost savings to health and
social care. Coiera (2015) reports that the literature on:

Telehealth is often challenging to interpret because so many studies are small, run for
short periods, often involve only a single institution and lack control arms in the study
design. The Whole-System Demonstrator project was conceived as a way of testing the
effectiveness of telehealth when delivered at larger scale, by randomizing patients in
the context of routine delivery of care (Steventon et al., 2013). The observed effects of
telehealth are also likely to be deeply linked to how these particular health systems
operated, with effects potentially attributable to the technology, the sociotechnical
processes required to make them work or local implementation variations … The study
concluded that the Demonstrator was not a cost-effective addition to standard support
and treatment, even if significant drops occurred in the cost of technology.

Telecare services in other countries such as Spain and Norway provide companion-
ship and social activity, which is the most appropriate way to consider its implementation
(EFORTT, 2011a,b, 2012). Telecare on its own is not a cost saver but rather a false economy.
Assisted living provides the expertise of technology systems designed to support people.
For these systems to be effective they must be specifically designed for the person’s unique
requirements. To achieve this, a robust assessment procedure is required. Currently, there is
no accepted assessment for telecare or telehealth. Telehealth is provided through medical
practitioners and their medical assessment, and the underlying criteria of the health system
they work within will determine whether a person is to receive telehealth interventions. For
telecare this is a completely different matter. In the United Kingdom, for example, there is
no formal telecare assessment which is universally approved and those that are suggested
as being useful tend to be manufacturer led and therefore designed to sell more technol-
ogy which is often redundant for the person or even worse disabling. Dewsbury and Ballard
(2014) developed a tool called the Dependability Telecare Assessment tool. This tool pro-
vides a qualitative framework from which to assess a person and considers the person in
relation to their surroundings and their relationship networks in helping the person deter-
mine the best telecare/telehealth solution. The tool derives from the work of the authors on
the Engineering and Physical Sciences Research Council-funded Design Innovation Research
14
Centre project. This tool provides a person-centred approach to assessment. It does not
produce a product selection; rather it focuses on the needs and requirements of the person
and their situation to determine the qualities of the technology that are needed.
Greenhalgh et al. (2013) reports that telecare is not an easy solution to demographic
ageing or care crises. ‘It cannot perform care on its own.’
This means that assisted living currently has the potential to be a personalised tech-
nology producing a supported, meaningful and fun environment in which people can

14 www.dirc.org.uk.