The paths of development for smart houses and home telehealth are now slowly coalescing-health care is, finally, entering into smart home design interests, now that our entertainment and creature comfort needs have been addressed. All along, we've maybe been too polite or self absorbed to think that much of smart house design has been aimed toward the very tuned in and fit consumer and their equally smart and fit houseguests. Elderly and failing grandmothers who just want to make a cup of hot tea safely in their own homes don't conjure the same splashy pictures of home entertainment systems that sense what you want, when, how loud, and how often. However, there are some pretty cool things we can install for our grandmothers, such as sensors for kitchen stoves to alert them about heated areas, and floorboards wired to detect movement and possibilities of falls. In fact, there's now truly the possibility for every familiar mainstay of our home furnishings-the fridge, the clock, even the bathroom toilet-to be wired for healthcare needs. This is how far we've come, ready or not: any appliance can double as a blood pressure cuff and/or beep or vibrate to reinforce medication reminders. Nothing in the ordinary house, it seems, is immune to reengineering.
Over the past year, waiting with trepidation for the Home of the Future that was to be imminent exactly at the turn of the century and would change home life forever, I've posed this question to informed designers who've thought through possible answers. The consensus: it's alarmist to think that smart houses will have too much control over our daily routines. In fact, one development trend enables each 'smart' appliance to be turned on and off, as needed. No, the Haagen Daas container won't always make rude remarks when you dip into it, again. Whew.
According to health care equipment designer Steve Kaufman, it's true that many fear a 'Big Brother' presence in our living rooms and kitchens, but "I like to think of this, for healthcare purposes and needs, as a Big Brother who is helping not watching." And, as Bob Ornstein, director of a smart housing project near Portland, OR, that now has residents, notes: "Immediate and focused response mechanisms are critical mainstays of any elder living program. Our residents wear call badges which have the residents' precise location tied to them and the calls are relayed directly to the resident's caregiver, not a distant operator. I think comfort and safety comes with the knowledge that if something goes wrong, there will be an adequate response." And yes, there are certain sensors that can be turned on and off to respect the individual's privacy.
This view - for smart houses to be as smart as they are needed or wanted to be-is well apart from a vision some have of a bustling 24/7 data sponge and responder. Today, we really do have the opportunity to tap into wires already in place in our homes for security and telecommunications purposes to enable constant monitoring, tracking, and transmitting of home care patient information to and from our homes. But we also really do have the opportunity to think carefully about what applications these collecting capabilities can have.
We're now at a next step, to get beyond just replicating the in-person home visit and even the outpatient clinical visit. That has been the benchmark of home telehealth progress to date: videovisits and quality of vital sign data transmitted have been measured in terms of how closely they replicated in-person visits, and by now, can demonstrate comparability in prescribed tasks. Except that the televisits are briefer.
According to health care industry commentator Elizabeth Hughes, RN, Ph.D.: "Home health nurses have limited time to make productive use of the amount of data they may be asked to collect. With an emphasis on cost containment and the Medicare Prospective Payment System (PPS) for Home Care in place, now more than ever, their task is to deliver specific skilled care with outcome measures within a prescribed time period." There are many new tools but nurses themselves have to be more resourceful-to figure out, based on specific patient needs and abilities, which interventions, including patient and family teaching of some particular clinical skills such as wound care, will be most effective over a long term.
Many new tools, some smart, some just showy, provide opportunities for collecting a personal warehouse of each patient's health care data. Every parameter really can be measured and transmitted on a 24/7 basis. But we have an opportunity now to focus on what will be used, what's needed, and what's wanted. To think simple. Take, for instance, an automated voice mail (transmitted via the very plain old rotary phone some patients still may have and prefer). Even that clunky old phone can be used as a single purpose, 'cutting edge' and very smart tool. It can be programmed in an adult caregiver's voice to call at 2 pm and say, "Mom, it's time to take 2 of your [pills]. And I love you." It's easy and fast, it's focused, and it works. Just maybe that's how smart new tools sometimes need to be.
Adler J. At MIT, they're testing future of an aging society. Chicago Tribune, June 2, 2002. (Link last checked on May 19, 2004).
Mann B. The Smart Medical Home. Computer Bits, January, 2003. (Link last checked on May 19, 2004).
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