|
 
 |
| COMMENTARY |
|
| Year : 2018 | Volume
: 4
| Issue : 3 | Page : 109-112 |
|
New trends in the use of digital interventions for self-care management
Simon Hooper
CEO and Co-Founder, Health-Connected Ltd, London, UK
| Date of Web Publication | 18-Oct-2018 |
Correspondence Address:
Simon Hooper
32 Admiralty Way, Teddington Middlesex TW11 0NL
UK
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/digm.digm_24_18
How to cite this article:
Hooper S. New trends in the use of digital interventions for self-care management. Digit Med 2018;4:109-12 |
| Introduction | |  |
With governments required to reduce costs through reducing public reliance on formalized care, such as general practitioners and hospital care, and with technology recognized as able to provide a “hospital at home,” the potential to address the myriad needs of personal health management and preventive healthcare is clearly apparent. While not formally voiced as policy, governments are looking to find ways to mobilize consumers to take responsibility for their and their families own care.
| The New Terminology | | |
Technology is causing treatment paradigms to be reconsidered. Previously, it was impossible to match treatment with cognitive and behavioral changes. Now, digital therapeutics and digiceuticals enable more flexible treatment and monitoring alternatives.
Digital therapeutics is defined as immersive programs that act reliably and remotely to change individual's behaviors to achieve positive clinical outcomes and reduce medical cost growth. They are often used in conjunction with medication but may replace conventional prescribing.
Digi pharma is consumer focused, such as nutritional supplements and FitBit. They are typically not reimbursed or Food and Drug Administration (FDA), National Health Service (NHS) authorized and are low priced, with consumers paying directly after marketing discovery.
| The Key Issues | | |
Hence, what are the key issues? Here are a few; a lack of consistent consumer engagement with healthcare tech, inability of data flow from consumer to the formal care organizations, fears regarding data security and exploitation, consumer expectation for solutions to be free, and the need for multiple solution integration to provide an embracing and appealing solution that covers the breadth of the consumers healthcare needs.
| Care Principles | | |
Health-Connected has built software that focuses specifically on enhancing person-centered care (PCC) delivery in multiple care sectors, from learning disabilities to mild cognitive impairment, elderly care, and dementia. The result is RemindMeCare (aka ReMe) that discovers personally meaningful content through interactive response to activities, which positively impacts on behavior and calms agitation, thereby reducing or complimenting the use of medication. Improved well-being is achieved as well as a propensity to support cognitive performance and the outcome data can be used in therapy and acute care strategies.
This paper seeks to define both the academic and healthcare organization defined principles and the new disruptive approaches on which ReMe has been built and which it is proposed will be at the heart of any innovative care system that emerges in the coming years.
Person-centered care
PCC is a cornerstone of care, whether defined by the NICE,[1] the NHS,[2] or the Dementia 2020[3] strategy documents or voiced in the work of academics such as Mitchell and Agnelli[4] and Brooker,[5] such that “knowing the person”[6] is a critical component of any care strategy whatever the setting, whether home-based or formal care, dementia, or learning disabilities.
The practice of true PCC requires the collection of key data, such as likes/dislikes, memories, habits, life story, family data, recent activities, and engagement. Conventionally, nondigitally recorded, ReMe collects these data in a gamified psychosocial intervention, through activities and care circle engagement. Defined by ReMe as electronic life records (ELRs), the data are fed back into activities so that they become increasingly bespoke to the individual or group and therefore enable both the ongoing discovery of daily engaging content and activities that benefit the person cared for, while also collating an invaluable resource of care data for use by the care professional [Figure 1]. | Figure 1: RemindMeCare My Story Personal Life Story profile shown on Android tablet integrated with Alexa
Click here to view |
Connected care
At the heart of any PCC, process must be social engagement. Whether with family, local community, carers, or businesses, achieving such connectivity can reduce loneliness, isolation, and stigma and generate well-being, whatever the persons diagnose.
However, achieving regular usage of any communication methodology can be difficult, and it is generally not the medium but the content, outcome, and rewards that achieve consistent engagement.
Phones and tablets can be hard to use; however, if the content is of specific interest (i.e., gardening, a picture of the grandchildren) and bespoke entertainment is provided in a user-friendly format, then greater responsiveness to care processes such as a medical alert delivered through the same tool will occur. Therefore, family engagement, news updates, media access to streamed content, bespoke daily content, and entertainment will have greater success than conventional means.
Further keys are visual and voice tools and the overall usability of the interface. In the latter, it is critical that the user does not feel stigmatized by the system as “needing” care. Daily “sticky” engagement generates an opt-in to the care support and remote care management processes that are part of the system. In essence, entertainment and activities are keys to connected care.
In the case of ReMe, the system “knows you” through its held ELR and therefore can bespoke delivered content and schedule alerts to the content of specific interest, as well as provide communications and remote care management.
Portable care
To date, it has been the case that care software is only useful for the care provider for which it has been created. Therefore, once a person moves, for example, from home care to a care home, or from a care home to a hospital, the care system no longer can operate, and the acquired knowledge of the person becomes unavailable to the new care organization.
ELR falls below the clinical regulatory ceiling so can be owned by the person and their family. This enables their taking responsibility for their care and data and requires them to provide ELR access rights to care providers they engage with on the care journey, thereby providing security and control for the consumer and data regulatory compliance (i.e., Europe's New General Data Protection Regulation) for care organizations.
Self-care management
The nature of assistive technology to enable the remote monitoring of conditions and the improvement of well-being is well documented, and there is no market shortage of IoT tools, wearables, monitors, and sensors. What is less voiced is that while they can serve to reduce falls, wandering, medication, etc., they generally work passively in background and so do not provide for direct engagement or stimulate well-being through activity.
ReMe is part of that new generation of apps that is focused on activity-based intervention that seeks to provide immersive experience that can generate well-being and engagement and through which data can be collected that support the care process. Virtual reality devices, such as Oculus, the use of voice-driven engagement, such as Alexa and Google Home, and interactive TV, integrated apps, and games designed specifically for a care sector, all have a growing propensity for positive impact on the self-care management needs of rapidly expanding care at home sector. The key to future care will be their integration both with each other and with daily activities, as well as their usability.
Consumer engagement
Digital care solutions often fail as they have been built to generate the outcomes that the care organization itself requires. Academia's built solutions often fail to reach the market, while commercial apps are often underfunded and so lack clinical credibility and are not considered medically robust.
The emerging new model as developed by Health-Connected is to address these failing by putting the consumer in the driving seat. By achieving first access through an app download and with the family not the clinician profiling the person cared for and setting up the initial defining ELR data, they thereby take ownership of the system and engage as they do with Facebook or LinkedIn. With the delivery of daily bespoke activities, the care system becomes rewards based, thereby achieving “stickiness” and repeat usage.
Therefore, the key to repeat usage and adherence to care notifications is the content that encourages the dopamine-driven desire to repeatedly engage with the system.
The medium of engagement is critical. Tablets have their place as does TV. However, recently, voice using Alexa and Google Home has become a principle mode of connecting with the person. Whether generic, such as Alexa, or with bespoke skills such as provided by ReMe, ReMe's voice skills enable remote care management, reminders, alerts, and entertainment tools, which significantly enhance the propensity for ongoing engagement by the user with the care system [Figure 2]. | Figure 2: RemindMeCare consumer-based portable care model for electronic life records showing users and impact along patient pathway (Source: RemindMeCare)
Click here to view |
Validation
Typically, digital solutions suffer from an inability to gain clinical validation and as a result find difficulty in achieving the recognition of formal care practitioners, which in turn hamper adoption at scale in any manner that can truly impact on health outcomes.
However, that is changing. In the UK, the NHS has launched their NHS Digital App library and doctors will soon be able to prescribe an app to a patient with the cost being born by their Clinical Commissioning Group using the EMIS App library. ReMe will be the first dementia and self-care management app to be available on prescription from a UK doctor.
The current studies in Kingston Hospital,[7] London, aim to establish ReMe's potential as a digi therapeutic capable of reducing medication, improving the admission processes, enhancing PCC, as well as achieving efficiency and cost-savings through digital reporting, reduced staffing, earlier discharge, and optimal step-down.
| Conclusion | | |
The potential for apps to impact on care at home care strategies is enormous. However, this will only be achieved if the consumer can see reason to adopt the new tech and are able to do so in a manner they are used, such as Facebook or LinkedIn.
The impact of the practitioner prescribing of apps on cost-savings for families by maintaining care at home for longer, and for care organizations by achieving efficient self-care management, could be substantial, and as a result, in the coming years, new business models will undoubtedly be developed that address this potential.
However, while the evidence for the efficacy of app intervention is currently limited, ReMe offers an insight into what one new treatment configuration of the future could look like.
| References | | |
| 1. | |
| 2. | |
| 3. | |
| 4. | Mitchell G, Agnelli J. Person-centred care for people with dementia: Kitwood reconsidered. Nurs Stand 2015;30:46-50.  |
| 5. | |
| 6. | Fazio S, Pace D, Flinner J, Kallmyer B. The fundamentals of person-centered care for individuals with dementia. Gerontologist 2018;58:S10-9. |
| 7. | |
[Figure 1], [Figure 2]
|
Search Pubmed for