The IoT in Healthcare – improving care in the home. Part 1
How can the IoT improve the lives of people being cared for at home?
I have the utmost respect and admiration for anyone caring for a relative in their own home. Sometimes even a simple necessity such as popping out to the local shop for bread or milk is a major logistics exercise or just not possible. When you are the main carer for a relative, it is a test of endurance, there is just no let up. I am not going to get on my soapbox about the lack of respite care and support but in this two-part blog I do want to discuss how IoT and Cloud technologies could be used to significantly improve the lives of people being cared for in their own homes.
Medication management
Medication management is less of an issue for regular carers as they live and breathe the medication routine day in, day out. Where the complications and risks arise is during those rare (if any) respite breaks or times when the main carer is indisposed due to illness or other family commitments. I have created a manual detailing my daughter’s care and medication. Anyone involved in the care of my daughter knows of this manual and can use it to ensure my daughter gets the medication as and when she needs it.
The NHS have the medication fairly well covered through my daughter’s medical records so our GP would be able to provide the information for the medication she takes. However, it is generally only the regular carers that know the detail as to how my daughter takes her medication. Karen is unable to swallow tablets or take any of her liquid medications neat from the bottle. Capsules have to be opened and diluted in water, tablets have to be dissolved in water, or crushed if they are not soluble and liquid medicines have to be mixed with water. It takes her over an hour to take her medication to prevent any adverse reaction. In addition to this, although Karen’s prescription shows the dosage, it says nothing about the fact that one of the tablets is cut in half so only half of the dose is given and another is cut to one sixteenth. This is part of a process of weaning her off of the medication. Although, one or two doctors know of this reduction, as far as I am aware, and I certainly haven’t been told by any doctors about any reliable means of recording this. If Karen’s main carers were suddenly taking ill she may be given the standard dose which will have serious adverse effects and could set her back over a year.
This is one example. I am sure my situation is not unique. I am also aware that many carers have no one else to support them, they really are on their own. So, how do they cope? How can we ensure a reliable hand over of care in times of emergency, or rare respite opportunities? Karen is extremely paranoid about her medication after the tow overdose near misses while in an acute hospital. Carers and those being care for deserve a more reliable method of medication management.
Continuing from an IoT medication management solution in hospitals, rehabilitation units and care homes, having a detailed medication regime recorded in the Cloud would enable everyone involved in the healthcare and care of the person in care would have ready access to the information. Combine this with IoT tags on medication containers linked to up to date information as to how the medication should be administered and we remove the risk of losing the paper copy or the paper copy being out of date. This would ensure continuity to the person in care whether they are in the home, transferred to a respite unit or care home, or admitted back into hospital.
Patient baseline
Establishing and maintaining a baseline is essential for any change in care circumstances. If the person in care is transferred into hospital this information would be useful to healthcare professionals. They are well aware of the facts recorded in the NHS records but this is not observational (as far as I am aware from my own experiences). Any information that can be conveyed to healthcare professionals as to the normal condition and mental state of the person in care would prevent any assumptions being made. I am not criticising the fact that assumptions are made, doctors in hospital do not have time to get to know their patients.
As I mentioned in an earlier blog, when my daughter was admitted to hospital the staff found it very extremely difficult to determine her baseline because she has Autism. As a result, some assumptions were made which delayed the procedures required to diagnose of her brain injury. People are always vulnerable when they are admitted to hospital but people in care are in care for a reason and this means they are rarely physically typical or neuro-typical. As a result, they are exposed to even greater risk for a multitude of reasons. Observation plays a big part in diagnosis in any field and observation relies on deviation from a baseline. If healthcare professionals do not know the baseline of a patient with special or complex needs, the potential for delayed or mistaken diagnosis increases along with the potential of serious consequences.
This is a recurring theme but a biometrically verified IoT tag mentioned in all of the examples in this blog series could be linked to patient baseline information and updated by carers to enhance the observations of the healthcare professionals. This would evolve into a very comprehensive description of the person in care and their specific needs.
Resource scheduling
My experience of the limited care services we have access to there is a great need for resource scheduling. The need is not as great as for professionals in hospital but the implications are far greater if the resource scheduling fails as carers may just fail to show up. For some people in care, especially those like my daughter, confined to their beds, a carer failing to show up results in a very serious situation, not only terms of care, but also health and safety.
I am sure there is a solution available somewhere that can help with this challenge. I am aware of task tracking systems used in cleaning and maintaining caravans so I am sure there are solutions out there that either meet the requirements or require minimal modification. A task management solution with geo-tracking of the care workers could be configured to raise alerts automatically should the care worker be running late or be facing traffic congestion so that emergency measures can be taken. Also, if a care worker is going to be absent the current provision falls flat on its face. Surely this is a simple algorithm to calculate who needs to go where and when with automatic communications to the stakeholders detailing the problem, the resolution and the timescales. In my experience, the current method is many phone calls to many unanswered mobile phones resulting in me or other members of the family having to drop everything a zero notice to get back home. I am sure there are more efficient ways of doing this with effective use of IT and in particular using IoT technologies.
Healthcare monitoring and management
If we are feeling unwell or suffer an injury but are still in a conscious state, most of us would able to make a decision as to whether we really do need casualty. Care staff looking after people with special needs are often in a position of having to make that decision for the person in their care. Establishing whether those in our care really do need casualty or not can be an extremely tough judgement call, especially for people lacking mobility or lacking any form of communication.
Around a month ago my daughter was taken ill in what seemed like a lightning strike. She was OK one minute and very poorly the next. NHS direct arranged for a doctor to call back. The doctor insisted on my daughter being taken into casualty. But I could not move her and she could not move herself. For a while we were in a stalemate situation until the doctor finally agreed to make a home visit. This whole process from phone call to visit took around six hours with the doctor calling at 3am and diagnosing the problem and prescribing the medicine. Although the outcome was good for my daughter it was an unnecessarily stressful process to get to that point. Should carers be expected to manually lift the person in their care out of bed and force them against their will to go to casualty in their wheelchair? I would think there is a law against that!
So, what can the IoT do to improve this situation? Referring back to my last blog on the IoT in care homes if personal carers were trained to capture data using a range of devices and sensors, the data could be automatically logged in the Cloud for analysis in near real time. Any deviation from a predetermined baseline can automatically alert healthcare professionals. A personal IoT tag associating the person in care with the observational data will reduce any collection and recording risks and will prevent any delays in getting the information online. A wide range of test results similar to those detailed in my previous blog can be collected and analysed.
Useful links…
Dail Mail – Dementia Care Lottery Exposed
Andrew Gunn – Inexcusable, a lack of digital innovation in healthcare provision