Earlier this year, as part of our preparations for Pitch-In, the Centre for Assistive Technology and Connected Healthcare (CATCH) at The University of Sheffield held an afternoon workshop on the broad topic of the Internet of Things for care.
In addition to academics, the attendees included representatives of SMEs, of care and residential housing providers, of local council strategists, and NHS policy makers and technologists. The levels of awareness and technological knowledge of IoT possessed by those present varied quite substantially, as did the experiences of working within the care services. The workshop was intended both to raise awareness of IoT and to facilitate a wide-ranging discussion of possible applications and potential obstacles without focusing on any one particular area or context.
IoT could help reduce hospital admissions, increase the efficiency of care provision, and even remodelling that provision itself.
Several general objectives, at different levels of abstraction, were suggested as promising areas for the application of IoT. These can be summarised as follows:
- To reduce the number of admissions into care homes and hospitals: by the provision of better monitoring of service users, especially the elderly, in their own homes to allow earlier interventions to modify existing care plans and avoid crises; by providing prompts for hydration, nutrition and medication, and also for social activities to combat isolation and poor mental health; by providing reassurance for relatives and other care-givers; by checking compliance with care plans; by detecting emergency events and worrying trends; by enabling greater control of the domestic (and external) environment; by encouraging service users to take better care of themselves and, where appropriate, to inculcate a culture of non-mediated healthcare.
- To increase the efficiency of current models of care provision: reducing the amount of travel for both service users and care-givers by, for instance, administering routine checks and tests in the home, and eliminating unnecessary visits entirely; by reducing the reliance on conventional healthcare delivery where this is unwarranted; by enabling care-givers to expand their greater caseloads in a sensible, sustainable manner.
- To contribute towards a fundamental remodelling of care provision: by taking a more data-centric view of care, in which capture of rich data becomes the norm, data which, when processed with appropriate analytics, would provide a more ‘holistic’ view of the health and wellbeing of individuals and populations.
Challenges to uptake exist at the human, organisational and data levels.
Each of these areas presents particular challenges for the current technology; in addition a number of task-independent barriers to the uptake of IoT systems were also identified. In high-level terms these can be categorised as follows:
- Human factors and social barriers to adoption and acceptance: these include privacy concerns and a lack of trust in the technology; the need for training for all users and technical support; the difficulty of establishing (cost or care provision) baselines; and potential conflicts of interest among the multiple stakeholders and their differing motivations.
- Methodological barriers: the necessity of demonstrating the correctness and completeness of IoT healthcare systems; and of demonstrating their reliability and failsafe operation when incorporated into wider care organisations.
- Organisational barriers: the resistance to change from the entrenched care culture in many services; scepticism and risk-aversion fostered by the existing high rate of (technical) change, and (the perception of) money wasted on legacy IT systems and failed IT projects; lack of clarity about regulation and legal liabilities and obligations.
- Data barriers: the need to ensure secure and resilient transfer and storage of data; the question of how to deal with the quantity of data produced; the ownership of data and the role of commercial companies in a ‘data market’; the lack of clear standards for data sharing and for expressing its provenance, and of demonstrable methods for data interpretation and analysis.
As a whole, then, the results of the workshop lay down a number of challenges to the use of IoT in this sector, both in terms of realising the promise and overcoming the obstacles it presents, setting out some key objectives for Pitch-In to begin addressing.