What is the ideal GUI for the home healthcare patient?
What is the ideal GUI for the home healthcare patient?
By BETTY GASCH
Healthcare InfoTech Contributing Writer
As the drive continues to move care more often and at an increasingly rapid pace toward the patient’s home, the question arises as to what is needed to enable healthcare application developers who have web-enabled content to access computer illiterate patients (particularly the elderly) to take advantage of these applications. It is most often the elderly who require on-going monitoring and medical management but who are least likely to have computers and Internet access in their homes. There have been a number of approaches to this problem to date.
One plan is to send caregivers into the home equipped with computer technology and train the elderly to interact with the sophisticated tools that they bring. But Medicare budget challenges continue to make this solution too costly. These budget constraints continue to force the number of home visits by professionals to decline, so that there can be no assurance of the coverage of home visits for even the "routine" patient interactions. Even if all necessary visits were covered by Medicare, the professionals entering the home are frequently not as technologically skilled as they are medically knowledgeable and require extensive training to truly become computer literate themselves.
To address this need, companies such as Physix (Houston) and others have developed computer-based systems that plug into a patient’s telephone line and allow the patient to enter parameters such as weight or blood glucose readings, that are sent to the physician or other medical team member who is responsible for their care. This scheme involves a dedicated computer-like box that sits in the patient’s home, and while designed to be relatively easy to use, is nonetheless very computer-like and therefore foreign to many elderly patients, some of whom have difficulty operating their microwave ovens and VCR’s.
A more remote approach to providing uncomplicated patient home access is the Information-phone from companies such as Solution Corporation of America (Nashville, TN). This device is a variation of the touch-tone telephone which actually looks like a phone with a handset and keypad, but becomes a medical GUI (graphical user interface) device due to its hidden features. Concealed beneath the telephone is an ASCII keyboard that transforms the phone into an information system device. Suddenly, the patient’s phone becomes the interface over the Internet to the remote home healthcare agency, the physician office or the disease management company. The telephone hardware, called an "iphone," is manufactured by Cidco (Morgan Hill, CA).
The iphone is billed as a communication device but also contains a 14.4 kbaud modem for access to the Internet and HTML 3.2 compatible web browser. Some might argue that 14.4 kbaud is a bit too slow by current standards, but then the phone doesn't send data continuously and the modem is certainly cheap. The patient connects to Big Planet, the exclusive Internet service provider (ISP) for the iphone. From Big Planet the phone can browse anywhere in cyberspace and retrieve e-mail as well. It is this Internet access which allows users to find a variety of Internet enabled medical applications. The phone contains a 32-bit processor, expansion ports, a 7.4 inch VGA display. The iphone can store 200 names which can be speed dialed. Caller ID is also provided.
It is the ease of use and the Internet access of the iphone , especially for the non-technical elderly, which is most interesting to the web-enabled healthcare application providers. The patient using the iphone can push a button and access any web site at any time. Home care agencies who need to decrease the number of home visits by their professional staff could use the iphone to monitor daily weight for their congestive heart failure patients or daily blood glucose readings for their diabetic patients by establishing a web site with a script that allows the user to enter the information. If the information is not entered or if the agency wants to contact the patient, it can send the patient e-mail. If the parameters reported by the patient were not within the established norms of the agency, patients could be sent e-mails instructing them to go to a web site that contains specific medical information. If a visit was required or if a nurse made a scheduled home visit, there would be ready access to patient information as well as patient education material. If patients became proficient with the iphone, they could access their own disease information.
These information telephones are already being piloted for home healthcare applications in parts of the U.S. and are proving easy to use extensions of the familiar telephone. Some home care agencies are experimenting with the idea of placing one of the devices in each of the homes that they service. The phone costs around $300, as well as an Internet service provider access fee of about $25 a month.
The patient can then access the home care agency with a simple push of a button anytime, day or night, should the patient need help or emergency assistance. When the RN or other provider from the agency enters the home in order to provide care, they log in to the agency’s web site via the phone and concurrently document the care they provide.
The speed-dial feature of the iphone can also be very helpful to the elderly patient. The agency nurse can program this feature with numbers for the patient’s pharmacy, doctor’s office, emergency numbers and other providers. There is one button to dial to a preselected medical equipment supplier for simplified ordering or reordering of supplies and one button connects to the local pharmacy for any prescriptions that the patient might require. This keeps things simple for patients because they will need to interact with the system at various times. The buttons are also large enough for most of the elderly to be able to see. If patients desire more information about their disease condition, there is also access to a variety of information via the web.
In the future, the information phone could be connected to devices that will monitor the patient’s medication schedule. The idea is to connect the information phone to a appliance that holds all of the patient’s prepoured medication. The system would notify patients as to their need to take a medication and then the appropriate drawer in the container would open. For the present, the information telephone is capable of flashing an alarm on the phone that alerts the patient to a message. The patient must then be able to access the Internet (via a simple button touch) and read the message about which medication to take. This alarm system can also be used to alert the patient to the presence of a message left by the doctor. This message may be as urgent as a physician’s response to a high glucose level or as routine as the need for the patient to schedule a six-month revisit. The only differentiation in alarms in the present system is noted once the patient enters and reads the message box.
The information phone is more user friendly than the plug-in systems for the element of the aging population that requires frequent monitoring, but is not savvy enough to operate, or perhaps does not own, a computer. It is disease management in its most rudimentary form, but a form that enables a great number of seniors to be included. Look for this approach to enhance its offerings and capabilities for interaction and access to the outside medical world and yet remain simple to use and telephone-like in appearance.
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