Joe’s view of telehealth for dummies

Dad died 17 years ago. He was something of a character; soldier, sergeant busted to private after putting a fascist through a window in a bar room brawl in Berlin in 1948, trawlerman, stand-up comedian, criminal, milkman, HGV driver, bus driver and eventually European sales director for Standard Oil of California.

He was a force of nature, always with a crowd round him. My childhood memories are full of laughter coming up from downstairs, where the growns-ups are having fun. I can hear Dad booming above the hub-bub, telling stories and singing songs on request.

In these memories, Mam comes upstairs to chase us back to bed when my big sister and I are spotted peering through the banisters in our pyjamas at the fun below. I may have been biased, but Mam was always the prettiest Mam at the party.

Dad might have been the life and soul of the party, but Mam was the bed-rock of the family; the great woman behind the great man. Him the full sails, she the keel. They were inseparable.

Lesson one: forget 111

Dad got pancreatic cancer. He was gone in a few dreadful, messy weeks. My mother’s home was burgled while we were at the funeral. They took everything. Mam said: “It’s just stuff.”

Over the next six months, she stopped eating and we moved her in to our house. I thought we’d lose her. Then, after about a year, her life turned on a song she heard on the radio. It was a Noel Coward song about a widow who visited the Isle of Capri called ‘A Bar on the Piccola Marina’ .

She decided to go on holiday on her own. She went to the Isle of Capri and had a great time. She never looked back. She took up dancing, made friends aplenty, and developed a busy social life.

She moved back into her own home. I bought her a mobile phone which, because of her increasing deafness, was a godsend; texting became her preferred means of communication. However, she has steadfastly resisted my attempts to get her a home computer.

Last month she was 81. Fiercely independent, living alone; I stopped worrying about her. Then, two months ago, I got a text message from her asking if I could take her to hospital.

She had fallen and injured her ankle and had missed two weeks of dancing sessions because of the pain. This was an almost unheard of call for help. Even then, it was Saturday morning when she called: “I didn’t want to bother you at work, I know you’re busy.”

I went straight to her house and saw that her ankle was swollen and exquisitely tender. I rang NHS 111 to find out what our options were. We were advised to go to our walk in centre.

Got there at 11 am. Seen at midday. At 12.05, we were told to go to A&E because x-ray had closed at 12.00. Memo to self; “In future, go straight to A&E.”

No CCTV, no iPhones

At A&E, there is a two hour wait in overcrowded waiting area with no refreshments (coffee machine broken). Mam is x-rayed, seen by a nurse, and diagnosed with a sprain. She’s sent home and advised to mobilise with analgesia. She’s dancing again within three weeks.

No harm done, and some lessons learned about not wasting time with 111. But hang on a minute here; my mother suffered in silence for a fortnight. And my “Alright Mam? Need owt from Marksies?” text messages no longer seem adequate.

We both realise that if this had been a broken hip, and she had fallen with her phone out of reach, the whole episode could have been very much more serious. I need to have a better idea of how Mam is, and I need to be able to check that she is ok from a distance.

The tricky bit is going to be persuading her to accept some sort of CCTV so that I can look in on her, if necessary from Turkey. This suggestion meets with a plain: “No, I don’t want to be spied on.”

Seconds out, Round 2: “OK Mam, I understand you don’t want to be spied on, how about an iPhone?”

In a two week experiment, Mam fails to get to grips with the user interface. She is too used to the mechanical feedback of real push buttons to cope with virtual ones, so my plan to use ‘device locator’ to track whether she is going out every day is foiled.

The internet scamming problem

We agree to search for other options. I offer a variety of commercial services (not cheap) which involve Mam wearing a panic button around her neck. Rejected with: “Try me when Cartier bring one out.”

OK, then. A trip to the iPhone shop reveals a motion sensor which, with an internet connection, can tell me, say, how often, and when Mam walks past it in the hall between lounge and kitchen.

Mam loves a cuppa and anything less than six a day would ring alarm bells for me; so this may have alerted me to the ankle issue.

Unfortunately, this is declined because she doesn’t want a computer in the house because of all the horror stories about elderly people being duped out of their savings in internet scams.

“But Mam, if you don’t use the internet there’s no way you can get scammed” is met with: “I definitely can’t get internet scammed if I don’t have the internet.”

So we reach stalemate. Mam acknowledges the need for a way to check on her, but none of the available solutions are acceptable to her. I continue to phone regularly and she regularly fails to reply (didn’t hear it, left the phone at home when she went out).

So how can I check that Mam is moving about at her normal pace, without an internet connection? What I need is a kettle that will send me a text message every time she makes a cup of tea.

A solution at the bottom of a cup of tea

I keep reading about the failure of various telehealth projects, but maybe we just haven’t got a simple enough and cheap enough solution. One that works so well that individuals are willing to pay for it themselves, instead of expecting the NHS to fund it.

We don’t need a big system. The information governance parameters are set by my mother, so we don’t need a committee of Royal Medical Colleges. We want to use existing kit and infrastructure; after all, my Mam’s tea consumption doesn’t need a special, secure, password protected network.

There’s a saying among engineers that if you didn’t fix the problem with gaffer tape you didn’t use enough gaffer tape, so I’ve taped the spare iPhone to the kettle. Now, I just need an app that sends me a text when the kettle is poured. Over to you, HANDI.

Joe McDonald will be jointly chairing the second CCIO Leaders Network Annual Conference that runs alongside EHI Live 2013; at which there is a new HANDI Health Apps zone with a village featuring leading suppliers – and a workshop on how to build your own apps.

EHI Live 2013 is more than a meeting, more than an exhibition. For anyone involved in the use of information in healthcare it’s a golden opportunity to update knowledge, get answers to questions, meet the experts and think about the future. This year’s conference is free for all visitors to attend.