Ramin Nilforooshan: Technology Integrated Health Management for dementia

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Dr Ramin Nilforooshan, Clinical Lead, Surrey Dementia Test Bed Project, discusses using technology to improve the quality of life for people with dementia.

This presentation was recorded at our Digital Health and Care Congress 2017 on 11 July 2017.

Transcript

So very briefly the idea is about, as I said, providing people with better control of what they do.  We’re working with many collaborators.  We asked them to put forward what they could do and then bring every technology together, make sure that the technology works in the same language, bringing one network, one hub and then transfer all the data to a monitoring service, monitoring team and have a suitable pathway after that. 

But I’m focussing on this talk about how we use the end users to design the sort of service that we wanted to have.  So, this is what we’ve done.  We look at the sort of, all the devices going to persons home.  The devices are something that you could buy off the shelf, nothing new but what we did, we asked the University of Surrey to make sure that all the devices used, one gateway, one hub otherwise you’re going to end up with so many gateways at home.  Everything comes to sort of IOT test, Cloud and then from there become a sort of very easy integrated view dashboard and we use the monitoring team.  

The monitoring team are assistant.  They’re not qualified and we did it on purpose because we want to make sure that we could reduce the cost and they would be supervised following the clinical algorithm.  So, we’ve written clinical algorithm for every idea that comes.  They follow the algorithm and then it depends on what type of response they need to do.  They could arrange emergency outpatient, or send someone to do a home visit.  The idea is, can I predict who will have UTI?  Who will become agitated?  Who needs to come to hospital today?  And also, can we change the setting of NHS how they transpire outpatient appointment. 

Bring someone every three months and say oh you’re doing well, is not the way that we want to do in future.  We want to make sure that data is available for clinicians and they decide who needs to come and also people with dementia.  

So, what’s the best approach?  I think the best approach is inviting everyone to come forward to tell you what they want.  So, we’re doing a randomised controlled trial, but alongside and before we started the randomised control trial, we did trusted users.  So, we asked a few people to come forward, and test the technology in their home and we continue with those people.  Some of you may have seen it on television yesterday on breakfast show BBC that there are recorded, sort of couple of videos of people that they’re using technology and they’re enjoying this routine of using the blood pressure, temperature, pulse, how they’re doing on a day to day basis.  

So, more than forty people got together from the academy, innovators, peoples, GPs, they all came together.  They said what we want to do in Surrey and we designed the service alongside what they think could work and then after that, we went to the innovator and said this is what we want to do, can you provide the technology for what the need of the people, and they said yes.  Again, we went back to the trusted users and say, here you are, that’s the devices, how do you feel about that?  And we continue evaluating this alongside with the randomised controlled trial. 

So, so far 200 people have been recruited to this trial, the trial will finish by March 2018 and results will be ready, hopefully, by July/August 2018.  

The world café approach, is the type of approach we did.  We invited people.  We sat them in a sort of a different table, we asked them to come with the ideas and then we bring the ideas together on a sort of a table and then ask each table to comment what are the priority and then based on that priority, we decided those are the things that we want to measure and evaluated.  Then we went back to them, and continue changing.  So, some of the devices we notice that it’s not working, it’s not the best friendly way of setting things in people’s home with dementia.  Therefore, we went back, we changed the design, we changed the way that they need to do it and then so far, the feedback is so positive.  They enjoy being part of it.  They feel that, okay, they’re being monitored.  It may be a sort of big brother house, but at least we know who needs to go to see their GP and we picked up so many things so far.  Those are anecdotal.  We haven’t got the results of RCT, but we picked up the emergency blood pressures, someone who needed to go and see their GP because of their UTI.  We prevented a couple of falls and so those are the things that so, so good.  

Those are websites, Twitter, and sort of email.  Please email us or let us know what you think.  We hope that we could recruit to sort of 400/500 people that we want. It’s a very tough two years programme, but so far, we’re doing fine. 

Many thanks.