Abstract
An information architecture is a high-level, conceptual design for a system which describes the fundamental requirements and principles of a system, and details its essential elements and characteristics. I conducted a comprehensive review of published literature on telecare, including government reports and case study papers. This enabled a complete picture to be constructed of telecare system components. The components can be divided into four separate categories: human components, ICT components, telecare operational units and supportive elements. The system requirements cover functional, non-functional and informational requirements. Telecare holds great potential for all sectors of society. Its true value may only be realised when the nature of information within the telecare system is fully understood. The thorough analysis, manipulation and usage of system data are the key to the future success of telecare services.
Introduction
Telecare involves the use of electronic devices in the home which monitor the environment in order to safeguard the well-being of residents. The devices, which monitor environmental variables such as movement, heat and moisture, are connected to remote service-centres. The service centres co-ordinate agencies such as the emergency services in response to alerts from the telecare devices. Home telecare is an example of how the use of relatively simple electronic devices when combined with the proper co-ordination and use of information generated and manipulated by information communication technology (ICT) and human agencies can save lives.
Technical matters are vitally important to a telecare system. For example, device functionality, secure radio frequency communications, correct programming of system software and database design are all important technical aspects of any telecare system and require careful attention. However, systems designers also need to recognise the fundamental requirements of a telecare system (which can be categorized as functional, non-functional and informational requirements). A telecare system which fails to adhere to these fundamental design principles will be flawed.
Beynon-Davies 1 defined an information architecture as the combination of information, information systems and resources, whilst Greefhorst et al. 2 argued that an information architecture describes the fundamental aspects of a system which guide the people who actually design and build the system. Therefore, a telecare system information architecture should clarify what ICT components, human participants and agencies constitute the system, and detail the requirements (functional, non-functional, informational) of the system. Setting out an information architecture for telecare systems will assist those designing, reviewing and assessing them through the definition of fundamental system requirements and principles.
Telecare system components
I conducted a comprehensive review of published literature on telecare, including government reports (e.g. Audit Commission 3 ) and case study papers (e.g. Porteous & Brownsell 4 ). This enabled a complete picture to be constructed of telecare system components. These can be divided into four separate categories: human components, ICT components, telecare operational units and supportive elements.
Human components
There are four human components:
The client. A telecare system requires a client to use and benefit from the system. The majority of telecare users in the UK are elderly, although people of any age may benefit from telecare. A personal protocol is created for each resident joining the telecare system. This details the personal data of the resident (including health issues) and what to do in an emergency (i.e. who to contact and how). The protocol data are held centrally in the telecare support-centre. Support-centre staff. Support-centre staff communicate with residents via telecare base units. The base units provide a link between the resident and the telecare system services which may be summoned into operation. To date, all telecare systems in the UK have been operated by support-centre staff, as the open and approachable nature of human operators is preferred to automated voice reply messages. The support-centre staff occupy a critical position in the telecare system infrastructure. Keyholders. Many telecare systems require the resident to nominate one or more keyholders. These people are usually the first to be contacted by the support-centre in the event of an alert and possess a key to enter the client's home. The most common keyholders are friends, relatives or neighbours of the resident. Not all telecare systems insist upon a keyholder being nominated. Wardens. Some telecare service operators use a resident warden in their telecare complexes to provide security and assistance to residents. Apart from testing telecare equipment periodically, they are not usually involved in telecare directly. Wardens can play different roles in different housing scenarios.
ICT components
There are four ICT components:
Software. Software is required in order for a telecare system to function correctly and efficiently. It facilitates interaction between the telecare devices and the base units. The software will also interact with resident data, their profiles, protocols and any response services. Different telecare operators employ different telecare software in their support-centres. Databases. A telecare system normally has a local database for storage of data and a central database which is the main repository of data. The local database (usually located within the base unit) transfers data to the central database (located in the support-centre) either instantaneously or at specified intervals. If for some reason, the central database is unavailable, data can be stored temporarily in the local database. Base unit. The base unit receives signals from the telecare devices around the home and then transmits data remotely to the support-centre where the signals are acted upon. The base unit commonly receives signals from telecare devices in radio signal format wirelessly before transmitting data to the support-centre in analogue format (using telephone lines). As the primary communications device between the resident and the support-centre, each base unit contains a built-in loudspeaker and microphone. Devices. A wide variety of telecare devices are available. The majority are wirelessly connected to the base unit. The devices usually require an independent power source (e.g. battery). Each resident chooses which telecare devices to install in their home, usually in consultation with carers, friends and family.
Telecare operational units
There are two operational units:
Support-centre. All telecare operations in the UK have support-centres, which monitor and respond to telecare alarm alerts. The support-centres are staffed 24 hours a day, 7 days a week by operators. The support-centre is the hub of the telecare system operation; its smooth, efficient operation being the key to successful service delivery. Support services. Each telecare service provider needs to provide certain supportive services. These include installation, maintenance and monitoring of telecare system components. Another service is the rapid response unit, usually consisting of a small team of medical personnel, who are able to travel to a residence quickly following a telecare alert. The rapid response unit covers the whole geographical area of the telecare operation.
Supportive elements
There are five supportive elements:
Power. Individual telecare devices typically have a battery installed whilst base units are connected to a mains electricity supply and also have an internal back-up battery in case of power failures. Telecommunications. Telecommunication links the telecare system components together. Communications within a telecare system may be via radio-frequency signal (e.g. device to base unit); conventional analogue telephone line (e.g. base unit to support-centre) or via mobile phone link (e.g. support-centre to rapid response unit). A telephone (connected to the base unit loudspeaker and microphone) is most commonly employed in telecare homes, although communication via mobile phone networks is also possible when conventional telephone lines are unavailable. Secure environment. The environment needs to be stable and secure so that devices will operate as intended (e.g. rainwater from a leaking roof may trigger a flood detector in a bathroom). Emergency response services. Emergency response services provide essential support to a telecare system. The resident's general practitioner may also be included in the protocol of an individual resident by agreement. Care/social services. Professional care and social services also form an integral part of a telecare system, although they play a more supportive role and usually do not respond to emergency alerts.
Requirements of a telecare system
Gortzis stated 5 that ‘a thorough theoretical analysis is the precondition for designing services aimed at improving structures and processes in a telecare environment.’ Part of this analysis is the definition of system requirements. These cover functional, non-functional and informational requirements.
Functional requirements
Functional requirements are what a telecare system needs to do in order to function correctly. These are:
The chosen environment must be monitored effectively by the devices, base unit and support-centre working in unison; Systems should be adaptable to specific environmental needs (e.g. large/small house); Individual requirements should be catered for; The system needs an effective alerting mechanism to ensure that the resident and the support-centre are aware that a particular telecare device has been activated; Communications throughout the telecare system should be effective and smooth; The system must function around the clock (24 hours a day, 7 days a week), with the residence being under continual monitoring; The system should record all system activity and update resident profiles accordingly (e.g. measuring types of alerts, numbers of alerts, responses, speed of responses, resolutions to alerts); The system should inform the resident about system functionality, usage and status; The system should continue to operate if major power sources or telecommunications are cut temporarily; Telecare equipment must be safe; If reliability is compromised, confidence in the telecare system will be seriously damaged; Any telecare system must provide a link from the resident to emergency services; Useful and informative data regarding system usage and activity should be generated for management use; The system should be capable of generating invoices for clients who rent telecare equipment from the service operator; Automatic termination of gas, water or electricity supplies will reduce the risks in emergency situations; The system must have adequate back-up systems and procedures in place in case of primary system breakdown. Back-up systems procedures should be detailed in a disaster plan; Testing is important to help guarantee system effectiveness and efficiency.
Non-functional requirements
There are three non-functional requirements:
Legal requirements. A telecare service operator must comply with the relevant legal requirements in the UK. These cover such matters as obtaining the consent of the resident to install telecare equipment, permitting access to the property in emergency situations and allowing maintenance of equipment. A service agreement between a client and the service provider will detail the obligations of each party in the telecare service scenario, such as proper use of equipment by the client and speed of response to alerts by the service provider. Regulatory requirements. The regulatory requirements governing telecare systems operations in the UK are not definitive at present. The Telecare Services Association, is a membership body in the UK for telecare service operators, offering three different types of accreditation. However, membership of the association is voluntary. Similarly, there is no legally required standard for telecare devices and hardware. The European Union proposes to make the frequency 869 MHz a requirement for social care devices across the EU. Apart from this technical regulation from the EU, there is little other direct regulation in the telecare sector in the UK. Ideal system characteristics. Expensive telecare equipment and service costs will deter uptake. Systems must therefore be affordable. System components should be mobile enough for removal and re-use if necessary. Service targets need to be set for functions such as speed of response to alerts and speed in answering queries. Residents must feel comfortable about using the system and systems must be discreet. A telecare system should also be adaptable to new technologies.
Informational requirements
Telecare systems use data in order to function. The five informational requirements define important principles regarding information usage:
Information security. Telecare depends on personal data. Such data should remain secure and private during data transmission. Internet-based communications should use encryption techniques to ensure that data are protected. Information security should not be compromised in a telecare system. The Data Protection Act 1998 gives clients the right to access data about themselves, whether held on computer or on paper. It is important that service operators make allowance for such requests Information speed. Speed is important during a telecare alert. The use of modern ICT helps to ensure a speedy response. Information accuracy. Any reduction in information accuracy could have serious consequences. Reduction of superfluous information. Information transmitted from one telecare component to another should consist only of the data of interest to the receiving component. Superfluous information should be eliminated from the information flow. Information value. The inherent value of data generated by a telecare system needs to be recognized. The Liverpool Telecare Pilot produced medical profiles for residents through a combination of the activity diagrams of clients and their personal data.
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The pilot study showed how valuable information may be gleaned from simple telecare devices around the home.
Conclusion
Setting out clear design guidelines for a telecare operation which specify the requirements, principles and components of the system can be described as an information architecture. Interest in telecare operations is likely to grow substantially over the next 20 years due to changing demographics and continuing pressures on health, social and care services. Thus, an information architecture which details the fundamental system requirements will form a useful reference for those investigating the principles of telecare. As technology continues to evolve in the future, clients will be presented with increasing opportunities to utilize data in more useful ways; an information architecture will be a useful tool for those engaged in systems design. Telecare holds great potential for all sectors of society. Its true value may only be realised when the nature of information within the telecare system is fully understood. The thorough analysis, manipulation and usage of system data are the key to the future success of telecare services.