Associated Pilot "SCUPS" in Slovenia

Motivation for the Proposal

Similarly to other developed western countries, the demographic forecasts for Slovenia indicate that population is growing older rather rapidly. According to the forecasts by the Statistical office of the Republic of Slovenia currently 18% of Slovenian population is older than 65 years and 4% is older than 80 years. These ratios are predicted to grow steadily as depicted in figure below and by 2030 one quarter of the population will be above 65 years.

These demographic trends are already challenging the existing social care and medical care systems and the challenge is only expected to become more demanding in the future. As in many other countries, ICT (Information and Communications Technologies), more specifically AAL technologies, have been recognized as key enabler for managing these challenges. In the last decade there has been a growing number of initiatives on developing, piloting and rolling out innovative technological solutions, which enable provision of social and medical care services remotely or at users’ homes.

The partners in this proposal have for many years been involved in projects and activities for developing and piloting appropriate environment and technologically enabled Telecare and eHealth services. The market for these services and enabling technological solutions is expected to grow in sync with the demographic trends depicted above. As an example of a potential this represents, we provide some details on market analysis for Remote Home Care (Telecare), which we have performed recently.

The estimates of the current market size can vary significantly when comparing different sources using different methodologies. We estimate the total available market (TAM) to be 4.172 million users in the UK [1], which represent 37% of 65+ populations. On the EU geography TAM is estimated on 26,9 million users. We further estimate the average annual price of telecare service to be 250 € according to IMSERSO Spain, who have published an in-depth analysis of telecare service price [2]. Therefore, the TAM estimate is 6,7 billion €. Current market size in Europe is estimated (5% penetration of the EU population aged 65+)2 is 0,9 billion €. The market is growing at the rate of more than 10% per year2, and a conservative estimate for potential take-up is at least twice the current prevalence in the countries where telecare services are already available. The technology share is approximately 15% in the telecare service and is rising with a larger penetration of advanced telecare technology.

The technological partners (Smart Com and SETCCE) have strong interest in further developing their relevant AAL solutions to address the growing demographic challenge. The social care providers (Pristan, CareDesign) are at the forefront of developing and delivering social care services remotely at users’ homes in Slovenia and want to improve and optimize their services with advanced technologies. Medical institution (University Rehabilitation Institute) is interested in introducing advanced systems for remote medical treatment of patients to increase their independence and reduce the burden of treating the patients within the Institute facilities, for the benefit of both the patients and the institute. These partners have cooperated in the past in the AAL R&D and pilots, e.g. the IRIS Smart Home (http://www.dom-iris.si/en/).

The AAL services in this proposal are based on the cloud and web based solutions for different types of users. Our experience to date shows that different AAL services are provided to elderly people by different service providers, such as home social care, medical tele monitoring, activity monitoring and alerting, geolocalisation and others. There is a lot of overhead in provisioning AAL services in that way. Every service providers needs to provide the whole vertical solution and include many subservice providers. This makes the services expensive, not particularly affordable for larger portions of elder populations and consequently inhibits the AAL service adoption. The universAAL platform aims to provide means for achieving interoperability among different AAL services and applications and consequently there is value for service providers in adopting it in order to provide more pervasive and integrated AAL services that give more value to the end users, both elderly living alone and their families who have interest in supporting them in this.

The motivation in piloting AAL services with universAAL platform is to exploit the features of universAAL in two main directions: a) extending the AAL applications with new features and b) providing and piloting composition of different services based on the common universAAL middleware in order to study and evaluate how different services combine and interoperate. Moreover, the integration with an open middleware by itself is a strong signal to potential users of our applications, that they are open and compliant to industry standards.

The Basis for the Proposal

The Slovene pilot aims to adapt and integrate two different AAL services provided by different service providers with the UniversAAL platform. These services are:

  1.  Home Care provided by the two social care providers (Pristan, CareDesign), while application is developed by Smart Com.
  2. Remote Rehabilitation and Diagnostics on demand provided by the University Rehabilitation Institute (URI), where application is developed by both URI and SETCCE.

 

Both these services will be adapted and later integrated with the universal platform in order to provide a combined service.

For the pilot with universAAL it is planned to involve about 50 elderly and 10 other users (caregivers, relatives/neighbours, therapists, doctors). Pilot will be partly funded by the involved partners.

Piloting Concept

Introduction and piloting commitment

Technological solution provider Smart Com and care service providers Pristan and CareDesign will be piloting adaptation and integration of Remote Home Care service to the uAAL platform.

Technical service integrator SETCCE and URI-Soča will be piloting adaption and integration of Remote Rehabilitation and Diagnostics.

The SCUPS pilot hereby commits to piloting only with universAALised applications.

Remote Home Care

Rationale

As explained in Section 1, demographic trends in developed countries are exerting ever more pressure on existing social care system and institutions. These trends are going to continue for the foreseeable future, so it is of utmost importance to develop and roll-out technological solutions and services to enable aging individuals remain as independent as possible for as long as possible in their own homes. The Remote Home care service facilitated by the partners in this pilot proposal is at the core of this challenge.

Scenario

The technological solution supporting Remote Home care service is depicted in Figure 1. User’s home is equipped with various sensors for the purpose of monitoring the environment and user activity, such as panic/SOS button, fall detector, presence/motion detector, door/window contact detector, door barrier, smoke/heat detector, water leak detector, gas leak detectors, temperature detector etc. The sensors and sensor clusters are connected to an intelligent sensor gateway (GW). The gateway listens for sensor input, performs intelligent filtering and pre-processing of sensor data before forwarding it via fixed and/or mobile network to the cloud based service application logic. Moreover, the gateway enables on-demand set-up of a caregiver established emergency call with the user.

The central application logic is responsible for collecting sensor data and alerts, processing them, routing them to appropriate stakeholders, providing reliable notifications via different communications channels with escalation and parallel mobilisation capabilities in case of emergency, etc. Moreover, it provides a graphical user interface (for different device types) with security and access control, which is used by different stakeholders for varying and tailored notifications, reports, status views, data insights, etc.

Various stakeholders are provided with access to different types of data and notifications. A formal caregiver (home care service providers) are subscribed to all sensor data and alerts on user and his home environment, while other stakeholders are served with only the subset of data, which is of relevance or interest for that specific stakeholders. For example, informal caregivers (family, neighbours, and friends) are subscribed to fall detection, panic button and fire alarms, emergency department is subscribed to fall detection alarm, while fire brigade is instantly and automatically notified of the fire alarm. Figure

Figure 1: Remote Home Care Scenario

Target and objectives of Remote Home Care

The main objective of the Remote Home Care service is to facilitate more independence, safety, and quality of living for users, especially elderly in their homes. This is achieved by combining complementary competences of technology and care service providers in order to provide a multitude of specific features that contribute towards this goal. The potential target features for the proposed pilot include the following.

Caregiver Established Emergency Call

In many situations, such as a fall, injury, sickness, stroke, etc., the user is not able to make an emergency call to ask for help a formal/informal caregiver or emergency service provider. In these situations an alarm typically is delivered to the care service provider, which can establish an emergency call with the user without user’s help to check what exactly happened to the user and what kind of help is required. At the users home this call is answered automatically by the sensor gateway, which also enables the user to talk hands-free with the caregiver.

Fall Detection

User is equipped with a wearable multifunctional device, including fall detector based on accelerometer and/or other sensors. In case of a detected fall, a fall alarm is delivered to relevant stakeholders via appropriate channels, depending on home configuration of the remote home care application.

SOS alarm

A wearable multifunctional device enables the user to trigger an SOS alarm in case of need, e.g. sickness, inability to move out of chair, bed, etc. An SOS alert is delivered to the home care provider which can then establish a caregiver triggered emergency call to talk to the user and discover exactly what he needs in order to be able to provide appropriate care to the user and/or notify other service providers.

Presence Detection

Dedicated sensors, e.g. door/window contacts and barriers are used for detecting presence of the user within the area with predefined perimeter and spawning an alert when user crosses these perimeters. This is used for e.g. detecting wandering of users with dementia.

Activity Detection

A combination of sensors is used for detection of user’s activities and if an unusual (in)activity is detected, an alert is sent to the caregiver. An unusual (in)activity is detected when a certain threshold is reached, for example if a user stays in bed beyond 9 a.m., when normally the user gets out of bed between 7:30 and 8:30 a.m.

Environmental Emergency Detection

Various sensors enable detection of environmental emergencies, such as fire, water spill, gas leak, open doors/windows (danger of hypothermia in winter). In these cases al alarm is sent to the caregiver, while emergency service provider can be alerted by the caregiver or directly.

Remote rehabilitation and diagnostics

The background and context

Active ageing is one of the key priorities of the European Union and international institutions. In addition, stroke is one of the most common causes of neurological disorders and consequently also movement disorders. At least one of the six people in the world suffers for stroke and every year almost 1.1 million Europeans die due to a stroke. This number is likely to rise in 2025 to 1.5 million. Therefore health care and continued rehabilitation after discharge from the hospital is indispensable. Patients who suffered from stroke return to their homes, but most of them still continue with rehabilitation on a daily basis at the outpatient unit. Only a few of them may have an option using the tele-rehabilitation and tele-diagnostics service at home.

Existing Remote rehabilitation pilot service

Remote rehabilitation will be provided as a pilot service by University rehabilitation institute (URI) – Soča Hospital.

Figure 2 depicts the scenario for the Remote Rehabilitation service, which is currently available as a lab pilot at URI. The basis of the service is a patented remote rehabilitation device, a standing frame with integrated sensors (accelerometer, gyroscope – 2D tilt sensor) and actuators (horizontal translational standing platform), which is connected to the remote rehabilitation application. The system is used by the therapist to remotely set rehabilitation tasks, follow therapy execution and progress, guide the patient in the therapy, and prepare reports for assessment of the therapy by doctors. The system is used by the patient to execute regular therapies according to the prescribed tasks and guidance from the therapist. Remote rehabilitation equipment and technical implementation of service is developed and maintained by the R&D engineers within the Research and Development Unit of URI. 

Figure 2: Remote Rehabilitation Scenario

Existing Remote Diagnosis pilot service

The remote diagnostics is provided as pilot service by the URI-Soča. The institution offers modern ICT infrastructure that is suitable for communication with service backend based in private clouds and multisensory devices that are ready to assess functional vital parameters (heart rate, blood pressure, body temperature) as well as motion parameters and more complex medical parameters (ECG) from personal health systems or self-designed built-in sensors. Such service can be provided to the following users: healthcare professionals, medical experts, patients and people residing in senior homes with healthcare support or for people living independently in the SmartHome (Dom IRIS).

The medical devices used for monitoring at home assess multiple functional vital parameters and transfers the information to the service backend deployed in private cloud of URI-Soča hospital. The fused information may present various level of information; some of the user that can access this information with the tablet or smartphone and some for the personal physician or first-aid medical staff. One of the main features of the installed modules should be identification of health hazards or risk of chronic diseases from data assessed. The outcomes may generate a concerning health alarm for the medical engineer who performs a professional overview of the certain patient’s medical status or for the person who prepares the report for the doctor or physician. On basis of this report the doctor can decide that the outpatient needs to visit his/her physician and can appoint the outpatient for further health examination.

The existing remote diagnostics monitoring and reporting software used in deployment of remote diagnostic service was developed and is maintained by SETCCE’s engineers and software developers. The deployment of remote diagnostic equipment and its connection to remote monitoring service is performed by the URI engineers.

Adaptation and integration of Remote rehabilitation and diagnostic through uAAL platform

As mentioned earlier, URI features a competent team of R&D engineers, which will adapt the existing Remote Rehabilitation service to make it open and interoperable to be integrated with the other AAL services.

SETCCE will act as a technical integrator and will extend and adapt the existing Remote Diagnostic service to make it interoperable and ready to be integrated with the Remote rehabilitation service. Additionally SETCCE will integrate both services (Remote Rehabilitation and Remote Diagnostics) by leveraging and integrating with the UniversAAL platform.

Specific rehabilitation devices, as well as medical devices for capturing health parameters and rehabilitation medical information are to be integrated and connected in a single service. The interoperability will be achieved using the UniversAAL platform.

The service is first going to be tested and validated in a Lab environment in premises of URI-soča. Integration with lab environment will be mainly in scope of SETCCE and lab testing will be mainly in scope of URI-soča.

The second part of the novel service integrated in the uAAL platform will consist of user evaluation and clinical proof of concept study. The user evaluation in general evaluates the usability, applicability and user-friendliness in end-users, i.e. elderly neuromuscular intact and impaired persons. However, the Remote rehabilitation and diagnostics always require an operator (biomedical engineer), therapist and a physician to monitor and evaluate the patients’ functional progress. Thus they are also considered users. In addition to the user experience, in rehabilitation medicine the clinical outcomes are considered the most important results of the evaluation. Several clinical case studies (up to 10) will be carried out with patients of the URI-Soča.

The main target audience are elderly after rehabilitation recently discharged from hospital . In addition to elderly people there may be emphasis to involve stroke survivors, amputees, heart arrhythmia and in outpatient hospital with elderly and healthy neuromuscular intact people.