Greenhalgh Trisha, Procter Rob, Wherton Joe, Sugarhood Paul, Hinder Sue, Rouncefield Mark
Department of Primary Care Health Sciences, University of Oxford, 2nd floor, New Radcliffe House, Walton St, Oxford, OX2 6GG, UK.
Department of Computer Science, Queen Mary University, Coventry, UK.
BMC Med. 2015 Apr 23;13:91. doi: 10.1186/s12916-015-0279-6.
We sought to define quality in telehealth and telecare with the aim of improving the proportion of patients who receive appropriate, acceptable and workable technologies and services to support them living with illness or disability.
This was a three-phase study: (1) interviews with seven technology suppliers and 14 service providers, (2) ethnographic case studies of 40 people, 60 to 98 years old, with multi-morbidity and assisted living needs and (3) 10 co-design workshops. In phase 1, we explored barriers to uptake of telehealth and telecare. In phase 2, we used ethnographic methods to build a detailed picture of participants' lives, illness experiences and technology use. In phase 3, we brought users and their carers together with suppliers and providers to derive quality principles for assistive technology products and services.
Interviews identified practical, material and organisational barriers to smooth introduction and continued support of assistive technologies. The experience of multi-morbidity was characterised by multiple, mutually reinforcing and inexorably worsening impairments, producing diverse and unique care challenges. Participants and their carers managed these pragmatically, obtaining technologies and adapting the home. Installed technologies were rarely fit for purpose. Support services for technologies made high (and sometimes oppressive) demands on users. Six principles emerged from the workshops. Quality telehealth or telecare is 1) ANCHORED in a shared understanding of what matters to the user; 2) REALISTIC about the natural history of illness; 3) CO-CREATIVE, evolving and adapting solutions with users; 4) HUMAN, supported through interpersonal relationships and social networks; 5) INTEGRATED, through attention to mutual awareness and knowledge sharing; 6) EVALUATED to drive system learning.
Technological advances are important, but must be underpinned by industry and service providers following a user-centred approach to design and delivery. For the ARCHIE principles to be realised, the sector requires: (1) a shift in focus from product ('assistive technologies') to performance ('supporting technologies-in-use'); (2) a shift in the commissioning model from standardised to personalised home care contracts; and (3) a shift in the design model from 'walled garden', branded products to inter-operable components that can be combined and used flexibly across devices and platforms. Please see related article: http://dx.doi.org/10.1186/s12916-015-0305-8.
我们试图界定远程医疗和远程护理的质量，目的是提高接受适当、可接受且可行的技术和服务以支持其带病或残疾生活的患者比例。
这是一项分三个阶段的研究：（1）对7家技术供应商和14家服务提供商进行访谈；（2）对40名年龄在60至98岁、患有多种疾病且有辅助生活需求的人进行人种学案例研究；（3）举办10次联合设计研讨会。在第一阶段，我们探讨了远程医疗和远程护理应用的障碍。在第二阶段，我们用人种学方法详细了解参与者的生活、患病经历和技术使用情况。在第三阶段，我们将用户及其护理人员与供应商和服务提供商聚集在一起，以得出辅助技术产品和服务的质量原则。
访谈确定了辅助技术顺利引入和持续支持方面的实际、物质和组织障碍。多种疾病的经历表现为多种相互强化且不断恶化的损伤，带来了多样且独特的护理挑战。参与者及其护理人员切实应对这些挑战，获取技术并改造家居环境。已安装的技术很少符合使用目的。技术支持服务对用户要求很高（有时甚至很苛刻）。研讨会上形成了六项原则。高质量的远程医疗或远程护理是：1）基于对用户重要事项的共同理解；2）对疾病自然史实事求是；3）与用户共同创造、不断发展和调整解决方案；4）有人情味，通过人际关系和社交网络提供支持；5）通过关注相互了解和知识共享实现整合；6）进行评估以推动系统学习。
技术进步很重要，但必须以行业和服务提供商遵循以用户为中心的设计和交付方法为基础。要实现ARCHIE原则，该领域需要：（1）从关注产品（“辅助技术”）转向关注性能（“使用中的支持技术”）；（2）将委托模式从标准化家庭护理合同转向个性化家庭护理合同；（3）将设计模式从“封闭系统”、品牌化产品转向可跨设备和平台灵活组合使用的可互操作组件。请参阅相关文章：http://dx.doi.org/10.1186/s12916-015-0305-8。
