Final Phase: Pilot Research Project & Evaluation Report

The following are the primary findings arising from Assistive Health Technologies for Independent Living—a pilot study. 

A market focus is critical

 The expected impacts of ageing and disability in the population are well documented and assistive technologies are expected to help alleviate the associated demands. But evidence reveals current high levels of unmet need among the aged and people with disability and low adoption of assistive technologies, despite their expected value in timely and cost-effective healthcare delivery. There is not yet sufficient market demand, and widespread operational implementations are minimal. Demand drives sustainability. There is no competitive market in Australia to bring assistive technologies into the mainstream and to make them a preferred option in healthcare delivery. An independent body is needed to create an environment in which new and old players can seek to change policies in order to service isolated consumers, improve efficiencies, and reduce risks and costs. At present many groups are trying to do the same thing, and the lack of a real market is inhibiting progress. 

Creation of a market will need to come from individuals and organisations investing their own time and money; government is unlikely to invest, so industry investment is critical. A user-centred network will offer end users direct access to technology and service providers, providing valuable definition of unmet user needs and rapid feedback about potential solutions. In this way the market starts to motivate the delivery of solutions, promoting the development of commercially sustainable solutions.

Expert ‘champions’ are required 

The participation of enthusiastic and knowledgeable promoters who want to assist in improving the current status of healthcare delivery is critical. Well-respected champions who have skills in planning for sustainability and who can promote this agenda and bring together clinicians and organisations are required. A culture of innovation will see larger health technology projects develop and lead to successful widespread adoption. Champions provide legitimacy and help bring clinicians and other groups together to build trust. Champions and managers with leadership skills in organisations are also crucial for the diffusion of technology. Workflow difficulties pose a major barrier to technology uptake, and good management skills can help promote technology benefits and accelerate adoption. A user-centred network will provide a vehicle for identification of such champions and offer them a voice that will be able to effect change among the interdisciplinary stakeholders.

A long-term business model is crucial 

Achieving success calls for a business model that has a focus on the value the technology and innovations can bring and their ability to improve productivity, combining innovations that are cost-effective with improved health outcomes in the long term. This project highlighted the need for a business model that is adaptable and sustainable. Development and use of technology should align with the desired outcomes and the business strategy and be based on market need. Few pilot programs of assistive technologies have moved to large-scale operational use. This raises the question of whether the technology is adequate to solve the problem arising. 

Defining the problem and how technology can assist is a vital step in developing or choosing the technology that will provide the desired outcomes, success and sustainability. There are many cases of the rapid adoption of innovations such as mobile phones and social media, but to date none of the assistive technologies comes anywhere near those experiences.

Innovation is about using knowledge and resources to create outcomes that are socially and economically valuable. A user-centred network will provide connections that will expand innovators’ resources, facilitating the creation of new business models that will have an impact locally and internationally.

New interdisciplinary players will be involved 

The healthcare market is changing, and external players are seeing the opportunity to break into the industry. The United States has seen deals with companies such as Costco, Nintendo, Samsung, FujiFilm and Apple. The new players moving into healthcare are interdisciplinary and contribute by leveraging diversification, expanding expertise range, and augmenting scale by providing the necessary capital. Large-scale coordination requires incentives and support to connect the groups. 

Participation of all players—from small, medium and large firms, from diverse industries and involving a range of experience levels and entrepreneurship—is to be encouraged. The EWG found there is a need to explore pathways to developing a market for health technologies that are based on healthcare service provision, rather than technology innovation alone: technology is secondary. As a consequence, there is potential for new players to move into this area and provide integrated solutions to delivering healthcare and offering assistive technologies as part of a suite of services. Collaboration and cooperation between interdisciplinary players, enabled and facilitated by a user-centred network, could accelerate this.

The mounting challenge of low population growth and increasing ageing in Australia is expected to place increasing pressure on the maintenance of healthcare standards in the face of rising costs. There is growing concern about the financial sustainability of a healthcare system in which care delivery occurs in a hospital-centric setting and is subject to capacity constraints and workforce shortages. Chronic illness and aged care accounted for over 70 per cent of Australia’s $140 billion expenditure on healthcare in 2011–12. 

Aged people use healthcare services more often and more intensively than younger people, a high proportion of lifetime costs being incurred towards the end of life. In Australia there are more than 3.2 million people aged over 65 years, and this is projected to rise to 5.8 million in 2031. Longer lifetimes and larger numbers of older people as a proportion of the population will see more people diagnosed with chronic conditions such as diabetes and cancer that require constant monitoring.

The development and deployment of new assistive and medical technologies can improve quality of life, facilitate healthy independent living and limit healthcare costs by providing innovative, cost-effective solutions. These are based on interdisciplinary approaches combining nanotechnology, biotechnology, information and communications technologies and cognitive science. Smart technologies such as these can enable older people to continue to live in their own homes for longer, control their treatments and medications better, identify the onset of symptoms before they need to seek emergency hospital treatment, and maintain close connections with family and society. 

Such technologies are also applicable to people with disability. About 4.3 million Australians live with severe and profound disability, and for a significant proportion of them the disability is such that they are unable to live alone safely. Together with the increased number of people of all ages with disability arising from disease and accidents, this has major impacts on the healthcare system and on healthcare costs.

The main target populations for application of smart technologies are people living alone with chronic health conditions, people with disability, people at high risk of falls, people living with dementia, people living in regional and remote locations, carers, and family members. There is a wide variety of technology-based products that can enable independent living when coupled with modern communication systems. Further, technology has the potential to allow for greater social engagement, which has been shown to be an essential feature of healthy ageing. Linking sensors and alarms to a response centre allows for increased security at home, and linking diagnostic devices to medical experts enables better management of chronic conditions and early detection of situations where treatment or assistance is required. 

A self-management approach can be expanded beyond the home by the use of smart phones with attached devices for measurement of critical health parameters. Individuals today have much higher expectations of healthcare providers than ever before. The media, call centres and the internet give people 24-hour access to expert consultation and information on which to base choices. Individuals attach a high level of importance to the evaluation and consumption of healthcare services, and the means to support them should be available. 

Despite evidence of successful application overseas and several successful examples in Australia, the healthcare industry and governments in Australia have been slow to make use of these technologies. This is not surprising: such technologies are disruptive in that they challenge current methods of working, power structures and cost reimbursement systems in the healthcare professions and can create conflicts of interest between stakeholders.

The interviews, consultations and the round table discussion held for this project provided a wealth of information and opinions on what barriers various interested parties encountered or perceived. The main findings from the project highlight the importance of a number of factors for healthcare delivery based on the use of assistive technologies:

• A market focus is critical.
• Expert ‘champions’ are required.
• Long-term business models are crucial.
• New interdisciplinary players will be involved.

The project identified the following barriers to the widespread adoption and deployment of technologies that can enable innovative models of healthcare delivery and independent living for individuals:

• The integration of technology. The technology is widely available for use in Australia, but it is too hard to use, too hard to integrate, or simply does not suit the needs of end users.
• A lack of incentives and subsidies to encourage health practitioners to adopt new technological systems and approaches.
• A lack of sufficient funding to provide effective solutions and to evaluate results in trials that can be translated to other settings to provide evidence to policy makers and governments.
• A lack of leadership and competency to navigate through the ‘silos’—state and federal governments, technology developers, health practitioners, care providers, policy makers and non government organisations. • The lack of champions to argue persuasively so as to influence the policy decisions of governments and major stakeholders.

Informed by studies of several outstanding Australian assistive technology projects, the project identified a number of factors that are essential for successful application of health technologies:

• Development and committed use of a long-term business plan.
• Using technology that is affordable and easy to access.
• Using technology that sits in the background of everyday living—where little or no action is required by users to gain the health benefits sought. • Consultation with end users and their family, friends and carers about technology—forming and using an environment in which needs and wants can be voiced and heard.
• Having a strong workforce and team commitment—a champion and staff who have experience working with the aged and people with disability and who are technology literate.
• Using technology infrastructure that can operate and integrate a range of devices and systems, especially as technology evolves. It is essential to not be ‘locked into’ just one provider.

To overcome these barriers and exploit the success factors, it is vital to bring together experts from a wide range of disciplines in a user-centred network for health technologies. By putting users at the centre of all activity, such a network offers a unique mechanism to support high-quality independent living and promote the creation and adoption of innovative approaches to healthcare. At present there are no formal networks of this kind in Australia. 

There are very limited mechanisms for bringing together stakeholders across a range of sectors to work on the development and deployment of smart technologies to deliver improvements in quality of life at a more economic cost. A model for the formation and operation of an Emerging Assistive and Medical Technologies Network, formerly proposed by the Academy of Technological Sciences and Engineering, is seen as a starting point for future development. A new approach to healthcare is urgently needed. 

A clear, unified voice provided through a strong interdisciplinary network based on a sustainable business model can convey the information needed to inform government, industry and the community of the benefits to be gained from collaboration in the development and deployment of assistive technologies. It will also provide a platform for implementation of new policies and initiatives designed to help the aged and people with disability live as healthily and independently as possible