METHODOLOGY FOR GENERATING A GUIDELINE SPECIFICATIONS OF SMART HEALTH HOME CARE

In this article we will develop a proposed methodology for generating smart home healthcare specifications for ICT products for home support. We will specify the service context that we use to define the specifications, then the main specific functions selected, and finally the social engineering methods to integrate the products developed as tools for home service work.

ASSOCIATED MEDICAL AND HEALTH ISSUES

The term “Telemedicine” has been used for several years, where medicine and therefore the medical profession are placed at the center of the system. We have observed for some time the disappearance of this term in favor of that of “Telehealth“.

Why this change in termination?It is clear that through this new term, we are putting the “assisted person” (or the patient) at the center of the device, and no longer the medical profession. This also refers to a change of strategic attitude towards this new thematic of “health at a distance” where the patient himself becomes educated in his own health, in a logic of health education, constituting a prevention axis.

It is therefore more obvious, at first to put the elderly person at the center of the system and to educate them about their own health, this concept is an integral part of a logic of home support. In the situation of a hospital at home, where we come back to a telemedicine pricipe as such.

Smart home healthcare specifications proposal

The proposal is to consider that the products developed are part of a service to the person by professionals in the business sector. The evolution of the service will depend on the degree of dependence of the person. In order to characterize a life trajectory dependent on dependence we define three archetypal situations:

– Daily Life Situation

– Home support situation

– Situation of hospitalization at home

The “daily life situation” is an ordinary life situation in which the person has a degree of autonomy which allows him to coordinate his activities in and with those around him. We can resume here the functional situations responding to the different needs of man:

– I live,

– I eat,

– I move,

– I take care of my body and my health,

– I’m dressing up,

– I have hobbies,

– I communicate,

– I’m educating myself,

– I team,

– I am a citizen,

– I finance myself and make sure.

The “Home Support situation” corresponds to a situation in which professionals support the dependent person in coordinating the actors helping him in his activities necessary for his vital needs.

The “home hospitalization situation” is an institutional situation in which the hospital takes care of home care, in coordination with professionals.

The transition from one situation to another evolves according to the degree of dependence and the state of health of the person, whether elderly or ordinary person.

The focus on the activities of the person at home leads to consider services as an economy of functionality. Defining the offers falling under the Functional Economy aims to take care of an expectation of a functional order from a customer (company or household), tending to substitute an offer of skills for an offer of products and leading companies to develop an integrated production of services and products, adapted to the client’s understanding of the function (“custom offer”).

The traditional services sector can be defined the Grouping of Service Professions (GSP) to bring together and represent the professions of services and support their development.

The GSP brings together five main activity groups: financial services (insurance, banking, ie 3% of employment), business services (advice, training, IT services: 20%), operational services (transport, logistics, temporary work , cleanliness, security, communication, fairs and shows, call centers: 40%), personal and personal services (hotels, traditional catering, fast food, tourism, property promotion and management, personal assistance, education: 30%) and services to communities (energy services, water distribution, waste collection, parking, public transport, catering: 7%). 

The GSP does not include in its perimeter the trade sector, because it operates on an economic model significantly different from that of service companies. Indeed, one of the common features of the latter is the preponderant share of the wage bill in turnover: service is above all men, clients, time, wages loaded with constraints. The development of service companies necessarily involves the creation of jobs … “

The functionality economy proposes to substitute a logic of product ownership for a logic of rental or pooling of products necessary for the functionality sought in a perspective of sustainability of these shared goods. This approach separates traditional interventions in a transverse logic, mixing merchant and non-merchant, together with professional (habitat, social, industrial, medical, etc.). Home support is only possible through the juxtaposition of services provided by professionals, but also by the presence of neighbors, friends and family.

According to our description of the scope of smart health home in the introductory chapter, we consider that two forms of services can exist, that oriented towards technical subsets, and those oriented towards the activities of the person at home, see figure next.

This model opens up fields of different possibilities combining logics of obtaining expected means with logics of expected results, and this, by using either artefactual means or human means at home.

Four types of services result from this typology:

– service in autonomy, the service provided is on the means necessary for the activities to ensure its functionality, is part of the traditional services (installation, maintenance, rental)

– accompanied service, the service rendered is in the context of activities that the person can no longer provide alone, requiring the physical assistance of a third person

– mediated service, the service provided remotely by means of artefactual or / and automatic intervention allowing the desynchronization of human resources intervening only on specific calls.

– relational, logical, club, portal or counter service connecting ecosystem players.

The following figure summarizes this description.

Figure 25 Typology of types of services in relation to home support and life trajector

The functional specifications of the artefacts necessary for home care are to be considered from three points of view:

– a point of view of the need to take into account the evolution of housing according to dependence (equipment logic),

– a point of view of the tools and means of action of professional home care workers (instrumental logic)

– a point of view of the person and his entourage (functional logic).

These functional specifications are developed with the stakeholders involved as part of a global social engineering approach to the organization of home care.

Figure 26 Definition of a functional specification

Studies on uses show that technologies do not predetermine uses, and that the modes of appropriation depend on sociological and psychological elements of users, therefore they cannot be conceived independently of the actors concerned. The needs analysis must be carried out by questioning the actors involved to identify the activity systems by identifying expectations and desires, the organizational modes, the collaborations that coexist, the operating rules and the instruments / tools necessary for the activities. 

In a second step, networks of contradictions carrying blockages in the development of activities will have to be identified, which will be sources of acceptability of an accepted change in a new mode of organization of activities with a view to improving the difficulties encountered by actors. These reflexive approaches are moments of appropriation and recognition of skills facilitating the implementation of new modes of organization accepted by the greatest number, setting “good practices”.

Figure 27 Social engineering methodology of innovation.

The integration of new artefacts can only be carried out in the personal practices of people at home and their entourage, as well as in personal practices only if prior use tests are carried out, measuring both their perceived usefulness and their acceptability social and economic as well as their usability.

In a second step, the usage analyzes in the work situation will make it possible to realize the reality of the processes of appropriation of the devices thus conceived and their effectiveness in home care in an economic perspective acceptable by all the stakeholders. as well as the person losing autonomy.

These evaluations of products with a view to home service and these evaluations of actual uses in the practice of services require a specific organization to support change practices which bring together technological and social engineering skills, bringing together engineers and stakeholders in the field of work ergonomics and psychosocial organizations, as service economists.

The functional specifications thus developed must take into account environmental criteria. The technical solutions envisaged must be concerned with energy savings (heating, electricity, air conditioning, etc.), and must be in accordance with environmental standards.

These criteria will make it possible to label apartments, services and products “Housing, Home support services and Sustainable environment” for example.

The specifications take into account needs for:

Compensate for the loss of autonomy,Help, control, act remotely on housing, Increase the security of goods and people, Maintain social ties, break isolation,

Facilitate communication between the different actors.

The development of the functional specifications is a privileged moment to bring together the actors of the same territory. It will take into account one or more of the typologies of services described, making it possible to ensure the scalability of the person’s dependency at home.

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