This category, sometimes called telehealth or digital health, is important for carers because it enables the health of those they look after to be managed at home for longer and more effectively. This benefits both carers and those they care for by:

• Reducing the need for carers to accompany or provide transport for those they care for to see clinicians and other professionals;
• Avoiding hospital stays that, for example for those with early-stage dementia, can accelerate the progress of that condition;
• Converting episodic care into continuous care, reducing exacerbations and unplanned hospitalisation, so again reducing carer burden as well as improving patient outcomes.

In addition it can benefit the carer by enabling any health problems that they have to be managed at home, keeping them better able to cope, and reducing time they have to spend away from those they care for. There are essentially two types of health monitoring – discontinuous and continuous. Discontinuous monitoring is typically done once a day unless a problem is identified (in which case it might be more frequent) and continuous where users either wear a monitor, or the area they are in monitors them via a camera or bed/chair they are in. Where a technology is manifested as a distinct item, it is sometimes referred to as a peripheral. However vital signs are increasingly being deduced from clever use of existing equipment, notably mobile phones and in some cases cameras. A health monitoring service is available free on the NHS for some parts of the UK for some conditions. It is also possible to purchase. The important thing to remember is that users need both the ability to read, record and transmit their vital signs, and they need a monitoring service to interpret changes and alert them or their carers of steps to take if things start going awry. Vital signs monitoring Case Study Andrew and Sue “I have been caring for my wife, Sue, for 20 years. She has final stage secondary progressive Multiple Sclerosis. My wife’s blood pressure goes up and down like a yo-yo. I use a blood pressure monitor to keep track of it, and get her treatment when she needs it. I started using the blood pressure monitor a few years ago when she was given a trial for a blood pressure medication. I wanted to monitor whether it was working and after the trial I proved it wasn’t making a difference, so using the monitor has helped reduce the amount of medication Sue takes. I also use a SAT monitor routinely three or four times a day to measure her oxygen levels. Low oxygen can be an indicator of congestion in the lungs. When this happens I can give her a chest massage to encourage the lungs to expand to help her breathe more easily and make her more comfortable. Keeping track of her health means that I can do a diagnosis, and get her treated more quickly without necessarily having a GP visit.” Suppliers of monitoring equipment & services include:

• Baywater: offers a full telehealth service including monitoring;
• Docobo: has a range of telehealth offerings;
• Florence: a simple telehealth service using SMS messaging;
• Inhealthcare: a sophisticated telehealth service also covering conditions like atrial fibrillation management not covered by many others;
• Kardia/AliveCor: the device syncs with a smartphone to give an ECG reading of your heart function. Using the free app, it can detect atrial fibrillation, which is a precursor to a blood clot that could cause a stroke or thrombosis. Also available as a strap for an Apple watch. Buy either of them here.
• Medvivo: currently primarily a monitoring (and out of hours GP) organisation;
• Pixie pads enable a smartphone to detect a UTI infection in an incontinent person;
• Telehealth Solutions offer telehealth services, including monitoring
• Tunstall : offers range of telehealth solutions, and service