April 18, 2007Med-e-Tel 2007, Luxembourg ETSI Workshop 1 Making Telecare Services Trusted, Usable and Accessible: ETSI’s User Experience Design Guidelines for Telecare Services Bruno von Niman ETSI STF 299 Leader ETSI TC Human Factors Vice Chairman vonniman consulting and ITS (Sweden)

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 2 What is ETSI?  A European standards organization  Officially recognized by the EU & EFTA  Setting globally-applicable standards for  Telecommunications, in general  Radio communications, especially mobile  Broadcasting, and  Other, related topics  Active in all areas of ICT  An independent, a non-profit organization, created in 1988  Offering direct participation of all members  More than 15,000 publications→ available for free!

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 3 ETSI The home of the GSM™ standards… … and of a lot of others, e.g. ISDN, DECT, DAB, DVB …

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 4 ETSI … …and a founding Partner in The 3rd Generation Partnership Project

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 5 Why standards?

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 6 Standardization is  Load sharing  Cost saving  Interoperability  Close co-operation of competitors  Reduction of solutions to a minimum: preferably → one!  Creation of a critical mass  Bringing about economy of scale  A fight against technical barriers to trade  Enabling development and use of common infrastructures

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 7 TC EE Environmental Engineering TC ERM EMC and Radio Spectrum Matters Status: TC HF Human Factors JTC Broadcast EBU/CENELEC/ETSI ECMATC32 Standardizing information & communication systems TC TISPAN Telecoms & Internet converged Services & Protocols for Advanced Networks TC SES Satellite Earth Stations & Systems TC MTS Methods for Testing & Specification TC ESI Electronic Signatures & Infrastructures TC TETRA Terrestrial Trunked RADIO TC DECT Digital Enhanced Cordless Telecommunication Technical Committees TC SCP Smart Card Platform TC AT Access and Terminals TC MSG Mobile Standards Group TC RT Railway Telecommunications TC TM Transmission and Multiplexing TC LI Lawful Interception TC PLT PowerLine Telecommunications TC Safety Telecommunications Equipment Safety TC STQ Speech processing Transmission & Quality TC BRAN Broadband Radio Access Networks ETSI Project eHealth (new!)

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 8 ETSI activities in e-Health  TC Human Factors:  Active in eHealth since 2003  Focus onTelecare  Technical Report (prestudy) TR : User aspects  ETSI Guide (under development) DEG : User experience guidelines  ETSI Project eHealth  Activities since 2006  Wider, ICT focus (ETSI Special Report SR published)  Following the recommendations of the eHealth Starter Group  ETSI Project (EP) established first meeting held on April 12, 2007  Welcome to join and shape future standards! For more information, please contact: Gaby Lenhart ETSI eHealth Project Officer

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 9 Standards- starting with the user experience!

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 10 ETSI TC Human Factors  Responsible for human factors  in all areas of telecommunications and ICT  Responsibility to ensure ETSI takes account of the needs of all users  generic, older, young, disabled, etc.  Produces standards, guidelines and Technical reports  that set the criteria necessary to ensure the best possible user experience  Chairman: Stephen Furner (BT, UK)  Vice Chairmen: Bruno von Niman (ITS, Sweden) Lutz Groh (Siemens AG, Germany)

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 11 Human factors- a wide and complex area  Human factors of eHealth/ telecare involves:  human confidence and decision making;  user education;  device setup, configuration, calibration and maintenance;  data collection, transmission and communication with diagnostic systems and carers;  user procedures;  cultural issues (e.g. use of language and illustrations);  the organization of the care provisioning process;  accessibility issues;  usability aspects relating to the specifics of mobile environments;  Telecare services are used by young and older people, impaired, disabled or temporarily ill people  should therefore be designed, deployed and maintained thereafter!

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 12 Demography changes  Western societies are aging  40% of the European population foreseen to be 65+ in 2051  Public health care spending is on the increase- OECD figures as % of GDP:  1970: 5 %  1990: 7%  2004: 8 %  already exceeds 10 % in Germany, Sweden, Switzerland and the USA  OECD recommends actions including:  the introduction of automated health ‑ data systems;  strategies making use of new technologies; and  improved quality of care through better information.  Better health care services are required on a global level  Costs and expenses not allowed to continuously increase  without a collapse of the system in the aging Western world)

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 13 Health & Social care models and costs Year Ratio Persons Aged to UK Long Term Healthcare Cost (£B) Support Ratio 1 UK Long Term Healthcare Cost 2 1.Office for National Statistics, Royal Commission Report into Long Term Care, 1999.

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 14 The “Usability Gap”  “Featurism” - product complexity increasing  Range of ICT users broadening – children, older, disabled people

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 15 e-Health and Telecare services Thanks to the smarter home, home help is required only twice a year… to adjust the clock!

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 16 Telecare is…  ICT-enabled delivery of health and social care services to individuals within the home or a wider area, involving  clients, carers and coordination agents.  A Business-to-Consumer (B2C) service model, including:  information and communication services;  safety and security monitoring;  personal monitoring;  electronic assistive technologies.  NOT telemedicine, a service offered to and used by healthcare professionals!  a Business- to-Business (B2B) service model

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 17 A historical perspective (pre-e-Infrastructures)  Medical care until the mid ‑ 1900s  provided by trained physicians in the client's home;  family and neighbours acting as nursing and supportive staff  This healthcare model has changed dramatically  Medical care is now care unit ‑ centric, requiring advanced equipment;  A GP or MD's visit to the client's home has become an unusual service.  Telemedicine was introduced in the 1960s  as isolated, stand alone efforts to overcome distances  Social care services supported by ICT since the 1990s  Through call centre services, home equipment for social alarms, etc.  Enabled by the underlying technology and availability of services.  The more widespread deployment of telecare was held back by the:  lack of reliable telecommunication networks and devices;  unavailability of hardware and software at reasonable costs;  lack of on ‑ line connectivity;  relatively stable demographics and lack of political support;  lack of client trust, acceptability and client expectations and habits;  resistance from healthcare professionals social patterns take generations to change

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 18 A historical perspective: e-Infrastructures as enablers  Users were not ready yet, nor were the prerequisites  technology, society, technical infrastructure, practitioners, procedures, budgets, etc  The proliferation of fixed and mobile broadband services (in and outside the home) is opening up opportunities for convenient and reliable delivery of telecare services  Thereby- the demand for end user (client) centric human factors guidelines  addressing design, development, deployment, use and maintenance of telecare services is on the increase  At present, demographic changes, limited resources, high user expectations, globalization and technology are  transforming medical and social care systems in many countries

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 19 Rationale for our work Telecare must move from the research labs to the real world; technology is there; still need to consider:  Intuitive and simple user interfaces  Reliability  Security and privacy issues  Interoperability  Business models A user centred approach is a pre-requisite to a successful uptake!

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 20 ETSI TR STF 264 “Telecare- user aspects”  Contribute to meeting the demand for care services enabled by narrow- and broadband, fixed and mobile technologies  Support EC policy framework  give vulnerable customers greater access to an independent life within the wider community; and  reduce the need for institutional care.  Not exclusively services for older community members  young people who need care at home,  permanent heart monitor wearers,  pregnant women, etc.  Identifies key issues, potential solutions, and provide recommendations for actions be taken in this area  Facilitate the development of European and international standards

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 21 ETSI Draft EG (STF299): “User experience guidelines for telecare services”  New, follow-up work started in February 2006  Funded by EC, EFTA and ETSI  ITS/vonniman consulting, BT, Telenor, AENOR/E.T.S.I./DIA/UNED  Will develop an ETSI Guide EG, ready in September 2007  addressing a subset of previously mentioned issues  providing guidelines for development and deployment Published and freely available in December 2007 (matter of ETSI member’s approval)  Portal, Reference Group end Newsletter 

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 22 Life-cycles and stakeholders  Life-cycles phases:  Research, Design and Development  Service provisioning  Stakeholders:  Users: Clients, carers (professional and informal)  Care service providers  Buyers and procurers  Developers  Communication access providers  etc

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 23 Guideline themes  Trust – trust is only established when the user believes issues relating to the security of information have been dealt with appropriately, and that the system can deliver what is expected of it.  User interaction - Interfaces should be designed with the needs of all end users in mind, requiring high degrees of flexibility and a sound knowledge of the end users abilities and preferences.  Service aspects – this theme is mainly concerned with the internal workings of the system developers and service providers, ensuring that any issues which might arise here are dealt with appropriately so that the service can be delivered.

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 24 Approach and structure  Trust 1.Privacy and confidentiality; 2.Ethics; 3.Legal aspects; 4.Availability and reliability; 5.Integrity; 6.Safety.  User interaction 1.Usability and accessibility; 2.Localization, customization and personalization; 3.User education.  Service aspects 1.Organisational aspects; 2.Servicing and maintenance; 3.Interoperability and roaming; 4.Development process and testing.

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 25 Guidelines across the innovation continuum and service lifecycle

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 26 Join us at near-future events  Med-e-Tel 2007 Workshop in Luxembourg (April 18, 2007,  DRT4ALL 2007 Workshop in Madrid, Spain (April 20, 2007,  HCI International 2007 Presentation and Poster (July , Beijing, China,  Electronic working- review of drafts  etc

April 18, 2007 Med-e-Tel 2007, Luxembourg ETSI Workshop 27 Future human factors issues to address  The need for an over-arching Telecare standard?  Acceptability of telecare services  Non-intrusiveness  Interoperability and portability between service providers  Consistency of user interfaces between services  Accessibility issues in more detail  embrace the design-for-all approach  Complementary assistive technologies  User understanding and confidence in systems  would a standards based approach help to eliminate misunderstanding?  Interoperability with other ICT devices and services  adaptability between solutions for different chronic diseases;  integrity of solutions within complex RF environments.  Addressing the needs of all user groups:  older people, children, others as clients;  carers needs across the age spectrum;  coordinators needs.  Guidelines for usability testing  etc

April 18, 2007Med-e-Tel 2007, Luxembourg ETSI Workshop 28 Thank you! Your input and comments are WELCOME! For more information and the latest Draft ETSI Guide, see: To work with us: (STF Leader)