Factors Affecting the Move to an eSystems Approach to Remote Care Delivery

Optimization of care provision, in the future, requires a shift from the current paternal model of dispensing care, to a collaborative model of coaching, supporting and enabling self-care and promoting independence. This will not be appropriate for all people and for all care providers but if resource utility is to be maximized, an approach must be developed that facilitates as much independence and selfdetermination as each person can safely and capably engage in. This requires that care provision be personalized and include broader engagement, such as social and family connections, as part of a person's care network. In order to facilitate a transformation of care providers into care collaborators, communications technology can play a significant enabling role as it has in other eSystems. Ubiquity of such technology across care providers, care receivers and their support networks can underpin new models of care provision. Developing a platform approach for communication and having a menu of interfaces and devices, care services can be personalized such that the technology reflects a person's specific needs. This novel approach to person-centered communication moves away from a "one-size-fits-all" model and can facilitate combinatorial interventions. However, the move to eSystemmediated autonomy in remote care provision is confounded by many factors. This paper will discuss the development of just such a communication platform and more than ten year's experience will be explored in developing combinatorial innovations reflecting personal needs in two care scenarios. Through working with care practitioners and patients the platform has addressed needs in primary, secondary and social care in the UK. The current challenges in scaling the approach will be examined from the point of view of the difficulties in mapping the use of eSystems on to the fragmented nature of current care delivery.