This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Virtual home assessments could reduce the need for in-person visits. New guidelines could help people develop and use the tools they need to carry out these assessments.
Home assessments are for people who struggle to do everyday activities because of disabilities, for example, after having a stroke. These people may require handrails or other adjustments to their home.
Researchers in Sheffield worked with service users and local healthcare professionals (including occupational therapists and social workers) to evaluate the pros and cons of virtual home assessments. The service users and allied health professionals gave feedback on virtual assessments in general, and also on a new video conferencing tool. They provided insights into how the assessments and the tool could be improved.
Virtual home assessments are faster than in-person visits and may allow people to be discharged from hospital more quickly. They also cut down on staff travel time and costs. However, key concerns included the safety of personal information, the availability of devices for service users and professionals, and verification of people’s identity.
The guidelines cover security, privacy and service user choice, among other issues. They are intended to help professionals create services that are practical, effective, and secure.
More information on home assessments is available on the NHS website.
The issue: home assessments are time consuming and expensive
Home assessments can take up to 4 hours and cost roughly £208 per visit. Conducting virtual home assessments could cut down on both time and cost.
Video consultations minimise face-to-face contact (important during the pandemic), and remove the need for travel. Remote consultations are cheap, short, and can allow relatives to join from elsewhere. They are being used increasingly. However, disadvantages include people being reluctant or unable to use new technology.
Home Quick is a new virtual home assessment tool for video consultations. It allows a professional to control a service user’s smartphone and capture real-time notes. Researchers explored allied health professionals’ and service users’ views on the tool, and on virtual home assessments in general.
What’s new?
Researchers explored the pros and cons of the tool at 6 focus groups with service users and relevant professionals. They included occupational therapists, physiotherapists, dieticians, speech and language therapists, as well as workers from local authorities and the voluntary sector.
The focus groups described the many benefits of virtual home assessments. They save time and money. They are faster than in-person visits, which means that people could be discharged from hospital more quickly. Recordings of visits could be shared with other bodies and reduce the need for multiple home visits. Virtual visits are safer for professionals because some homes can be hazardous or unhygienic.
Virtual visits also allow family members and carers to attend assessments from a distance. There is no need to travel, which means the same hospital could support more patients over a wider area.
However, key concerns with virtual assessments were:
- security; service users’ personal information should not be shared without their permission
- the availability of devices and stable Internet; a lack of technology could exclude certain service users (elderly people, for example) and widen health inequalities for those who could not afford the data to join a virtual assessment
- the need for professional training to use the tool and a lack of private consultation rooms for online assessments
- the impossibility of conducting some assessments remotely, such as checking for bad smells that indicate hygiene problems, or measuring room size and height to plan adjustments to someone’s home
- verification of whether the correct patient is being assessed in the correct property.
Why is this important?
Based on insights from the focus groups, a literature review, and real-life case studies of virtual home assessments, the researchers developed guidelines for virtual home assessment tools.
- Visible security: service users should have easy access to security information (such as who can view the recording) and be able to opt how long their data, including the recording, can be stored. Professionals should be reminded of security protocols within an app or programme.
- Accessible help features should be provided in multiple formats (such as voice and touch activation).
- Service user choice: people should be helped to decide for themselves if they want virtual home assessments (except when an in-person visit is essential).
- Privacy: photos and videos taken during the assessment must be saved securely.
- Professional environment: professionals should carry out assessments in private, formal settings with minimal background noise, and ensure the microphone and camera work before starting the assessment.
- Support multiple users: assessment tools should accommodate multiple users so that family or carers can join calls (with the service user's permission).
- Identity and location checks should be carried out, such as location tracking or patients showing identification on screen.
What’s next?
These guidelines are intended to help developers and other allied health professionals create virtual home assessment tools that are practical, effective, and secure. They comply with existing health technology guidelines, such as NHS Digital Design Principles and the Topol review.
Virtual home assessments will never totally replace home visits. For example, where a close inspection of housing conditions is required to assess the person and their environment in context, in-person visits will still be needed. In addition, some service users may lack access to technology and internet or prefer face-to-face contact. There will be an ongoing need for in-person visits to avoid widening health inequalities. However, virtual home assessments could replace some in-person visits, avoiding unnecessary travel and the associated time and cost.
Future research could investigate whether home assessment tools need to be adapted for people with specific needs, such as blindness. In addition, whether video conferencing could be used for specific assessments, such as memory tests or examining issues with people’s wheelchairs.
The focus groups were carried out in Sheffield, so future studies could investigate whether the findings are relevant in other cultural and geographical areas.
You may be interested to read
This Alert is based on: Lanfranchi V, Jones, N, Read, J, and others. User attitudes towards virtual home assessment technologies. Journal of Medical Engineering and Technology 2022;46:536–546.
An article summarising some of the preliminary studies that lead to this research.
A researcher blog about creating a human connection with service users via telehealth services.
A video demonstration of how virtual home assessment tools could be used.
NIHR Evidence Alert: Hospital at home is a good option for many older people
Funding: This study was supported by the NIHR Devices for Dignity MedTech Co-operative.
Conflicts of Interest: The authors declared no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
