Table 3 The ‘ARCHIE’ framework of quality principles for designing, installing and supporting telehealth and telecare products and services

Spend time with the individual to find out what activities and functions are personally meaningful and important to them. These are often socio-culturally framed (for example,. relating to historical accounts of their lives, family or community roles, and cultural or religious practices). ‘What matters to the person’ should be shared and understood by all involved in supporting him or her. Advocacy may be needed to represent the client and ensure their needs and goals remain central.

The idea that assistive technologies can cure degenerative disease or fully compensate for its effects is a modernist myth. With few exceptions, multi-morbidity steadily and inexorably compromises key aspects of functioning. Non-specific impairments (for example, chronic tiredness, loss of motivation, dulling of cognitive capacity) may interfere with a person’s ability and motivation to use a technology that has been designed to alleviate specific physical, mental or emotional impairments. Effective solutions take both the materiality and affordances (of technology) and the capability (of the user) into account.

Personalisation of solutions should be seen as a continual process that never ends, rather than as part of a standardised, one-off assessment. Formal and informal care networks require capacity to track and review the solution while in use, recognising that further customisation and innovation are likely. Creativity is needed to deal with diverse and abnormal situations, including ‘outside the box’ thinking and practical reasoning, rather than sticking rigidly to standard protocols and procedures.

Frequent inter-personal interactions with users and their carers (as informal as possible) will build their familiarity with the service and promote trust, a sense of being cared for and confidence to take the initiative if problems arise. Such interactions will also develop providers’ knowledge about key contextual factors that may have a bearing on delivery of effective and dependable support. Technology needs to be aligned with both formal and informal social support that can bridge the design-reality gap in ways that are sometimes very subtle. It is important to consider the available human resources within the intended user’s care network, and how members of this network might connect with the technology and service to support use and customisation.

Everyone involved (both lay and professional) must be clear about the patient’s or client’s changing needs and capabilities and about the technical and social supports in place. They must also have an ongoing sense of what the other collaborators are doing to provide a context for their own activity towards the common goal of supporting the person to achieve what matters to them. To that end, it is crucial to mobilise the different knowledge and expertise within the network – both formal (shared, for example, through systematic entry and exchange of data on records) and informal (shared, for example, through storytelling, inter-disciplinary case-based discussion and informal interactions).

Few telehealth and telecare programmes to date have maximised the potential to learn and improve. Technology designers and services need to monitor use and experience of technology solutions, workarounds developed for them and the repurposing of the technology and service, to inform ongoing innovation and improvements for both individual clients and the wider system.