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ISfT 2000 – MontrealISfT 2000 – Montreal
Healthcare Delivery Healthcare Delivery in the year 2050in the year 2050
Dr Ricky J Richardson Dr Ricky J Richardson BSc MBBSBSc MBBS MRCP(UK) FRCP FRCPCH DCH DTM&HMRCP(UK) FRCP FRCPCH DCH DTM&H
Chairman - UK Telemedicine AssociationChairman - UK Telemedicine AssociationChairman - European Commission’s - Thematic WorkingChairman - European Commission’s - Thematic Working
Group onGroup on e-health & Telemedicine - EHTELe-health & Telemedicine - EHTEL
Chairman and CEO - Richardson Consulting UK Limited Chairman and CEO - Richardson Consulting UK Limited Consultant Physician - Great Ormond Street Hospital forConsultant Physician - Great Ormond Street Hospital for
ChildrenChildren
Who will be the Who will be the primary care primary care
physician of the physician of the future?future?
The Patient !The Patient !
What is What is TeleHealth?TeleHealth?
The ATM of The ATM of HealthcareHealthcare
Traditional Healthcare Delivery Traditional Healthcare Delivery ModelModel
The Patient Community - Bottom of the pile!!
PhysicalMovementofPatients
3° HealthCare
2° HealthCare
1° HealthCare
Teaching Hospitals
Regional Hospitals
District General Hospitals
General Practitioners
Unchanged for 6000 years - circa 3000 BC!
The Paradigm ShiftThe Paradigm ShiftThe Seven Drivers Forcing ChangeThe Seven Drivers Forcing Change
• Obligatory search for cost containmentObligatory search for cost containment
• Changing demographicsChanging demographics
• Peripheralisation of health care deliveryPeripheralisation of health care delivery
• Changing disease patternsChanging disease patterns
• Impact of information technology including IT Impact of information technology including IT support for clinical decisions and support for clinical decisions and TelemedicineTelemedicine
• More informed and expectant patients More informed and expectant patients C-HealthC-Health
• The well-being factor –The well-being factor – responsibility shift into responsibility shift into patients hands - patients hands - The Wellness ParadigmThe Wellness Paradigm
The Economic IssuesThe Economic Issues
Cost Cost ToleranceTolerance
Day Care SurgeryDay Care SurgeryAmbulatory Diagnostic Ambulatory Diagnostic ClinicsClinicsPrimary/Preventative CarePrimary/Preventative CareThe well-being factor The well-being factor
TeleHealthTeleHealthPartnerships betweenPartnerships betweenPublic & Private SectorsPublic & Private Sectors
Change in HealthcareChange in HealthcareDelivery MechanismsDelivery Mechanisms
19501950 2000200019901990
DollarsDollars
20102010
The well-being factor
PRIMARYPRIMARY TELERADIOLOGYTELERADIOLOGY
AND TELEPATHOLOGYAND TELEPATHOLOGY E-Health &E-Health &TELEMEDICINETELEMEDICINE
Clusters of Clusters of Specialists withSpecialists withGlobal AccessGlobal Access
Allied HealthCare ProfessionalsPrimary HealthCare
The ‘Super’ Primary Care Physician
CommunityHospitals(Acute)
CommunityHospitals
(Non-acute)
Freestanding Diagnostic Centres
HomeHomeCareCare
HealthKiosks
DayCareSurgery
Maternity
AcuteTrauma
The Paradigm ShiftThe Paradigm Shift
??
Direct Access to specialistsDirect Access to specialistsWWWWWW IDTVIDTV IDTVIDTV WWWWWW
The Informed Wired upInformed Wired up Citizen Community
C-HealthC-Health
The Paradigm ShiftThe Paradigm ShiftThe ImpactThe Impact
•• Healthcare practices - Healthcare practices - changing roleschanging roles•• Healthcare trainingHealthcare training•• Financial Financial remuneration/rewardsremuneration/rewards•• Healthcare vocationHealthcare vocationWILL WE NEED DOCTORS AT ALL INWILL WE NEED DOCTORS AT ALL IN
PRIMARY CARE IN THE YEAR 2050 ?PRIMARY CARE IN THE YEAR 2050 ?
•• The Informed Patient (s)The Informed Patient (s) •• Family and friendsFamily and friends•• PharmacistsPharmacists•• Medical Auxiliaries / Medical Auxiliaries /
Community NursesCommunity Nurses•• A “Super” Primary A “Super” Primary
Care Physician?Care Physician?
Will the family doctor become Will the family doctor become ““The Wellness Guardian-Caretaker”?The Wellness Guardian-Caretaker”?
The Paradigm ShiftThe Paradigm ShiftWho will be the Who will be the PrimaryPrimary Care Care
Team of the Future?Team of the Future?
The Impact of Globalisation The Impact of Globalisation on Healthcare deliveryon Healthcare delivery
•• Healthcare Services move into the Retail Healthcare Services move into the Retail Environment (Shopping Mall medicine)Environment (Shopping Mall medicine)
• • C-health: - Health-on-line WebsitesC-health: - Health-on-line Websites• • District General and Regional Hospitals District General and Regional Hospitals
become become obsoleteobsolete as a concept as a concept • • Emergence of Emergence of EpicentersEpicenters of of
Medical ExcellenceMedical Excellence
The Impact of Globalisation The Impact of Globalisation on Healthcare deliveryon Healthcare delivery
Patients in the locality
Old MarketsOld Markets New MarketsNew MarketsThe Global Patient CommunityShipping Mercantile Cruise ships (SeaMed)Airline IndustryHotel ResortsMultinational Corporations (Shell /Amoco etc)The MilitarySpace Travellers
Airline Industry Operational ModelAirline Industry Operational Model
Telemedicine EquipmentTelemedicine Equipment
A&E DepartmentA&E Department Call-CentreCall-CentreCommunicationsCommunications
Data
Global NetworkGlobal Networkof participating of participating
hospitalshospitals Co-ordination Co-ordination of Serviceof Service
The Patient/Consumer The Patient/Consumer Health InformationHealth Information
Your own LifestyleYour own Lifestyle Your GeneticsYour Genetics
Human Genome ProjectHuman Genome ProjectChoosing DeathstyleChoosing Deathstyle
Health Cure & CareHealth Cure & Care
Information On:-• Hygiene• Nutrition• Addictions• Fitness
• Your Electronic Health Record - EHR• Conditions & Concerns• Quality of HC• Diseases & Treatment
More Money is spent in the USA on complimentary More Money is spent in the USA on complimentary medicine than “western” medicinemedicine than “western” medicine
Health on the NetHealth on the Net More time spent online More time spent online
on Healthcare than Pornography!on Healthcare than Pornography!June 1999June 199926,00026,000 health related websites available health related websites available33m 33m US citizens used the US citizens used the net for health advice in ‘98net for health advice in ‘9827%27% of female users & of female users & 15%15% of males look at of males look at medical information at medical information at least once per week least once per week (Source BMJ 13/11/99)(Source BMJ 13/11/99)Primary Hits (August 1999)Primary Hits (August 1999)
drkoop.com (No. 76) - drkoop.com (No. 76) - 3,474,0003,474,000
0
100
200
300
400
500
600
1994 1996 1998 2000 2002 2004 2006
On
Lin
e p
op
ula
tion,
mill
ions
Advanced Communications EngineeringAdvanced Communications Engineering
How many people on-line?How many people on-line?
The The data data wave wave goes goes mobilemobile
Advanced Communications EngineeringAdvanced Communications Engineering
• • Interactive Video Conferencing - 1980Interactive Video Conferencing - 1980
• • Tele-Radiology, USA - 1990Tele-Radiology, USA - 1990
• • International Telemedicine - 1994International Telemedicine - 1994
• • The Telemedicine Blueprint, Malaysia - The Telemedicine Blueprint, Malaysia - 19971997
• • Telemedicine “Comes of Age” - 1998 -Telemedicine “Comes of Age” - 1998 - TeleHealth ? e-Health Citizen-TeleHealth ? e-Health Citizen-
Health?Health?
• • Telemedicine becomes “Medicine” - 1999Telemedicine becomes “Medicine” - 1999
TelemedicineTelemedicineThe story so farThe story so far
• • Hospitals become a thing of the past - 2006?Hospitals become a thing of the past - 2006?
TelemedicineTelemedicineThe story so farThe story so far
Integration of ITIntegration of ITinto Business Sectorsinto Business Sectors
Inte
gra
tion
of
ITIn
teg
rati
on
of
IT
IT as a gadget Trojan horse: networks, … Full Integration of IT into Business (Organisational, Legal) Re-engineering of the system
19801980 19901990 20002000 Jean-Claude HealyJean-Claude HealyMay 2000May 2000
(Banks) (Health…)ManufacturingManufacturingBusiness ServicesBusiness Services Public ServicesPublic Services
Technology driven DisappointmentHealthcare Professionals: HELP!!!!! Accept theSit on the fence “I told you so !” inevitable and or Resist want control control
GlobalisationGlobalisationHealthcare Economists Healthcare Economists Patient PowerPatient PowerThe Medical ProfessionThe Medical ProfessionThe World Wide WebThe World Wide WebNew TechnologiesNew Technologiese.g. Mobile Videophonese.g. Mobile Videophones
19801980 19911991 October 2000October 2000
ICT Solutions inICT Solutions in Healthcare delivery Healthcare delivery
The Telemedicine MarketThe Telemedicine Market (1)(1)
USAUSA
1997 - $643 Million 1997 - $643 Million
2002 - $3000 Million2002 - $3000 Million
EuropeEurope
Euro 50 Million Euro 50 Million
Euro 542 MillionEuro 542 Million
The Telemedicine Market The Telemedicine Market (2)(2)
What about the rest of the world?What about the rest of the world?
Four Flagship ApplicationsFour Flagship Applications
• • Tele-ConsultationTele-Consultation
• • Tele-ContinuingTele-Continuing Medical Medical Education for Health Education for Health Professionals Professionals
• • Mass Customised Mass Customised Personalised Information Personalised Information and Education and Education
• • Lifetime Health PlanLifetime Health Plan
Concurrent implementationConcurrent implementation leads to reform leads to reform
The Telemedicine BlueprintThe Telemedicine BlueprintMalaysiaMalaysia
Centum City Telemedicine ProjectCentum City Telemedicine Project
Centum City Telemedicine Centum City Telemedicine ProjectProject
Land based PopulationLand based Population• Pusan City ResidentsPusan City Residents• North Korea with MinistryNorth Korea with Ministry• of Healthof Health• Centum City PopulationCentum City Population
•ResidentsResidents•Daily WorkersDaily Workers•Visitors/TouristsVisitors/Tourists
•Korean nationalsKorean nationals•International Patients - Medical TourismInternational Patients - Medical Tourism
Centum City Telemedicine Centum City Telemedicine ProjectProject
Mobile PopulationMobile Population
•Mercantile ShippingMercantile Shipping•Ship ownersShip owners•Seamans UnionsSeamans Unions
•Cruise LinesCruise Lines - Star Cruises- Star Cruises
•Airlines Airlines - Korean Air- Korean Air
Centum City Telemedicine Centum City Telemedicine ProjectProject
Medical TourismMedical Tourism
• 2 hours by air for 2 billion people2 hours by air for 2 billion people• 1% with disposable income = 20 million1% with disposable income = 20 million
•Cardiac - Cancer - Mental HealthCardiac - Cancer - Mental Health•Costs can be competitiveCosts can be competitive•Popular Tourist Resort for familiesPopular Tourist Resort for families
Centum City Telemedicine ProjectCentum City Telemedicine ProjectMedical TourismMedical Tourism
USAUSA
EUROPEEUROPE
AUSTRALIAAUSTRALIA
(For24hrmedical coverage)
Telemedicine links
The SpokesThe Spokes
The New TechnologiesThe New TechnologiesVideophonesVideophones
HospitalMinor Injury UnitMinor Injury Unit
X-Ray Camera BedUltrasound
Scanner
Camcorder
Videophone
Videophone
Group Conference System
Motion Media TechnologiesMotion Media Technologies
ISDN/InterNet
Eyesite 300 Home Care systemEyesite 300 Home Care system4 remote cameras/devices
Remote care & monitoring of patients - hospitals - Remote care & monitoring of patients - hospitals - homes- anywherehomes- anywhere
In emergencies.. it can be triggered by a panic call In emergencies.. it can be triggered by a panic call button button
CarerCarer
HomeHome
Motion Media TechnologiesMotion Media Technologies
Comms
CommunicationsCommunicationsSystem OverviewSystem Overview
Thematic Working Group 2Thematic Working Group 2EHTELEHTEL
• • To make medical servicesTo make medical services - wheresoever- wheresoever sourcedsourced - ubiquitously available across Europe- ubiquitously available across Europe
• • To promote e-health & Telemedicine across To promote e-health & Telemedicine across Europe at all levelsEurope at all levels
• • To identify To identify barriersbarriers to to e-health & Telemedicine e-health & Telemedicine and use all means to and use all means to overcome them overcome them
• • To identify and promote To identify and promote technologies & solutions technologies & solutions to achieve this aimto achieve this aim
Healthcare DeliveryHealthcare Deliveryin the new Millenniumin the new Millennium
Where are we going?Where are we going?• • The Multi-media Electronic Health RecordThe Multi-media Electronic Health Record• • Total Hospital Information SystemsTotal Hospital Information Systems • • HomeCare Monitoring for the HomeCare Monitoring for the
elderly/post inpatient careelderly/post inpatient care• • Medical services move into the Medical services move into the
Retail EnvironmentRetail Environment• • A more holistic approach to A more holistic approach to
healthcare deliveryhealthcare delivery -- Traditional Medicine}Traditional Medicine}- Preventive Medicine} At Primary care level- Preventive Medicine} At Primary care level- Self Treating Patients} - Self Treating Patients} “The Wellness “The Wellness
Guardian”Guardian”- Curative Medicine}- Curative Medicine}
Future environmentFuture environmente-COMMERCEe-COMMERCE
C-HEALTHC-HEALTH
ISDN CABLE
LAN-WAN WIRELESS NETWORKS
Health ContactHealth Contact CENTRECENTRE
e.g.NHS DIRECTe.g.NHS DIRECT
Drivers of changeDrivers of change
MEDICAL DEVICES & VITAL SIGNSMONITORING
FIXED &MOBILE VIDEO
PRODUCTS
ELECTRONIC HEALTHRECORD
TeleHealthTeleHealthRemaining IssuesRemaining Issues
• • Universal languageUniversal language
• • International - intergalactic? – International - intergalactic? –
medical licensingmedical licensing
• • Medico-legal liabilityMedico-legal liability
• • Litigation: changing attitudesLitigation: changing attitudes
• • International (cross border) remunerationInternational (cross border) remuneration
• • The speed of change in the IT worldThe speed of change in the IT world
• • How will we train the physicians for How will we train the physicians for
tomorrow’s world????????tomorrow’s world????????
The Developing WorldThe Developing World
South AfricaSouth Africa 2000 New cases HIV 2000 New cases HIV Every dayEvery day
34 million cases infected34 million cases infected 1 million are children1 million are children
11 million have died11 million have died 5,500 funerals a day (7 x 747s)5,500 funerals a day (7 x 747s)
Zanzibar Zanzibar Hospitals with no telephone, Hospitals with no telephone, no sheets, no medicinesno sheets, no medicines
HOW CAN WE PLAY OUR PART?HOW CAN WE PLAY OUR PART?
The Developing World The Developing World Can leap-frog the traditional evolutionary processCan leap-frog the traditional evolutionary process
ChinaChina - - The Golden Health ProjectThe Golden Health ProjectMalaysiaMalaysia -- The Telemedicine Blue PrintThe Telemedicine Blue PrintAfricaAfrica -- ? Take some responsibility ?? Take some responsibility ?
3000 BC 2000 AD Time
The Community
PhysicalMovement
ofPatients
3° HealthCare
2° HealthCare
1° HealthCare
The Informed Community
Clusters ofClusters ofSpecialistsSpecialists
?
Allied HealthCare Professionals1° HealthCare
The ‘Super’ Primary Care Physician
CottageHospitals
(Acute)
CommunityHospitals(Non-acute)
HomeCare
HealthKiosks
day-careSurgery
FreestandingDiagnostic
Centres
MaternityAcute
Trauma
Telemedicine
PrimaryTeleRadiology
and TelePathology
11 22 33 44 55 66 77 88
Healthcare Delivery TrendsHealthcare Delivery Trends
Global NetworkedHealthcare
Consumer pressuresConsumer pressures
Information Information technologytechnology
Delivery Delivery mechanismsmechanisms
TeleHealthTeleHealthThe Major ConsequencesThe Major Consequences
• • Improvement of skills at primary care levelImprovement of skills at primary care level
• • what do we do with new skills?what do we do with new skills?
• • KEEP CARE LOCALKEEP CARE LOCAL
• • The InterNet becomes the platformThe InterNet becomes the platform
•• multi-media health records - by emailmulti-media health records - by email
• • Constant Physiological Constant Physiological
Monitoring – HomecareMonitoring – Homecare
• • Access to global Epi-centres of Access to global Epi-centres of
medical expertisemedical expertise
Technology and Skill Technology and Skill TransferTransfer
Passively – Use of a global telemedicine Passively – Use of a global telemedicine networknetwork
Pro-actively – Global CME programmePro-actively – Global CME programme
Mass Public Health InformationMass Public Health Information
Health on-line WebsitesHealth on-line Websites
The Watershed Generation GapThe Watershed Generation Gap
HUMAN NEURO-PHYSIOLOGY IS CHANGINGHUMAN NEURO-PHYSIOLOGY IS CHANGING
USUS
The seekersThe seekers
and findersand finders
OUR CHILDRENOUR CHILDREN
The filterersThe filterers
and applyersand applyers