ISfT 2000 – Montreal
Healthcare Delivery
in the year 2050
Dr Ricky J Richardson BSc MBBS
MRCP(UK) FRCP FRCPCH DCH DTM&H
Chairman - UK Telemedicine Association
Chairman - European Commission’s - Thematic Working
Group on
e-health & Telemedicine - EHTEL
Chairman and CEO - Richardson Consulting UK Limited
Consultant Physician - Great Ormond Street Hospital for
Children
Who will be the
primary care
physician of the
future?
The Patient !
What is
TeleHealth?
The ATM of
Healthcare
Traditional Healthcare Delivery Model
Teaching Hospitals
3°
HealthCare
Regional Hospitals
2°
HealthCare
District General
Hospitals
1°
HealthCare
General
Practitioners
The Patient Community - Bottom of the pile!!
Unchanged for 6000 years - circa 3000 BC!
The Paradigm Shift
The Seven Drivers Forcing Change
•
•
•
•
•
Obligatory search for cost containment
Changing demographics
Peripheralisation of health care delivery
Changing disease patterns
Impact of information technology including IT
support for clinical decisions and Telemedicine
• More informed and expectant patients C-Health
• The well-being factor – responsibility shift into
patients hands - The Wellness Paradigm
The Economic Issues
Day Care Surgery
Ambulatory Diagnostic
Clinics
Primary/Preventative Care
The well-being factor
Dollars
TeleHealth
Partnerships between
Public & Private Sectors
Cost
Tolerance
Change in Healthcare
Delivery Mechanisms
1950
1990
2000
2010
The Paradigm Shift
The Informed Wired up Citizen Community
The well-being factor
C-Health
WWW IDTV Direct Access to specialists IDTV WWW
Freestanding Home Health DayCare CommunityCommunity Acute Mater
Diagnostic Care Kiosks Surgery Hospitals Hospitals Trauma nity
(Non-acute) (Acute)
Centres
Allied HealthCare Professionals
Primary HealthCare
The ‘Super’ Primary Care Physician
PRIMARY
TELERADIOLOGY
E-Health &
AND TELEPATHOLOGY
TELEMEDICINE
?
Clusters of
Specialists with
Global Access
?
The Paradigm Shift
The Impact
Healthcare practices - changing
roles
• Healthcare training
• Financial remuneration/rewards
• Healthcare vocation
•
WILL WE NEED DOCTORS AT ALL IN
PRIMARY CARE IN THE YEAR 2050 ?
The Paradigm Shift
Who will be the Primary Care Team
of the Future?
•
•
•
•
•
The Informed Patient (s)
Family and friends
Pharmacists
Medical Auxiliaries /
Community Nurses
A “Super” Primary
Care Physician?
Will the family doctor become
“The Wellness Guardian-Caretaker”?
The Impact of Globalisation
on Healthcare delivery
•
•
•
•
Healthcare Services move into the Retail
Environment (Shopping Mall medicine)
C-health: - Health-on-line Websites
District General and Regional Hospitals
become obsolete as a concept
Emergence of Epicenters of
Medical Excellence
The Impact of Globalisation
on Healthcare delivery
Old Markets
Patients in the
locality
New Markets
The Global Patient
Community
Shipping
Mercantile
Cruise ships (SeaMed)
Airline Industry
Hotel Resorts
Multinational Corporations
(Shell /Amoco etc)
The Military
Space Travellers
Airline Industry Operational Model
Telemedicine Equipment
Global Network
of participating
hospitals
Co-ordination
of Service
Data
A&E Department
Communications
Call-Centre
The Patient/Consumer
Health Information
Your own Lifestyle
Your Genetics
Health Cure & Care
Human Genome Project
Choosing Deathstyle
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
medicine than “western” medicine
Health on the Net
More time spent online
on Healthcare than Pornography!
June 1999
26,000 health related websites available
33m US citizens used the
net for health advice in ‘98
27% of female users &
15% of males look at
medical information at
least once per week
(Source BMJ 13/11/99)
Primary Hits (August 1999)
drkoop.com (No. 76) 3,474,000
Advanced Communications Engineering
On Line population, millions
How many people on-line?
600
500
400
300
200
100
0
1994
1996
1998
2000
2002
2004
2006
Advanced Communications Engineering
The data
wave
goes
mobile
Telemedicine
The story so far
•
Interactive Video Conferencing - 1980
•
Tele-Radiology, USA - 1990
•
International Telemedicine - 1994
•
The Telemedicine Blueprint, Malaysia - 1997
•
Telemedicine “Comes of Age” - 1998 TeleHealth ? e-Health Citizen-Health?
•
Telemedicine becomes “Medicine” - 1999
Telemedicine
The story so far
•
Hospitals become a thing of the past - 2006?
Integration of IT
Integration of IT
into Business Sectors
Business Services Public Services
Manufacturing
(Banks)
(Health…)
1990
2000 Jean-Claude Healy
IT as a gadget 1980
Trojan horse: networks, …
May 2000
Full Integration of IT into Business (Organisational,
Legal) Re-engineering of the system
ICT Solutions in
Healthcare delivery
Globalisation
Healthcare Economists
Patient Power
The Medical Profession
The World Wide Web
New Technologies
e.g. Mobile Videophones
1980
1991
October 2000
Technology driven Disappointment
Healthcare Professionals:
HELP!!!!! Accept the
Sit on the fence
“I told you so !” inevitable and
or Resist
want control
The Telemedicine Market
USA
(1)
Europe
1997 - $643 Million
Euro 50 Million
2002 - $3000 Million
Euro 542 Million
The Telemedicine Market
What about the rest of the world?
(2)
The Telemedicine Blueprint
Malaysia
Four Flagship Applications
•
Tele-Consultation
•
Tele-Continuing Medical
Education for Health
Professionals
•
Mass Customised
Personalised Information
and Education
•
Lifetime Health Plan
Concurrent implementation leads to reform
Centum City Telemedicine Project
Centum City Telemedicine Project
Land based Population
• Pusan City Residents
• North Korea with Ministry
• of Health
• Centum City Population
•Residents
•Daily Workers
•Visitors/Tourists
•Korean nationals
•International Patients - Medical Tourism
Centum City Telemedicine Project
Mobile Population
•Mercantile Shipping
•Ship owners
•Seamans Unions
•Cruise Lines
- Star Cruises
•Airlines
- Korean Air
Centum City Telemedicine Project
Medical Tourism
• 2 hours by air for 2 billion people
• 1% with disposable income = 20 million
•Cardiac - Cancer - Mental Health
•Costs can be competitive
•Popular Tourist Resort for families
Centum City Telemedicine Project
Medical Tourism
Telemedicine
links
USA
EUROPE
AUSTRALIA
The Spokes
(For24hrmedical coverage)
The New Technologies
Videophones
X-Ray Camera Bed
Ultrasound
ISDN/InterNet
Scanner
Camcorder
Videophone
Minor Injury Unit
Videophone
Group Conference System
Hospital
Motion Media Technologies
Eyesite 300 Home Care system
4 remote cameras/devices
Carer
Comms
Home
Remote care & monitoring of patients - hospitals homes- anywhere
In emergencies.. it can be triggered by a panic call button
Motion Media Technologies
Communications
System Overview
Thematic Working Group 2
EHTEL
• To make medical services - wheresoever
sourced - ubiquitously available across Europe
• To promote e-health & Telemedicine across
Europe at all levels
• To identify barriers to
e-health & Telemedicine
and use all means to
overcome them
• To identify and promote
technologies & solutions
to achieve this aim
Healthcare Delivery
in the new Millennium
Where are we going?
• The Multi-media Electronic Health Record
• Total Hospital Information Systems
• HomeCare Monitoring for the
elderly/post inpatient care
• Medical services move into the
Retail Environment
• A more holistic approach to
healthcare delivery
- Traditional Medicine}
- Preventive Medicine}
At Primary care level
- Self Treating Patients} “The Wellness Guardian”
- Curative Medicine}
Future environment
ISDN
Drivers of change CABLE
LAN-WAN
WIRELESS
NETWORKS
FIXED &
MOBILE VIDEO
PRODUCTS
e-COMMERCE
C-HEALTH
Health Contact ELECTRONIC
HEALTH
CENTRE
RECORD
e.g.NHS DIRECT
MEDICAL
DEVICES &
VITAL SIGNS
MONITORING
TeleHealth
Remaining Issues
• Universal language
• International - intergalactic? –
•
•
•
•
•
medical licensing
Medico-legal liability
Litigation: changing attitudes
International (cross border) remuneration
The speed of change in the IT world
How will we train the physicians for
tomorrow’s world????????
The Developing World
South Africa
2000 New cases HIV Every day
34 million cases infected
1 million are children
11 million have died
5,500 funerals a day (7 x 747s)
Zanzibar
Hospitals with no telephone,
no sheets, no medicines
HOW CAN WE PLAY OUR PART?
The Developing World
Can leap-frog the traditional evolutionary process
The Informed Community
3°
HealthCare
2°
HealthCare
1°
HealthCare
Physical
Movement
of
Patients
The Community
1 2 3 4
Freestanding
Diagnostic
Centres
Home
Care
Health day-care
Kiosks Surgery
Community
Hospitals
Cottage
Hospitals
(Non-acute)
(Acute)
China
Malaysia
Africa
-
6 7 8
Acute
Trauma
Maternity
Allied HealthCare Professionals
1° HealthCare
Primary
The ‘Super’ Primary Care Physician
TeleRadiology
Telemedicine
and
TelePathology Clusters of
?
Specialists
2000 AD
3000 BC
5
Time
The Golden Health Project
The Telemedicine Blue Print
? Take some responsibility ?
Healthcare Delivery Trends
Consumer pressures
Information
technology
Global Networked
Healthcare
Delivery
mechanisms
TeleHealth
The Major Consequences
• Improvement of skills at primary care level
what do we do with new skills?
•
KEEP CARE LOCAL
• The InterNet becomes the platform
•
multi-media health records - by email
• Constant Physiological
Monitoring – Homecare
• Access to global Epi-centres of
medical expertise
•
Technology and Skill Transfer
– Use of a global telemedicine
network
Pro-actively – Global CME programme
Mass Public Health Information
Health on-line Websites
Passively
The Watershed Generation Gap
US
OUR CHILDREN
The seekers
and finders
The filterers
and applyers
HUMAN NEURO-PHYSIOLOGY IS CHANGING