NATIOAL PUBLIC HEALTH SERVICE FOR WALES
CJ/Designed for Life/Impact of Medical Technological Advances
IMPACT OF MEDICAL TECHNOLOGICAL ADVANCES
Impact of Medical Technological Advances
Key Messages
IT & Telecommunications
 Significant capacity shortcomings in ICT in Wales have been identified.
 Technological developments are likely to be one of the most important drivers of
medical spending.
 ICT will improve links between healthcare providers.
 The focus of care will shift from secondary services.
 Patients will have greater control over their care.
 Telemedicine could improve links between patients and expert opinion.
 Telemedicine can enable self-diagnosis and self-care at home.
Genetics
 Genetic screening could identify people at risk of a particular disease and allow
appropriate interventions to be introduced before the disease develops.
 The earliest gains are predicted in pharmacogenetics.
 Ethical and financial issues could slow advances.
Minimally invasive surgery
 Minimally invasive surgery will reduce hospital stay and promote outpatient
operations.
Miniaturisation
 Care could be moved from secondary to primary services
 Miniaturisation could potentially enable people with chronic diseases to remain out of
hospital.
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Aim:
To provide pointers to the impact of medical technological advances.
Methodology
Because of the timescale available to undertake this piece of work, the author does not
claim to provide a definitive list of future medical technological advances and their
impact. Instead this paper uses evidence from already known literature and a search of
relevant and well respected sites and sources of information, to provide an overview of
future medical technological advances.
Introduction
Health care technology is defined as,
‘prevention and rehabilitation, vaccines, pharmaceuticals, and devices, medical and
surgical procedures, and the systems within which health is protected and maintained 1’.
New medical technologies can bring many benefits to patients, carers and clinicians,
including 2:
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improving the quality of life of patients through more efficient and effective
treatments;
enabling patients to remain in their homes rather than be admitted to hospital or care
homes;
making remote diagnosis and treatment possible;
reducing treatment times;
enabling clinicians to treat more patients more effectively.
Main areas of new technological advances
The main areas of technological development likely to affect healthcare towards 2015
have been categorised as 3:
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IT and telecommunications, including decision support systems.
advances in molecular genetics;
developments in biotechnology which will enable advances in genetics to be
exploited;
development of bioengineering to produce artificial body parts and organs;
further developments in minimal access surgery;
use of robotics in surgery;
further developments in transplantation.
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IMPACT OF MEDICAL TECHNOLOGICAL ADVANCES
IT & Telecommunications
Information Technology in Wales
Significant capacity shortcomings in ICT have been identified in Wales 4. The Wanless
Report recommended an overhaul of information systems in Wales to improve quality,
timeliness and coverage and that ICT should be a priority for investment.
Securing Our Future Health found technological developments have been and are likely
to be one of the most important drivers of medical spending 5.
In Wales, Informing Healthcare is one of the key enablers for Designed for Life. It is the
programme to develop new methods, tools and information technologies to transform
health services for people in Wales 6.
The programme will be responsible for:

the creation and development of an individual health record that provides information
to the patient and those who look after them when needed;

the implementation of a number of service improvements which will provide
clinicians, carers and patients with the tools, skills and knowledge to adopt best
practice;

the delivery and maintenance of an integrated national technical network which
supports patient care delivery by enabling information to be shared irrespective of
organisational boundaries.
Key Messages
 Significant capacity shortcomings in ICT in Wales have been identified.
 Technological developments are likely to be one of the most important drivers of
medical spending
Information & Communications Technology
Key developments in ICT include 3:
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Decision support systems;
Medical record keeping and transfer;
Aids to rehabilitation and enablement;
Public access to information.
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Wanless identifies a range of new information technologies which could potentially be
used in health care 5:
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The internet is a source of information, which can be used by patients and
professionals.
Digital TV has the potential to provide health information programmes.
Personal Digital Assistants are small portable computers which could be used by
health professionals on the move.
Wireless Application Protocol (WAP) phones provide mobile internet access for
health care professionals at locations which are convenient for the patient.
Telemedicine has the potential for medical consultations to be carried out remotely
via e-technology.
Computers and telecommunications technology will promote and increase 7
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remote monitoring and diagnosis;
links between hospitals, between hospitals and general practitioners, between
hospitals and clinics;
the speed of communication;
the capacity for remote consultation, operations and teaching.
Advances in medical technology will increase the trend to move care away from acute
hospitals into primary care, new specialised acute procedures centres, new recovery
centres and the home. New technologies mean more diagnosis and treatment can be done
in the community or daycare settings 7. Electronic records will make care faster and safer
and allow people to monitor the quality of their own care 8.
The Department of Health has identified significant opportunities for the use of
Information and Communications Technology (ICT) to improve the quality of care and to
meet patient expectation, including 2:
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improving efficiency and streamlining the work of professionals;
monitoring, performance management (clinical & non clinical) and clinical
governance, dissemination of evidence based best-practice;
convenience;
joined-up working through the NHS and social care;
reduction in human errors.
Key Messages
 ICT will improve links between healthcare providers.
 The focus of care will shift from secondary services.
 Patients will have greater control over their care.
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Telemedicine
Telemedicine is an umbrella term that encompasses any medical activity involving an
element of distance 9.
Telemedicine methods will allow patients to have the expert opinions that they may not
have otherwise had 10.
Telemedicine will have a role in linking populations in remote geographical areas with
their required level of expertise 10.
Appropriately developed telemedicine facilities will reduce the need for buildings,
facilities and personnel. Diagnostic specialists will be concentrated in fewer locations
with information transmitted from community settings by non-medical staff 10.
Telemedicine will provide a mechanism for linking different specialist interests with each
other and with general care in the community 10.
Telecommunications will allow links to small local centres where common conditions
can be diagnosed and treated, to self-diagnosis and self-care at home, with the help of
developments in instrumentation such as blood glucose monitors 3.
The Department of Health has stated that telecare and related technologies can allow 2:
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Avoidance of unnecessary hospital admission and timely discharges;
Falls prevention strategies;
Saving lives through more reliable fire/smoke detection for older people;
Timely information to inform people’s care package reviews;
Improving quality of life and reducing care costs for people with long term conditions
and with strokes;
Better monitoring of people with chronic obstructive pulmonary disease and diabetes
which can alert to changes in condition and significantly reduce out-patient
attendances.
Key Messages
 Telemedicine could improve links between patients and expert opinion.
 Telemedicine can enable self-diagnosis and self-care at home.
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Genetics
Advances in genetics are anticipated to support four areas of healthcare:
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Prevention & diagnosis, including screening
Therapy
Enhancement
Reproduction
Early diagnosis is predicted to improve the management of disease, and in the case of
carriers, inform reproduction choices 11. Genetic screening could identify people at risk of
a particular disease and allow appropriate interventions to be introduced before the
disease develops 12. As a result, the role of medicine could shift from treating the
symptoms of disease to eliminating its cause.
Therapeutic and preventative benefits arising from the discovery of genes could lag 20 to
50 years behind the diagnosis. Some question the appropriateness of screening and
diagnosis if there are no treatments available. This could have the following impact 13:
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Demands on the healthcare workforce to educate and counsel;
Increased monitoring;
Increase reassurance.
Ultimately gene therapy will mean the replacement or deletion of the defective gene to
eliminate the associated illness; this is unlikely to begin to have a profound effect on UK
health in 2020.
The earliest gains are predicted to come from the use of genetic information to predict the
effectiveness and side effects of drug therapies 14. Many believe that pharmacogenetics
could have an impact on the care of more that 15% of patients by 2018 15.
Morris & Detmer argue that the development of pharmacogenetics will be disruptive to
healthcare; genetics has the potential to redefine ‘disease’, ‘treatment’ and ‘patients’ and
demand new relationships with ‘patients’ 11.
Although the opportunities of advances in genetics are recognised, some issues have been
identified 3:
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Genetic services are likely to be integrated within primary care, with implications for
training, workload and resourcing. GPs may be unwilling to raise the issue of genetic
risk with patients in the absence of effective screening technologies and therapies to
reduce the risk or prevent disease and patients may be unwilling to make lifestyle
changes in the context of genetic determinism.
Genetic screening and selection within reproductive technology potentially allows
parents to specify their child’s characteristics, raising difficult ethical issues about the
value of life.
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The development and implementation of new technologies will be affected by the
extent to which they are seen to be safe and ethically acceptable.
Financial factors.
Key messages
 Genetic screening could identify people at risk of a particular disease and allow
appropriate interventions to be introduced before the disease develops.
 The earliest gains are predicted in pharmacogenetics.
 Ethical and financial issues could slow advances.
Tissue Engineering / development of bioengineering to produce artificial body parts
and organs
Tissue engineering involves combining human cells with synthetic biomaterials to
produce products such as skin, cartilage, bones and organs. It is an area of huge potential
given the needs of an ageing population 11.
One condition tissue engineering could impact is heart disease. People with heart disease
may have the option of cardiac vessel regenerative tissue implants, thereby avoiding the
need for bypass surgery or angioplasty 14.
The development of bioengineering to produce artificial body parts and organs is
predicted to replace transplantation within the next three decades, alleviating the problem
of the shortage of donors for transplantation 3.
This area is very much in the development phase; some progress is predicted by 2020.
Ethical concerns may affect progress in this field.
Minimally invasive surgery
Minimally invasive surgery has already transformed many surgical procedures, including
cardiac surgery. The same technology is being applied in other surgical procedures; high
tech surgery will therefore become the norm for many operations, this will impact on
staff, space and equipment requirements 16.
Radiosurgery
The least invasive of all minimally invasive surgical technologies is radiosurgery. The
used of radiosurgery has developed and is now being used to treat many brain tumours
and cerebral vascular malformations as well as Parkinson’s disease and epilepsy.
Radiosurgery has replaced conventional neurosurgical procedures for all these conditions
16
.
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The increased use of radiosurgery could mean more patients being treated in a special
facility in the department of radiation, moving the point of treatment to a different site in
the hospital and reducing the length of stay for patients 16.
Minimally invasive surgery is forecast to account for half of all surgical interventions
within 10 to 15 years 3.
Minimally invasive surgery will reduce the prevalence of traditional hospitals.
The need for lengthy post-operative stays will be reduced using minimally invasive
surgical techniques.
Key message
Minimally invasive surgery will reduce hospital stay and promote outpatient
operations.
Robots
The use of robots in surgery is predicted to develop by 2015 3.
The use of robots in surgery will increase accuracy and consistency 3.
The use of robots is also predicted to increase in rehabilitation (REF: BMA).
Robots are also expected to be used in hospitals for running central supply services,
filling requests and orders in the pharmacy, as well as a range of other tasks 16.
Miniaturisation
Increasing the use of miniaturisation is likely to increase the scope for diagnosis and
treatment at home and in primary care.
Some argue a shift of functions from secondary to primary care will come from
miniaturisation and increasing ease of use is anticipated to lower screening costs;
improve outcomes; and lower use of secondary care. This will result in greater patient
satisfaction and greater access to these services as unit costs drop.
Screening is beneficial to health service costs because it reduces treatment costs in the
longer term. There is evidence that good management of chronic conditions such as
diabetes can significantly reduce costs by avoiding early development of expensive
complications 17. Others however question whether improved diagnosis will actually
increase the demand for secondary care.
Implantable devices are also predicted to impact on diagnostics and early delivery of
therapy. The development of implantable devices with telemedicine can be used for the
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management of chronic conditions, enabling people with a chronic disease to remain out
of hospital, which will benefit the individual and potentially reduce hospital costs 17.
Key messages
 Care could be moved from secondary to primary services
 Miniaturisation could potentially enable people with chronic diseases to remain
out of hospital.
Effect of new technologies on the healthcare workforce
Developments in new technologies will potentially result in substantial changes in the
skill mix of staff, and have major training implications for medical, nursing and technical
staff 7.
Developments in technology have already led to changing professional roles and
boundaries both within the medical profession and between health professionals,
especially between doctors and nurses. Towle argues that minimally invasive techniques
could lead to surgery disappearing as a speciality and gradually being merged with
internal medicine so that specialists deal with organ systems 18.
Trends in developing technologies could lead to a largely technical role for doctors
confined to the ‘high tech’ end of healthcare with other functions being performed by
non-medical staff. Patients could be predominantly with non-medical personnel with telelinkages to the specialist. This would lead to doctors becoming remote from their patients
10
.
In 1999 the Department of Health launched a strategy to ensure that doctors and nurses
have the skills they need to use make best use of new technology introduced into the
NHS . The strategy Working Together with Health Information provides the framework
for ensuring that NHS professionals have the skills and knowledge to use information and
new technology 19.
Aswell as changing roles of professionals, new occupations resulting from new
technologies in healthcare have also been identified, for example, telemedicine
practitioners, presenters and consultants 20.
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Limitations of technology
Although technological advances are predicted to improve healthcare and service
delivery, some limitations of these developments have been identified:
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New technologies can be expensive;
Installing equipment outside the clinical environment, for example patients’ homes,
can be problematic;
Patients can find it difficult to use the technology;
Reduced contact for patients;
Potentially increase the burden of responsibility on carers.
Technological advances may be less useful because of problems with
implementation. The development of telemedicine has been restricted by medicolegal
and ethical concerns about security, confidentiality and integrity of information.
As technology is refined, it can be applied to more vulnerable and older groups, and
thus also contribute to higher costs given the capacity of these groups to attract costs
11
.
The WHO warns that concentrating on technological development could reinforce or
even widen health inequalities and highlight the need to guard against the dominance of
expensive high technology therapies which only benefit relatively few people 21.
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References
1. University of York Centre for Reviews and Dissemination Available online:
http://www.york.ac.uk/inst/crd/hfaq2.htm.
2. House of Commons Health Committee. The Use of New Medical Technologies within
the NHS. Fifth Report of Session 2004-05 Volume 1.
Available online http://www.parliament.the-stationeryoffice.co.uk/pa/cm200405/cmselect/cmhealth/398/398i.pdf.
3. British Medical Association. Future scenarios in UK healthcare. Available online:
http://www.bma.org.uk/ap.nsf/Content/Healthcare+funding+review+Research+report+5.
4. Wanless D. 2003. The Review of Health and Social Care in Wales; the report of the
project team advised by Derek Wanless. NAfW: Cardiff.
5. Wanless D. 2002. Securing our future health – taking a long term view. The Treasury:
London.
6. National Assembly for Wales. 2003. Informing Healthcare NAfW: Cardiff. Available
online: www.wales.nhs.uk/ihc
7. Towle A. Continuing medical education: Changes in health care and continuing
medical education for 21st century. BMJ 1998;316:301-304.
8. Welsh Assembly Government 2005. Designed for Life: Creating World Class Health
and Social Care for Wales in the 21st Century. Available online
http://www.wales.nhs.uk/documents/designed-for-life-e.pdf.
9. Wootton R. Telemedicine. BMJ 2001;325:557-60.
10. Marinker M. Peckham M. 1998. Clinical Futures. BMJ Books.
11. Slote Morris Z. Detmer D. 2004 Where will technology take us? Nuffield Trust.
Available online: http://www.nuffieldtrust.org.uk/ecomm/files/271004technology4.pdf.
12. Ginsburg GS. McCarthy JJ. 2001. Personalised medicine: revolutionized discovery
and patient care. Trends Biotecnol 19:491-96. Slote Morris Z. Detmer D. 2004. Cited in
Where will technology take us? Nuffield Trust. Available online:
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13. Cantor C. 1992. The challenges to technology and informatics. The Codes of Codes,
Scientific and Social Issues in Human Genome Project. Kelves D. Hood L. Cambridge
MA, Harvard University Press. Cited in Slote Morris Z. Detmer D. 2004 Where will
technology take us? Nuffield Trust. Available online:
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14. Saritas O. Keenan M. Broken promises and/or techno dreams? The future of health
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%20Medic.pdf.
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17. Rashid A. Ed. 2000. The Impact of New Technologies on Future of Primary Care.
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18. Banta HD. Minimally invasive surgery. Implications for hospitals, health workers and
patients. BMJ 1993;307:1546-9. Cited in Towle A. Continuing medical education:
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19. Department of Health. 1999. Working Together With Health Information. NHS
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