impact of medical technological advances final 24oct

8/4/2019 Impact of Medical Technological Advances Final 24oct

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NATIOAL PUBLIC HEALTH SERVICE FOR WALES IMPACT OF MEDICAL TECHNOLOGICAL ADVANCES

CJ/Designed for Life/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 outpatientoperations.

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.

MethodologyBecause 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:

• 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 carehomes;

• 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:

• 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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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 likelyto 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 transformhealth services for people in Wales 6.

The programme will be responsible for:

• the creation and development of an individual health record that provides informationto 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:

• 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:

• 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

• 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 donein 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 tomeet patient expectation, including 2:

• 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 anelement of distance 9.

Telemedicine methods will allow patients to have the expert opinions that they may nothave otherwise had 10.

Telemedicine will have a role in linking populations in remote geographical areas withtheir 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 locationswith 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 conditionscan 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:

• 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-patientattendances.

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:

• 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 thesymptoms 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 impact13

:

• 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 pharmacogeneticscould 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 tohealthcare; 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 beenidentified 3:

• 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 geneticrisk 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 thevalue 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 potentialgiven 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, includingcardiac 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 tumoursand cerebral vascular malformations as well as Parkinson’s disease and epilepsy.

Radiosurgery has replaced conventional neurosurgical procedures for all these conditions16.

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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 years3

.

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 andtreatment 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 asdiabetes 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 remainout 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 techniquescould 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 tele-linkages to the specialist. This would lead to doctors becoming remote from their patients10.

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 newtechnologies 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:

• 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 withimplementation. 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 costs11.

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 withinthe NHS. Fifth Report of Session 2004-05 Volume 1.

Available online http://www.parliament.the-stationery-

office.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 Healthand Social Care for Wales in the 21 st 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:http://www.nuffieldtrust.org.uk/ecomm/files/271004technology4.pdf.

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:http://www.nuffieldtrust.org.uk/ecomm/files/271004technology4.pdf.

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14. Saritas O. Keenan M. Broken promises and/or techno dreams? The future of health

and social services in Europe. Foresight 2004;6:281-291.

15. Melzer D. Raven A. et al. 2003. My very own medicine:what must I know?

Information Policy for Pharmacogenetics. London, Wellcome Trust. Available online:http://www.phgu.org.uk/about_phgu/resources/pdf/HD1032%20CHR_MySery%20own

%20Medic.pdf.

16. Wilson C. The impact of medical technologies on the future of hospitals. BMJ

1999;319:1287-1289.

17. Rashid A. Ed. 2000. The Impact of New Technologies on Future of Primary Care.The Nuffield Trust: London. Cited in Slote Morris Z. Detmer D. 2004 Where will

technology take us? Nuffield Trust. Available online:

http://www.nuffieldtrust.org.uk/ecomm/files/271004technology4.pdf.

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:Changes in health care and continuing medical education for the 21st century. BMJ

1998;16:301-304).

19. Department of Health. 1999. Working Together With Health Information. NHSExecutive: London. Available online:

http://www.dh.gov.uk/assetRoot/04/06/22/14/04062214.pdf.

20. Masys DR. Effects of Current And Future Information Technologies On The Health

Care Workforce. Health Affairs 2002:21;33-41.

21. World Health Organisation. Health Futures: in support of health for all. Geneva:

WHO, 1993. Cited in British Medical Association. Future scenarios in the UK healthcare.

Available online:http://www.bma.org.uk/ap.nsf/Content/Healthcare+funding+review+Research+report+5.

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