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