Title: TeleMedicine in the United Kingdom: The WorldCare Story
1ISfT 2000 MontrealHealthcare Delivery in the
year 2050Dr Ricky J Richardson BSc MBBS
MRCP(UK) FRCP FRCPCH DCH DTMH Chairman - UK
Telemedicine Association Chairman - European
Commissions - Thematic Working Group on
e-health Telemedicine - EHTEL Chairman and CEO
- Richardson Consulting UK Limited Consultant
Physician - Great Ormond Street Hospital for
Children
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3Who will be the primary care physician of the
future?
4The Patient !
5What is TeleHealth?
6The ATM of Healthcare
7Traditional Healthcare Delivery Model
Teaching Hospitals
3 HealthCare
Regional Hospitals
PhysicalMovementofPatients
District General Hospitals
2 HealthCare
General Practitioners
1 HealthCare
The Patient Community - Bottom of the pile!!
Unchanged for 6000 years - circa 3000 BC!
8The 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
9The Economic Issues
Day Care Surgery Ambulatory Diagnostic
Clinics Primary/Preventative Care The well-being
factor TeleHealth Partnerships between Public
Private Sectors
Dollars
Cost Tolerance
Change in HealthcareDelivery Mechanisms
1950
2000
1990
2010
10The Paradigm Shift
The well-being factor
The Informed Wired up Citizen Community
C-Health
WWW
IDTV
IDTV
WWW
Direct Access to specialists
Acute Trauma
Freestanding Diagnostic Centres
CommunityHospitals(Acute)
CommunityHospitals(Non-acute)
HomeCare
HealthKiosks
DayCareSurgery
Mater nity
Allied HealthCare Professionals
Primary HealthCare The Super Primary Care
Physician
PRIMARY TELERADIOLOGYAND TELEPATHOLOGY
?
?
E-Health TELEMEDICINE
Clusters of Specialists with Global Access
11The Paradigm ShiftThe 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 ?
12The Paradigm ShiftWho 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?
-
13The 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
14The Impact of Globalisation on Healthcare
delivery
15Airline Industry Operational Model
Telemedicine Equipment
Global Network of participating hospitals
Co-ordination of Service
Data
AE Department
Call-Centre
Communications
16The Patient/Consumer Health Information
Your Genetics Human Genome Project Choosing
Deathstyle
Your own Lifestyle
Health 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
medicine than western medicine
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18- 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
19How many people on-line?
Advanced Communications Engineering
20The data wave goes mobile
Advanced Communications Engineering
21TelemedicineThe 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
-
22TelemedicineThe story so far
- Hospitals become a thing of the past - 2006?
23Integration of ITinto Business Sectors
Business Services
Public Services
Manufacturing
(Banks)
(Health)
Integration of IT
1980
1990
2000
IT as a gadget Trojan horse networks,
Full Integration of IT into Business
(Organisational, Legal) Re-engineering
of the system
Jean-Claude Healy May 2000
24ICT 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
25The Telemedicine Market (1)
USA 1997 - 643 Million 2002 - 3000 Million
Europe Euro 50 Million Euro 542 Million
26The Telemedicine Market (2)
What about the rest of the world?
27The Telemedicine BlueprintMalaysia
- 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
28Centum City Telemedicine Project
29Centum 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
30Centum City Telemedicine Project
- Mobile Population
- Mercantile Shipping
- Ship owners
- Seamans Unions
- Cruise Lines
- - Star Cruises
- Airlines
- - Korean Air
31Centum 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
32Centum City Telemedicine Project
Medical Tourism
33The New TechnologiesVideophones
Videophone
X-Ray Camera Bed
Ultrasound Scanner
ISDN/InterNet
Camcorder
Group Conference System
Videophone
Hospital
Minor Injury Unit
Motion Media Technologies
34Eyesite 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
35CommunicationsSystem Overview
36Thematic Working Group 2EHTEL
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
37Healthcare Delivery in the new MillenniumWhere
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
38Future environment
ISDN CABLE LAN-WAN WIRELESS NETWORKS
Drivers of change
e-COMMERCE
C-HEALTH
Health Contact CENTRE e.g.NHS DIRECT
ELECTRONIC HEALTH RECORD
FIXED MOBILE VIDEO PRODUCTS
MEDICAL DEVICES VITAL
SIGNS MONITORING
39TeleHealthRemaining 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
tomorrows world????????
40The 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?
41The Developing World
Can leap-frog the traditional evolutionary
process
The Informed Community
4
2
6
7
8
3
5
1
Maternity
AcuteTrauma
CottageHospitals(Acute)
CommunityHospitals(Non-acute)
HomeCare
HealthKiosks
day-careSurgery
FreestandingDiagnosticCentres
3 HealthCare
Allied HealthCare Professionals
PhysicalMovementofPatients
1 HealthCare
The Super Primary Care Physician
2 HealthCare
Primary TeleRadiology and TelePathology
?
1 HealthCare
Telemedicine
Clusters ofSpecialists
The Community
Time
2000 AD
3000 BC
China - The Golden Health Project Malaysia - Th
e Telemedicine Blue Print Africa - ? Take some
responsibility ?
42Healthcare Delivery Trends
Consumer pressures
Global Networked Healthcare
Information technology
Delivery mechanisms
43TeleHealthThe 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
44Technology and Skill Transfer
- Passively Use of a global telemedicine
network - Pro-actively Global CME programme
- Mass Public Health Information
- Health on-line Websites
45The Watershed Generation Gap
US The seekers and finders
OUR CHILDREN The filterers and applyers
- HUMAN NEURO-PHYSIOLOGY IS CHANGING