richardson consulting uk ltd the british embassy seoul, korea “ehealth; the road ahead dr ricky j...

Richardson Consulting UK LtdRichardson Consulting UK Ltd

The British Embassy The British Embassy Seoul, Korea Seoul, Korea

““eeHealth; The Road AheadHealth; The Road Ahead

Dr Ricky J Richardson BSc MBBSDr Ricky J Richardson BSc MBBS MRCP(UK) FRCP FRCPCH DCH DTM&HMRCP(UK) FRCP FRCPCH DCH DTM&H

Chairman - UK Telemedicine AssociationChairman - UK Telemedicine AssociationChairman - Thematic Working Group 2 Chairman - Thematic Working Group 2

e-health & Telemedicine - EHTEL - European Commissione-health & Telemedicine - EHTEL - European CommissionChairman and CEO - Richardson Consulting UK Limited Chairman and CEO - Richardson Consulting UK Limited

Consultant Physician - Great Ormond Street Hospital for ChildrenConsultant Physician - Great Ormond Street Hospital for Children


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

EurosEuros

20102010


The well-being factor

PRIMARY TELERADIOLOGYPRIMARY TELERADIOLOGYAND TELEPATHOLOGYAND TELEPATHOLOGY

eeHealth &Health &TelemedicineTelemedicine

Clusters of Clusters of Specialists withSpecialists withGlobal AccessGlobal Access

Allied HealthCare Professionals

Primary HealthCare The ‘Super’ Primary Care Physician

CommunityHospitals

(Acute)

CommunityHospitals

(Non-acute)

Freestanding Diagnostic Centres

HomeHomeCareCare

HealthKiosks

DayCareSurgery

MaternityAcute

Trauma

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 - changing rolesHealthcare practices - changing roles•• Healthcare trainingHealthcare training•• Financial remuneration/rewardsFinancial remuneration/rewards•• Healthcare vocationHealthcare vocation

WILL 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 1999

26,00026,000 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) - 3,474,000drkoop.com (No. 76) - 3,474,000


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 gadgetTrojan 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…)ManufacturingManufacturing Business ServicesBusiness Services Public ServicesPublic Services


Technology driven Disappointment

Healthcare Professionals: HELP!!!!!Sit on the fence or Resist “I told you so !” Accept the inevitable and

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 19901990 December 2000December 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 Ministry of HealthNorth Korea with Ministry of Health• Centum City PopulationCentum City Population

•ResidentsResidents•Daily WorkersDaily Workers•Visitors/TouristsVisitors/Tourists

•Korean nationalsKorean nationals•International Patients - Medical TourismInternational Patients - Medical Tourism



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



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

(For 24hr medical 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 TechnologyMotion Media Technology

ISDN/InterNet


Eyesite 300 Home Care systemEyesite 300 Home Care system4 remote cameras/devices

Remote care & monitoring of patients - hospitals - homes - anywhereRemote care & monitoring of patients - hospitals - homes - anywhereIn emergencies…. it can be triggered by a panic call button In emergencies…. it can be triggered by a panic call button

CarerCarer

HomeHome

Motion Media TechnologyMotion Media Technology

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


Thematic Working Group 2Thematic Working Group 2Activities (2000)Activities (2000)

MarchMarch - - TWG2 EstablishedTWG2 Established- Chair Appointed- Chair Appointed

AprilApril - - Membership Assembled Membership Assembled (50 - September 2000(50 - September 2000))- Draft Action Plan Submitted- Draft Action Plan Submitted- Draft Budget Submitted- Draft Budget Submitted- Preparation for Pro-EHTEL Negotiations- Preparation for Pro-EHTEL Negotiations

May 9th May 9th - First Meeting - DTI (UK) London- First Meeting - DTI (UK) London- Action Plan agreed - for implementation - Action Plan agreed - for implementation - Budget Approved- Budget Approved- Treasurer Appointed - Dr Stephan Schug (DK)- Treasurer Appointed - Dr Stephan Schug (DK)

- - DTI (UK) offer to provide Secretariat RoleDTI (UK) offer to provide Secretariat Role


Thematic Working Group 2Thematic Working Group 2Activities (2000)Activities (2000)October/NovemberOctober/November

- - Website Development Defined and Agreed and Content providedWebsite Development Defined and Agreed and Content provided- Phase Two Action Plan Defined and Budget set- Phase Two Action Plan Defined and Budget set- PRO-EHTEL Funding Secured, Supplemented by Industry- PRO-EHTEL Funding Secured, Supplemented by Industry- Agreements with Industry Partners on Physical Demonstration sites- Agreements with Industry Partners on Physical Demonstration sites- Promotion of e-Health/Telemedicine at all levels throughout Europe- Promotion of e-Health/Telemedicine at all levels throughout Europe

• Ministers of HealthMinisters of Health• Private SectorPrivate Sector• Telemedicine e-Health ConferencesTelemedicine e-Health Conferences• Key HealthCare Decision MakersKey HealthCare Decision Makers

- Articles written and published on e-Health in European Journals - Articles written and published on e-Health in European Journals - Promotion of European e-Health and Telemedicine beyond Europe- Promotion of European e-Health and Telemedicine beyond Europe


Thematic Working Group 2Thematic Working Group 2Activities (2001 and Beyond)Activities (2001 and Beyond)January 2001 - July 2003 - PRO-EHTELJanuary 2001 - July 2003 - PRO-EHTEL- - Further Development of Virtual Demonstration WebsiteFurther Development of Virtual Demonstration Website- Establishment of Three (3) Physical Demonstration Sites- Establishment of Three (3) Physical Demonstration Sites- Active Promotion of e-Health and Telemedicine across Europe- Active Promotion of e-Health and Telemedicine across Europe- Growing List of Industry Partners become members- Growing List of Industry Partners become members

of EHTEL/TWG2of EHTEL/TWG2- TWG2/EHTEL acts as a Core Central Resource for:- TWG2/EHTEL acts as a Core Central Resource for:

• European CommissionEuropean Commission• Governments of European Member StatesGovernments of European Member States• Other Parties interested in European Medical ServicesOther Parties interested in European Medical Services


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


The most robust economy in decades is being conducted in the riskiest environment ever

This year 35 million businesses passed along confidential information to 2 million people who had no business seeing it

Government Health Warning!Government Health Warning!


YES the internet YES the internet isis insecure insecure

Would Would you trust you trust an an electronic electronic message message that that came to came to you from you from an an unknown unknown company company in in Colombia, Colombia, Moscow, Moscow, or China?or China?

Lack of trust in an openLack of trust in an open

system is preventing growthsystem is preventing growth

It doesn’t have to be that wayIt doesn’t have to be that way


These folks operate e-health in the most These folks operate e-health in the most litigious society on earthlitigious society on earth

They protect They protect their business their business

with standards with standards based security based security

protocolsprotocols

They can’t They can’t afford to take afford to take

any risksany risks

……and neither and neither can youcan you


This technology requiresTrusted Service

Providers to manage it

International e-health standards have been

developed for: -

Credential checkingAuthenticationRights managementAccessSigningCertification Audit

There is plenty of technology There is plenty of technology that enables Internet securitythat enables Internet security

de la Rue / Presideode la Rue / Presideo


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 Professionals

1° HealthCare The ‘Super’ Primary Care Physician

CottageHospitals

(Acute)

CommunityHospitals(Non-acute)

HomeCare

HealthKiosks

day-careSurgery

FreestandingDiagnostic

Centres

MaternityAcute

Trauma

Telemedicine

PrimaryTeleRadiology

and TelePathology


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 – Monitoring – HomecareHomecare

• • 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 CHANGINGMary LobascherMary Lobascher 2000

USUS

The seekersThe seekers

and findersand finders

OUR CHILDRENOUR CHILDREN

The filterersThe filterers

and applyersand applyers

richardson consulting uk ltd the british embassy seoul, korea “ehealth; the road ahead dr ricky j...

Documents

atm of healthcare slide

wellness paradigm slide

healthcare delivery

impact healthcare practices

patient community

paradigm shift

patients hands

informed patient s family