EHealth eEurope eVolution Dr Ricky J Richardson BSc MBBS MRCP(UK) FRCP FRCPCH DCH DTM&H Chairman UK eHealth Association Chairman UK eHealth Association.

eeHealth Health eeEurope Europe eeVolutionVolution

Dr Ricky J RichardsonDr Ricky J RichardsonBSc MBBS MRCP(UK) FRCP FRCPCH DCH DTM&HBSc MBBS MRCP(UK) FRCP FRCPCH DCH DTM&H

ChairmanChairman UK UK eeHealth AssociationHealth Association ChairmanChairman eeHealth Working Group - Health Working Group - EHTELEHTEL Board MemberBoard Member European Health Telematics Association European Health Telematics Association –– EHTELEHTEL Vice PresidentVice President International Society for International Society for TelemedicineTelemedicine ClinicalClinical DirectorDirector HealthSystems HealthSystems Consultants LtdConsultants Ltd

ConsultantConsultant PaediatricianPaediatricianGreat Ormond Street Hospital for Children, LondonGreat Ormond Street Hospital for Children, London

The Portland Hospital for Women & Children, LondonThe Portland Hospital for Women & Children, LondonThe Speech, Language and Hearing Centre, LondonThe Speech, Language and Hearing Centre, London

Health is far too Health is far too important a subject to important a subject to be left in the hands of be left in the hands of

the medical the medical professionals !!!!professionals !!!!

Dr Halfdan Mahler - DG Emeritus - Dr Halfdan Mahler - DG Emeritus - WHOWHO

after Oscar Wildeafter Oscar Wilde

BIOLOGIC PHYSICAL

INFORMATION

FUTUREFUTURE

RoboticsHPCC/WWWMEMS/Nano

GenomicsBioinformaticsBiocomputation

BiosensorsBiomaterialsBiomimetic

Cellular cyborg

The BioIntelligence AgeThe BioIntelligence Age

Who will be at Who will be at the the

primary care primary care interface of the interface of the

future?future?

The The eePatient Patient !!

and theand the eeNurseNurse

The The eePatient Patient is part of the is part of the therapeutic therapeutic

team!!!!team!!!!

What is What is eeHealth?Health?

The The (e)(e)ATM of ATM of HealthcareHealthcare

eeHealthHealth• Clinical ApplicationsClinical Applications

TelTeleeConsultations Consultations (previously (previously Telemedicine)Telemedicine)

Clinical Decision Making Support SoftwarClinical Decision Making Support Softwaree

Vital Signs Monitoring SVital Signs Monitoring Seervicesrvices

TeleHomTeleHomeeCareCare

National National eePrescribingPrescribing & & eeBooking ServicesBooking Services

Finance Departments

Community Health

Provision

Patient Care Practitioners

Government

Transport Strategy & Planning

Research and Development

Medical Devices

Professional Associations

eHealteHealthh

Insurance Companie

s

Medical Information

Quality Standards

Information Technology

Social Welfare

Suppliers

Alternative Medicine

Patients

Technical Support

Personnel

Medical SchoolsAmbulance

sParamedics

Human Resource

s

Pharmaceuticals

Patient Care

Facilities

Alternative Health Centres

Clinics Surgeries

Specialists:(Orthopaedics, Radiologists, Paediatrics

General Practitioners

Home Monitoring

Primary Care Centres

Hospices

Specific Care Centres

Hospitals

The Paradigm ShiftThe Paradigm ShiftThe The eighteight Drivers Forcing Change 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 Impact of information technology

including IT support for clinical decisions - including IT support for clinical decisions - Telemedicine & Telemedicine &

eeHealthHealth • More informed and expectant patients C-More informed and expectant patients C-

HealthHealth• The well-being factorThe well-being factor – responsibility shift – responsibility shift

into patients hands - into patients hands - The Wellness The Wellness ParadigmParadigm

• Knowledge Management – changing worldKnowledge Management – changing world

Integration of IT into Integration of IT into Business SectorsBusiness 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

Traditional Healthcare Delivery

Model

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 well-being factor

PRIMARY TELERADIOLOGYPRIMARY TELERADIOLOGYAND TELEPATHOLOGYAND TELEPATHOLOGY

eeHealth &Health &TelemedicineTelemedicine

Clusters of Clusters of Specialists Specialists withwithGlobal AccessGlobal Access

Allied HealthCare Professionals

Primary HealthCarePrimary HealthCare The ‘Super’ Primary Care PhysicianThe ‘Super’ Primary Care Physician

CommunityHospitals

(Acute)

CommunityHospitals(Non-acute)

Freestanding Diagnostic Centres

HomeCare

HealthKiosks

DayCareSurgery

MaternityAcute

Trauma

??

Direct Access to specialistsDirect Access to specialistsWWWWWW IDTVIDTV IDTVIDTV WWWWWW

The Informed Wired upInformed Wired up Citizen Community

C-C-HealthHealth

The Impact of Globalisation The Impact of Globalisation on Healthcare deliveryon Healthcare delivery

Healthcare Services move into the Healthcare Services move into the Retail Environment Retail Environment Shopping Mall Shopping Mall medicinemedicine

C-health: - Health-on-line C-health: - Health-on-line WebsitesWebsites

District General and Regional District General and Regional Hospitals become Hospitals become obsoleteobsolete as a as a conceptconcept

Emergence of Emergence of EpicentersEpicenters of of Medical ExcellenceMedical Excellence

Managed Clinical NetworksManaged Clinical Networks

The Impact of Globalisation

on Healthcare deliveryHospitals……….. to

eHospitals Patients in the locality

Old MarketsOld Markets  New MarketsNew Markets

The Global Patient CommunityShipping Mercantile Cruise ships (SeaMed)Airline IndustryHotel ResortsMultinational Corporations (Shell /Amoco etc)The MilitarySpace Travellers

The Paradigm ShiftThe Impact

Healthcare ProfessionalsHealthcare Professionals

• Healthcare practices - Healthcare practices - changing roleschanging roles• Nurse Practitioners at Nurse Practitioners at Primary CarePrimary Care• • Healthcare trainingHealthcare training• • Financial Financial remuneration/rewardsremuneration/rewards• • Healthcare vocationHealthcare vocation

PatientsPatientsPartners Partners in the healthcare in the healthcare

processprocess

The ePatientFamily and friendsPatient Web CommunitieseNurse PractitionersPharmacists?????????????

The Paradigm ShiftThe Paradigm ShiftWho will be the Primary Care Who will be the Primary Care

Team of the Future?Team of the Future?

Will the family doctor Will the family doctor become “The Wellness become “The Wellness Guardian-Caretaker”?Guardian-Caretaker”?

Technology drivenDisappointment

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

GlobalisationGlobalisationHealthcare Economists Healthcare Economists Patient PowerPatient PowerThe Medical ProfessionThe Medical ProfessionThe World Wide WebThe World Wide WebNew TechnologiesNew Technologiese.g. Mobile Videophonese.g. Mobile VideophonesG3 mobile networksG3 mobile networks

19801980 19901990 September September 20032003

ICT Solutions inICT Solutions in Healthcare Healthcare deliverydelivery

• •Dr Kenneth Bird – Logan Airport – MGH – 1967Dr Kenneth Bird – Logan Airport – MGH – 1967• Interactive Video Conferencing - 1980Interactive Video Conferencing - 1980•Tele-Radiology, USA - 1990Tele-Radiology, USA - 1990• International Telemedicine - 1994International Telemedicine - 1994•The Telemedicine Blueprint, Malaysia - 1997The Telemedicine Blueprint, Malaysia - 1997•Telemedicine “Comes of Age” - 1998 - Telemedicine “Comes of Age” - 1998 -

TeleHealth ? TeleCare ? Citizen-Health?TeleHealth ? TeleCare ? Citizen-Health?•Telemedicine becomes “Medicine” - 1999Telemedicine becomes “Medicine” - 1999•eeHealth : The Road Ahead - 2003Health : The Road Ahead - 2003

Telemedicine & Telemedicine & eeHealth Health The story so farThe story so far