TeleMedicine in the United Kingdom: The WorldCare Story
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Transcript TeleMedicine in the United Kingdom: The WorldCare Story
The British Embassy
Seoul, Korea
“eHealth; The Road Ahead
Dr Ricky J Richardson BSc MBBS
MRCP(UK) FRCP FRCPCH DCH DTM&H
Chairman - UK Telemedicine Association
Chairman - Thematic Working Group 2
e-health & Telemedicine - EHTEL - European Commission
Chairman and CEO - Richardson Consulting UK Limited
Consultant Physician - Great Ormond Street Hospital for Children
Richardson Consulting UK Ltd
Richardson Consulting UK Ltd
Who will be the
primary care
physician of the
future?
Richardson Consulting UK Ltd
The Patient !
Richardson Consulting UK Ltd
What is
TeleHealth?
Richardson Consulting UK Ltd
The ATM of
Healthcare
Richardson Consulting UK Ltd
Traditional Healthcare Delivery Model
Teaching Hospitals
3°
HealthCare
2°
HealthCare
1°
HealthCare
Regional Hospitals
District General
Hospitals
General
Practitioners
The Patient Community - Bottom of the pile!!
Unchanged for 6000 years - circa 3000 BC!
Richardson Consulting UK Ltd
The Paradigm Shift
The Seven Drivers Forcing Change
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•
•
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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
Richardson Consulting UK Ltd
The Economic Issues
Day Care Surgery
Ambulatory Diagnostic
Clinics
Primary/Preventative Care
The well-being factor
Euros
TeleHealth
Partnerships between
Public & Private Sectors
Cost
Tolerance
Change in Healthcare
Delivery Mechanisms
1950
Richardson Consulting UK Ltd
1990
2000
2010
The Paradigm Shift
The Informed Wired up Citizen Community
The well-being factor
WWW
Freestanding
Diagnostic
Centres
IDTV
Home
Care
Direct Access to specialists
Health
Kiosks
DayCare
Surgery
IDTV
C-Health
WWW
Community Community Acute
Hospitals
Hospitals Trauma Maternity
(Non-acute)
(Acute)
Allied HealthCare Professionals
Primary HealthCare
PRIMARY TELERADIOLOGY
AND TELEPATHOLOGY
The ‘Super’ Primary Care Physician
?
Richardson Consulting UK Ltd
Clusters of
Specialists with
Global Access
?
eHealth &
Telemedicine
The Paradigm Shift
The 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 ?
Richardson Consulting UK Ltd
The Paradigm Shift
Who 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”?
Richardson Consulting UK Ltd
The Impact of Globalisation
on Healthcare delivery
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•
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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
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The Impact of Globalisation
on Healthcare delivery
Old Markets
Patients in the
locality
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New Markets
The Global Patient
Community
Shipping
Mercantile
Cruise ships (SeaMed)
Airline Industry
Hotel Resorts
Multinational Corporations
(Shell /Amoco etc)
The Military
Space Travellers
Airline Industry Operational Model
Telemedicine Equipment
Global Network
of participating
hospitals
Co-ordination
of Service
Data
A&E Department
Richardson Consulting UK Ltd
Communications
Call-Centre
The Patient/Consumer
Health Information
Your own Lifestyle
Your Genetics
Health Cure & Care
Human Genome Project
Choosing Deathstyle
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
Richardson Consulting UK Ltd
Richardson Consulting UK Ltd
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
Richardson Consulting UK Ltd
Advanced Communications Engineering
On Line population, millions
How many people on-line?
600
500
400
300
200
100
0
1994
Richardson Consulting UK Ltd
1996
1998
2000
2002
2004
2006
Advanced Communications Engineering
The data
wave
goes
mobile
Richardson Consulting UK Ltd
Telemedicine
The 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
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Telemedicine
The story so far
•
Hospitals become a thing of the past - 2006?
Richardson Consulting UK Ltd
Integration of IT
Integration of IT
into Business Sectors
Manufacturing
1980
Business Services
(Banks)
1990
Public Services
(Health…)
2000
Jean-Claude Healy
May 2000
IT as a gadget
Trojan horse: networks, …
Full Integration of IT into Business (Organisational, Legal) Re-engineering of the system
Richardson Consulting UK Ltd
ICT Solutions in
Healthcare delivery
Globalisation
Healthcare Economists
Patient Power
The Medical Profession
The World Wide Web
New Technologies
e.g. Mobile Videophones
1980
Technology driven
1990
Disappointment
Healthcare Professionals:
Sit on the fence or Resist
Richardson Consulting UK Ltd
December 2000
“I told you so !”
HELP!!!!!
Accept the inevitable and
want control
The Telemedicine Market
USA
(1)
Europe
1997 - $643 Million
Euro 50 Million
2002 - $3000 Million
Euro 542 Million
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The Telemedicine Market
What about the rest of the world?
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(2)
The Telemedicine Blueprint
Malaysia
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
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Centum City Telemedicine Project
Richardson Consulting UK Ltd
Centum 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
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Centum City Telemedicine Project
Mobile Population
•Mercantile Shipping
•Ship owners
•Seamans Unions
•Cruise Lines
- Star Cruises
•Airlines
- Korean Air
Richardson Consulting UK Ltd
Centum 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
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Centum City Telemedicine Project
Medical Tourism
Telemedicine
links
USA
EUROPE
AUSTRALIA
The Spokes
Richardson Consulting UK Ltd
(For 24hr medical coverage)
The New Technologies
Videophones
Ultrasound Scanner
Videophone
X-Ray Camera Bed
ISDN/InterNet
Camcorder
Videophone
Minor Injury Unit
Group Conference System
Hospital
Motion Media Technology
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Eyesite 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 Technology
Richardson Consulting UK Ltd
Communications
System Overview
Richardson Consulting UK Ltd
Thematic Working Group 2
EHTEL
• 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
Richardson Consulting UK Ltd
Thematic Working Group 2
Activities (2000)
March
April
May 9th
- TWG2 Established
- Chair Appointed
- Membership Assembled (50 - September 2000)
- Draft Action Plan Submitted
- Draft Budget Submitted
- Preparation for Pro-EHTEL Negotiations
- First Meeting - DTI (UK) London
- Action Plan agreed - for implementation
- Budget Approved
- Treasurer Appointed - Dr Stephan Schug (DK)
-
DTI (UK) offer to provide Secretariat Role
Richardson Consulting UK Ltd
Thematic Working Group 2
Activities (2000)
October/November
- Website Development Defined and Agreed and Content provided
- Phase Two Action Plan Defined and Budget set
- PRO-EHTEL Funding Secured, Supplemented by Industry
- Agreements with Industry Partners on Physical Demonstration sites
- Promotion of e-Health/Telemedicine at all levels throughout Europe
• Ministers of Health
• Private Sector
• Telemedicine e-Health Conferences
• Key HealthCare Decision Makers
- Articles written and published on e-Health in European Journals
- Promotion of European e-Health and Telemedicine beyond Europe
Richardson Consulting UK Ltd
Thematic Working Group 2
Activities (2001 and Beyond)
January 2001 - July 2003 - PRO-EHTEL
- Further Development of Virtual Demonstration Website
- Establishment of Three (3) Physical Demonstration Sites
- Active Promotion of e-Health and Telemedicine across Europe
- Growing List of Industry Partners become members
of EHTEL/TWG2
- TWG2/EHTEL acts as a Core Central Resource for:
• European Commission
• Governments of European Member States
• Other Parties interested in European Medical Services
Richardson Consulting UK Ltd
Healthcare Delivery
in the new Millennium
Where 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}
Richardson Consulting UK Ltd
Future environment
Drivers of change
ISDN
CABLE
LAN-WAN
WIRELESS
NETWORKS
e-COMMERCE
C-HEALTH
Health Contact
CENTRE
e.g.NHS DIRECT
FIXED &
MOBILE VIDEO
PRODUCTS
MEDICAL
DEVICES &
VITAL SIGNS
MONITORING
Richardson Consulting UK Ltd
ELECTRONIC
HEALTH
RECORD
Government Health Warning!
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
Richardson Consulting UK Ltd
YES the internet is insecure
Would you
trust an
electronic
message
that came
to you
from an
unknown
company in
Colombia,
Moscow, or
China?
Lack of trust in an open
system is preventing growth
It doesn’t have to be that way
Richardson Consulting UK Ltd
These folks operate e-health in the most
litigious society on earth
They protect
their business
with standards
based security
protocols
They can’t
afford to take
any risks
…and neither
can you
Richardson Consulting UK Ltd
There is plenty of technology
that enables Internet security
This technology requires
Trusted Service Providers
to manage it
International e-health standards
have been developed for: Credential checking
Authentication
Rights management
Access
Signing
Certification
Audit
d
de la Rue / Presideo
Richardson Consulting UK Ltd
TeleHealth
Remaining Issues
• Universal language
• International - intergalactic? –
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•
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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
tomorrow’s world????????
Richardson Consulting UK Ltd
The 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?
Richardson Consulting UK Ltd
The Developing World
Can leap-frog the traditional evolutionary process
The Informed Community
Freestanding
Diagnostic
Centres
3°
HealthCare
Physical
Movement
of
Patients
Home
Care
Health day-care
Kiosks Surgery
Community
Hospitals
Cottage
Hospitals
(Non-acute)
(Acute)
1° HealthCare
The ‘Super’ Primary Care Physician
Primary
TeleRadiology
and
TelePathology
1°
HealthCare
The Community
?
-
Telemedicine
Clusters of
Specialists
2000 AD
3000 BC
Richardson Consulting UK Ltd
Maternity
Allied HealthCare Professionals
2°
HealthCare
China
Malaysia
Africa
Acute
Trauma
Time
The Golden Health Project
The Telemedicine Blue Print
? Take some responsibility ?
Healthcare Delivery Trends
Consumer pressures
Information
technology
Global Networked
Healthcare
Delivery
mechanisms
Richardson Consulting UK Ltd
TeleHealth
The 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
•
Richardson Consulting UK Ltd
Technology and Skill Transfer
– Use of a global telemedicine
network
Pro-actively – Global CME programme
Mass Public Health Information
Health on-line Websites
Passively
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The Watershed Generation Gap
US
OUR CHILDREN
The seekers
and finders
The filterers
and applyers
HUMAN NEURO-PHYSIOLOGY IS CHANGING
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Mary Lobascher 2000