The 2nd EHTEL ConferenceThe 2nd EHTEL ConferenceRotterdamRotterdam

18th September 200118th September 2001

T2T2--eeHealthHealth Working Group Working Group ReportReport

Dr Ricky J RichardsonDr Ricky J RichardsonBSc MBBS MRCP(UK) FRCP FRCPCH BSc MBBS MRCP(UK) FRCP FRCPCH

DCH DTM&HDCH DTM&HChairman Chairman -- UK Telemedicine AssociationUK Telemedicine Association

Chairman Chairman -- T2T2--eHealtheHealth Thematic Working Group Thematic Working Group -- EHTELEHTELBoard Member Board Member -- International International eHealth eHealth AssociationAssociation

Chairman and CEO Chairman and CEO -- Richardson Consulting UK Limited Richardson Consulting UK Limited Consultant Physician Consultant Physician -- Great Ormond Street Hospital for ChildrenGreat Ormond Street Hospital for Children

The Portland Hospital for Women and ChildrenThe Portland Hospital for Women and ChildrenThe Speech, Language & Hearing Centre, LondonThe Speech, Language & 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 professionalsprofessionals !!!!!!!!

Dr Dr Haflan Mahler Haflan Mahler -- DG Emeritus DG Emeritus -- WHOWHOafter Oscar after Oscar WildeWilde

Who will be the Who will be the primary care primary care

physician of the physician of the future?future?

The The eePatientPatient

What is What is eeHealthHealth??

The (The (ee)ATM of )ATM of HealthcareHealthcare

eeHealthHealth!! Clinical ApplicationsClinical Applications

MonitoringMonitoring TelTeleeConsultationsConsultations

Clinical Decision Making Support SoftwarClinical Decision Making Support Softwaree

Vital Signs ServicVital Signs Serviceess

TeleHomTeleHomeeCareCare

!! eeDisseminationDissemination of Healthcare Professional Educationof Healthcare Professional Education

!! Public Health Public Health eeducation & Informationducation & Information

!! LifeTimeLifeTime Health RHealth Reecords cords -- longitudinal healthcare longitudinal healthcare event recordingevent recording

!! eeHealthHealth ServicesServices-- National National eePrescribingPrescribing ServicesServices-- HomeCarHomeCaree MonitoringMonitoring-- eeNursingNursing-- Ministry of Health online Ministry of Health online wweebsites bsites

The Paradigm ShiftThe Paradigm Shift

The The SevenSeven Drivers Forcing ChangeDrivers 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 support for clinical decisions -- Telemedicine Telemedicine & & eeHealthHealth

•• More informed and expectant patients More informed and expectant patients CC--HealthHealth•• The wellThe well--being factor 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 Primary/Preventative CareCareThe wellThe well--being factor being factor

eHealtheHealthPartnershipsPartnerships betweenbetweenPublic & Private SectorsPublic & Private Sectors

Change in HealthcareChange in HealthcareDelivery MechanismsDelivery Mechanisms

19501950 2000200019901990

EurosEuros

20102010201020102010201020102010

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 well-being factor

PRIMARY TELERADIOLOGYPRIMARY TELERADIOLOGYAND TELEPATHOLOGYAND TELEPATHOLOGY

eeHealth &Health &TelemedicineTelemedicine

Clusters of Clusters of Specialists withSpecialists withGlobal AccessGlobal Access

Allied HealthCare Professionals

Primary HealthCareThe ‘Super’ Primary Care Physician

CommunityHospitals

(Acute)

CommunityHospitals

(Non-acute)

Freestanding Diagnostic

CentresHomeHomeCareCare

HealthKiosks

DayCareSurgery Maternity

AcuteTrauma

??

Direct Access to specialistsDirect Access to specialistsWWWWWW IDTVIDTV IDTVIDTV WWWWWW

The Informed Wired upInformed Wired up Citizen Community

CC--HealthHealth

The Paradigm ShiftThe Paradigm ShiftThe ImpactThe Impact

••Healthcare ProfessionalsHealthcare Professionals• Healthcare practices Healthcare practices -- changing roleschanging roles• • Healthcare trainingHealthcare training• • Financial remuneration/rewardsFinancial remuneration/rewards• • Healthcare vocationHealthcare vocation

PatientsPatients•• Partners Partners in the healthcare in the healthcare processprocess

• • Interactive Video Conferencing Interactive Video Conferencing -- 19801980• • TeleTele--Radiology, USA Radiology, USA -- 19901990• • International Telemedicine International Telemedicine -- 19941994• • The Telemedicine Blueprint, Malaysia The Telemedicine Blueprint, Malaysia -- 19971997• • Telemedicine “Comes of Age” Telemedicine “Comes of Age” -- 1998 1998 --

TeleHealth ? TeleHealth ? TeleCare TeleCare ? Citizen? Citizen--Health?Health?• • Telemedicine becomes “Medicine” Telemedicine becomes “Medicine” -- 19991999

•• eeHealthHealth : The Road Ahead : The Road Ahead

20012001

TelemedicineTelemedicineThe story so farThe story so far

Integration of ITIntegration of ITinto Business Sectorsinto Business Sectors

Inte

gra

tio

n o

f IT

Inte

gra

tio

n o

f IT

IT as a gadgetTrojan horse: networks, …Full Integration of IT into Business (Organisational, Legal) Re-engineering of the system

19801980 19901990 20002000 JeanJean--Claude HealyClaude HealyMay 2000May 2000

(Banks) (Health…)ManufacturingManufacturing Business ServicesBusiness Services Public ServicesPublic Services

• General Hospitals become a thing of the past • General Hospitals become a thing of the past

The The eHealtheHealth Future

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 Technologies

19801980 19911991 October October 20012001

ICT Solutions inICT Solutions in

Healthcare deliveryHealthcare delivery

European Health European Health TelematicsTelematics AssociationAssociationEHTELEHTELMissionMission

••To develop a To develop a Pan European StrategyPan European Strategy for for coherent healthcare provision for all Eurocoherent healthcare provision for all Euro--citizens through health citizens through health telematicstelematics••To bring healthcare services To bring healthcare services into the homeinto the home of of every Euroevery Euro--citizencitizen••To facilitate this process by:To facilitate this process by:--

•• Overcoming regulatory barriers, Overcoming regulatory barriers, •• Allowing remuneration flow and Allowing remuneration flow and •• Identifying (and if necessary developing)Identifying (and if necessary developing)

appropriate technologiesappropriate technologies

• • To make medical servicesTo make medical services -- wheresoeverwheresoeversourcedsourced -- ubiquitously available across ubiquitously available across EuropeEurope

• • To promote To promote eHealtheHealth & Telemedicine across & Telemedicine across Europe at all levelsEurope at all levels

• • To identify To identify barriersbarriers to to eHealtheHealth & Telemedicine & 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 2 Thematic Working Group 2 -- EHTELEHTEL

T2 T2 eHealtheHealth

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

MarchMarch -- TWG2 EstablishedTWG2 Established-- Chair AppointedChair Appointed

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

May 9th May 9th -- First Meeting First Meeting -- DTI (UK) LondonDTI (UK) London-- Action Plan agreed Action Plan agreed -- for implementation for implementation -- Budget ApprovedBudget Approved-- Treasurer Appointed Treasurer Appointed -- Dr Stephan Dr Stephan Schug Schug (DK)(DK)-- DTI (UK) offer to provide Secretariat RoleDTI (UK) offer to provide Secretariat Role

Thematic Working Group 2Thematic Working Group 2Activities (2000)Activities (2000)MayMay-- Selected Industry Players “Sounded Out” for participationSelected Industry Players “Sounded Out” for participation-- Action Plan Amended (17th May) and ReAction Plan Amended (17th May) and Re--circulatedcirculated-- EHTEL agree to fund Feasibility Phase (30KEuro until 30th JuneEHTEL agree to fund Feasibility Phase (30KEuro until 30th June))-- ProPro--EHTEL Negotiations (140K Euro for TWG2 Requested)EHTEL Negotiations (140K Euro for TWG2 Requested)

June 16th June 16th -- Second Meeting Second Meeting -- DTI (UK) LondonDTI (UK) London

-- Website Development Sub Committee Appointed and Tasks setWebsite Development Sub Committee Appointed and Tasks set-- Revised Action Plan Revised Action Plan --Phase One Phase One -- and Revised Budget Agreedand Revised Budget Agreed-- Promotional Activities and Speakers for European Telemedicine Promotional Activities and Speakers for European Telemedicine

Conferences AgreedConferences Agreed-- Terms of Reference for Industry Invitation Agreed Terms of Reference for Industry Invitation Agreed

Thematic Working Group 2Thematic Working Group 2

Activities (2000)Activities (2000)JuneJune-- Virtual Demonstration Website DevelopmentVirtual Demonstration Website Development

Specification DraftedSpecification Drafted-- Presentations madePresentations made

Gothenburg, SwedenGothenburg, SwedenGenoa, ItalyGenoa, ItalyDept of Health, London, United KingdomDept of Health, London, United Kingdom

-- Industry Players invited informally to participateIndustry Players invited informally to participate

Thematic Working Group 2Thematic Working Group 2Activities Activities -- July July -- December 2000December 2000

Monthly Meetings hosted by Dept Trade & Industry Monthly Meetings hosted by Dept Trade & Industry London London -- 25 to 30 active members25 to 30 active members

•• WebsiteWebsite Design Specification Tendered & Design Specification Tendered & CommissionedCommissioned

•• Position Paper for the development of Position Paper for the development of eHealth eHealth -- EuropeEurope

•• Presentations at all European Health ConferencesPresentations at all European Health Conferences

•• Face to Face Presentations with Ministers of HealthFace to Face Presentations with Ministers of Healthand Political Decision Makers and Political Decision Makers across Europeacross Europe

Thematic Working Group 2Thematic Working Group 2Activities Activities January January -- October 2001October 2001

Monthly Meetings Continue………………………... Monthly Meetings Continue………………………...

January January -- JuneJune -- London, UKLondon, UK hosted by DTIhosted by DTI

July July -- Frankfurt, GermanyFrankfurt, Germany hosted by hosted by SiemensSiemens

September September -- TriesteTrieste, Italy, Italy

October October -- Rotterdam, HollandRotterdam, Holland

((November November -- Ipswich, UK Ipswich, UK hosted by BThosted by BT))

Thematic Working Group 2Thematic Working Group 2Activities (2001)Activities (2001)

T2 T2 eHealth eHealth WebsiteWebsite Design Team Design Team Dr Dr Aase Tveito Aase Tveito -- ChairpersonChairpersonDr StephanDr Stephan SchugSchugAndrew Andrew RuckRuckDr Dr Gudrun ZahlmannGudrun Zahlmann(Dr Ricky Richardson)(Dr Ricky Richardson)

Designed…………….Designed…………….by GEMISISby GEMISISBuilt Built ……Oxford Computer Consultants.……Oxford Computer Consultants.Populated with Content !!!Populated with Content !!!

Launch starts October 2001Launch starts October 2001

Thematic Working Group 2Thematic Working Group 2Activities (2001)Activities (2001)

Presentations Presentations EuropeEurope

Conferences across EuropeConferences across EuropeHealth Forum Health Forum -- GasteinGastein, Austria , Austria --

Sept 2001Sept 2001

InternationallyInternationallySaudi Arabia, Brazil, BruneiSaudi Arabia, Brazil, BruneiMalaysia, Singapore, South Malaysia, Singapore, South Korea, New ZealandKorea, New ZealandSouth Africa, USASouth Africa, USA

Thematic Working Group 2Thematic Working Group 2Activities (2001)Activities (2001)

Industry Liaison:Industry Liaison:TeleCommsTeleComms

British British TeleCommTeleComm

Engineering and Systems IntegrationEngineering and Systems IntegrationBAE SYSTEMSBAE SYSTEMS

PharmaceuticalPharmaceuticalGlaxoSmithKlineGlaxoSmithKline

TechnologyTechnologyMotion Media TechnologyMotion Media Technology

Clin

ical

app

licat

ion

CM

E

Publ

ic H

e alth

Info

r ma t

ion

Life

Tim

e H

ealth

Pla

n

TeleTele--ConsultationsConsultations

Clinical Support Clinical Support SoftwareSoftware

Vital Signs Vital Signs MonitoringMonitoring

TeleHomeCareTeleHomeCare

eeDisseminationDisseminationHealthcare Healthcare ProfessionalsProfessionalsContinuing Continuing EducationEducation

National Healthcare trend analysis & ePrevention

eeHealthHealth

Public Health Information &Education

Schools

Health websites

The Paradigm ShiftThe Paradigm Shift

Where have we reached?••

The Revolution is OVER !The Revolution is OVER !eeHealthHealth is Theis The

eeVOLUTIONVOLUTION!!

eeHealthHealth!! TelTeleeConsultations Consultations YES YES -- SOMESOME!! eeDisseminationDissemination of Healthcare Professional of Healthcare Professional

EducationEducation NOT YETNOT YET

!! Public Health Public Health eeducation & Information ducation & Information SOME SOME BUT NOT FOCUSED OR UNIFORMBUT NOT FOCUSED OR UNIFORM

!! LifeTimeLifeTime Health RHealth Reecords cords NONO

!! eeHealthHealth ServicesServices A LITTLEA LITTLE-- National National eePrescribingPrescribing ServicesServices-- HomeCarHomeCaree MonitoringMonitoring-- eeNursingNursing-- eeMinistryMinistry of Health online of Health online websites websites

The Opportunities for EuropeThe Opportunities for Europe•• Partnerships Partnerships with Premier Healthcare with Premier Healthcare

Providers worldwideProviders worldwide•• Technology Technology Innovation and DevelopmentInnovation and Development•• Best practiceBest practice Implementation on a large Implementation on a large

scalescale•• EvaluationEvaluation of clinical and cost benefitsof clinical and cost benefits

The European Community will be 500 The European Community will be 500 million Euromillion Euro--citizens by Deccitizens by Dec 20042004

Future Future eeHealthHealth environmentenvironmenteHealth eHealth ServicesServicesISDN

CABLELAN-WAN

WIRELESS NETWORKS

Health ContactHealth ContactCENTRECENTRE

e.g.NHS DIRECTe.g.NHS DIRECT

Drivers of Drivers of changechange

MEDICAL DEVICES &

VITAL SIGNSMONITORING

FIXED &MOBILE VIDEO

PRODUCTS

ELECTRONIC HEALTH

RECORDS

TheThe Healthcare TeamHealthcare TeamDoctors,Nurses,Technicians,AdministratorsDoctors,Nurses,Technicians,Administrators

If you want to If you want to workwork as a teamas a team

You must You must traintrain as a teamas a team

Tan Sri Tan Sri Dato Dr Dato Dr Abu Abu Bakar Bakar bin bin SuleimanSuleimanMay 2001 May 2001 -- JeddahJeddah

TheThe eeHealthcareHealthcare TeamTeamDoctors,Nurses,Technicians,AdministratorsDoctors,Nurses,Technicians,Administrators

Integration of Health SciencesIntegration of Health Sciencesis the utmost priorityis the utmost priorityto train the future to train the future eeHealthcareHealthcareprofessionalsprofessionalsTrain as a Team, Work as a TeamTrain as a Team, Work as a TeamPlace the Patient at the centre of Place the Patient at the centre of

CareCare

Is this acceptable in our world?Is this acceptable in our world?

The Developing World The Developing World Can leapCan leap--frog the traditional evolutionary processfrog 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° HealthCareThe ‘Super’ Primary Care Physician

CottageHospitals

(Acute)

CommunityHospitals(Non-acute)

HomeCare

HealthKiosks

day-careSurgery

FreestandingDiagnostic

CentresMaternityAcute

Trauma

Telemedicine

PrimaryTeleRadiology

and TelePathology

eeDisseminationDisseminationof Healthcare Professionalof Healthcare Professionaleeducationducation & public & public health informationhealth informationleads to leads to eePreventionPrevention

Health Equity for the Health Equity for the global communityglobal community

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 professionalsprofessionals !!!!!!!!

Dr Dr Haflan Mahler Haflan Mahler -- DG Emeritus DG Emeritus -- WHOWHOafter Oscar after Oscar WildeWilde