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www.healthsysconsult.co.uk Med-e-Tel Luxembourg 18th April 2008 Professor Ricky J Richardson Life President Chairman Vice President Founding Director Group Clinical Director Visiting Professor – eHealth Co-Chairman UK eHealth Association eHealth Working Group - EHTEL European Commission - 1999 – 2003 International Society for Telemedicine & eHealth European eHealth Forum HealthSystems Group of companies Imperial College, London Commonwealth eHealth Initiative Consultant Paediatrician – practicing at:- Great Ormond Street Hospital for Children, London The Portland Hospital for Women & Children, London The Child and Family Practice, 57A Wimpole Street Princess Margaret Hospital (BMI), Windsor www.healthsysconsult.co.uk www.healthsysconsult.co.uk Take Home Messages Mobile eHealth applications Location Neutral - Transborder Transactions Infrastructure - Radical Revision Personalised Healthcare Delivery Groups of countries sharing healthcare resources, medical knowledge and skills www.healthsysconsult.co.uk eHealth-Health System Transformation C19th Chemistry Pharmaceuticals C20th Physics Imaging C21st ICT Knowledge based Healthcare Prof Yunkap Kwankam WHO 2007 www.healthsysconsult.co.uk eHealth-Health System Transformation 1990 – 2000 Telemedicine and eHealth Pilot Projects plus Malaysia (national programme) 2000 – 2005 The First National eHealth Programmes – NHS Connecting for Health 2005 to 2015 Regional eHealth Networks The Commonwealth ePortugese Network Many others………….. www.healthsysconsult.co.uk The Biological Continuum Population Whole Body Systems Organs Tissue Cells Proteins Genes www.healthsysconsult.co.uk The Care Continuum Home Care Primary Care Secondary Care Tertiary Care Population The T Model of Healthcare after Atun and Kitney © 2008 Systems Organs Tissue Cells Proteins Genes The Biological Continuum Whole Body Telecare www.healthsysconsult.co.uk eHealth-Health System Transformation In Future - the only Healthcare Plan will be YOURS!!!! Prof Richard Kitney -2005 www.healthsysconsult.co.uk Health Transition Demographic transition THE TIME BOMB !! Epidemiological transition Fertility declines Infectious Disease Mortality declines Population ages Chronic and non Communicable Diseases emerge Copyright Professor Rifat Atun – Imperial College www.healthsysconsult.co.uk Population ageing and health The next 50 years ! 1995 to 2045 More developed countries 160 140 1 4 0 Less developed countries 600 500 120 400 100 80 300 60 200 40 100 20 0 0 1995 2005 2015 2025 2035 2045 1995 2005 2015 2025 2035 2045 80 1 4 0 Least developed countries 70 60 Under 65s 65s and over 50 40 30 Estimated future numbers of dependent people by age 20 10 0 1995 2005 2015 2025 2035 2045 www.healthsysconsult.co.uk Demographics Ageing population - Implications Increased Dependency ratio Increased cost of long term care Who will support the health and welfare system in the Future? www.healthsysconsult.co.uk Pakistan at a glance Country Profile: Population: 156 million GDP Real Growth rate: 6.6% (2005) But GDP per capita: approx $2225 Population living below the national poverty line (2004/05): 32% Total health expenditure as % of GDP: 2.4 Maternal Mortality Rate: 320 / 100,000 Infant Mortality Rate: 80 / 1,000 (almost one in ten children die before their first birthday) 12 www.healthsysconsult.co.uk Pakistan – a potential exemplar? • Pakistan is a transitional economy country that has made major strides in its development, there are however… - Alarming health indicators such as high infant and maternal mortality rates - This has been compounded by social welfare indicators such as low GDP per capita • With the new political dispensation there is an opportunity to transform Pakistan’s Health System. • Some health problems can be classed as ‘wicked’– that is their resolution may in practice involve a trade off between potentially conflicting public expectations of government’s role i.e. • Government as a guardian of cultural and religious traditions vs. • Reproductive health policy • Women in the workforce • In certain situations, non government organisations may have more freedom to act 13 www.healthsysconsult.co.uk Specific healthcare priorities for Pakistan 1. Improving Health Services 2. Managing Chronic Disease 3. Managing Infectious disease 4. Reaching vulnerable groups 5. Reforming Health policy www.healthsysconsult.co.uk Punjab: Proposed 100 Day Health Actions 1. Emergency services 2. Autonomous Hospital 3. Recruitment and promotion for Doctors / Paramedics 4. Drug Supply 5. Non availability of female doctors 6. Quality of medical education 7. Private Sector Mainstreaming 8. Minimum service delivery standards 9. Renal dialysis 10. Control of Infectious Hepatitis 11. Drug Act 2007 www.healthsysconsult.co.uk eHealth …….is:the instrument for productivity gains in the context of existing healthcare systems but also provides the backbone for the future citizen centred healthcare environment Jean-Claude Healy World Health Organisation September 2004 www.healthsysconsult.co.uk Healthsystems Transformation eHealth Public Health Improvement - Epidemiology Patient Learning – use of media channels Care Provider eLearning Clinical Applications Health Informatics - Medical Devices www.healthsysconsult.co.uk Who needs eHealth? www.healthsysconsult.co.uk She does !!! www.healthsysconsult.co.uk He does. www.healthsysconsult.co.uk He does www.healthsysconsult.co.uk They do!!!! www.healthsysconsult.co.uk In Rural India - THEY DO ! www.healthsysconsult.co.uk In rural and urban Pakistan - they do www.healthsysconsult.co.uk What will they all have in common? A mobile phone www.healthsysconsult.co.uk Potential of eHealth to support some policy objectives in Punjab Issue eHealth solution Emergency services Mobile / Telephone / internet based advice to extend service beyond major cities Autonomous Hospital Extend reach of tertiary services via ‘pro poor’ telemedicine clinics delivered from centres of excellence Recruitment and promotion for Doctors / Paramedics Implement ‘professional networking sites’ supported by Government to improve communications / raise morale Drug Supply On-line ordering and monitoring of drug supplies at remote sites www.healthsysconsult.co.uk Mobile Telecare Based on a Primary Care Centre built inside a standard 44 Tonne Container Mobile Primary Care Centre Satellite Footprint 150 Km Medical Centre/Medical Information Centre (EPR, PACS etc) Remote Villages www.healthsysconsult.co.uk Some eHealth initiatives to consider for Punjab Mobile / Telephone / internet based emergency medical advice service ‘Pro poor’ telemedicine clinics delivered from centres of excellence ‘Professional networking sites’ and promotion for recruitment On-line ordering and monitoring service for drug supplies at remote sites Telemedicine consultations by lady doctors based centrally On-line educational tools and access to on line courses for medical students , with associated participation in international regulatory / standardisation Standards based inter-operable eHealth architecture to ensure that private providers can operate seamlessly with public sector www.healthsysconsult.co.uk Where does Web-based Medicine take the Punjab? • Access to the remote expert • Borderless Medicine • Direct access to the international medical market www.healthsysconsult.co.uk Access to the Remote Expert • Integrated medicine across the country – Health Care professionals in more remote areas can have instant access to top specialists without either party leaving their office www.healthsysconsult.co.uk Borderless Medicine • Direct access to international experts – Health Care professionals in Pakistan can have direct access to leading specialists in other countries at minimum cost www.healthsysconsult.co.uk Old Method for Teleradiology Glasgow Transfer of images between the two sites for reading Lahore Images can be lost or incorrectly catalogued www.healthsysconsult.co.uk Web-based Teleradiology No transfer of images between sites –images are viewed and read anywhere. Images stored on a central server Images cannot be lost or incorrectly catalogued www.healthsysconsult.co.uk This is what we have now!! Historical focus of ICT has been on automation not transformation Paper Kills !!!!! Richard Granger - Director General NHS CfH www.healthsysconsult.co.uk www.healthsysconsult.co.uk EU / WHO / Commonwealth initiatives :Countries are forming groups to share scarce health resources, skills and knowledge where they share a common language, culture or heritage. World Health Organisation – Global eHealth Strategy (193 countries) European Community (25 countries) ASEM eHealth Working Group (43 countries) Commonwealth eHealth Programme (53 countries – 1.8 billion citizens) Launch date – 19th May 2008 by Archbishop Desmond Tutu at Commonwealth Ministers of Health Conference – World Health Assembly ePortuguese eHealth Network (9 countries – 250 million citizens) eHealth has become a core pre-occupation of governments worldwide Public Private Partnerships are essential to achieve eHealth goals www.healthsysconsult.co.uk Traditional Healthcare Delivery Model Teaching Hospitals 3° HealthCare Regional Hospitals 2° HealthCare District General Hospitals 1° HealthCare General Practitioners The Patient Community - Bottom of the pile!! Unchanged for 6000 years - circa 3000 BC! www.healthsysconsult.co.uk Future Health System Transformation The Informed Wired up Citizen Community The wellness paradigm C-Health WWW Freestanding Diagnostic Centres IDTV Home Care IDTV Direct Access to specialists Health Kiosks DayCare Surgery Community Hospitals (Non-acute) WWW Community Acute Hospitals Trauma Maternity (Acute) Allied HealthCare Professionals Primary HealthCare The ‘Super’ Primary Care Physician PRIMARY TELERADIOLOGY AND TELEPATHOLOGY ? Clusters of Specialists global spread & universal access ? eHealth & Telemedicine www.healthsysconsult.co.uk We are at the dawn of the age of citizen centric Healthcare Systems www.healthsysconsult.co.uk Emerging trends for telehealth solutions Personalised and home based services: • • • • • Self care home care sensors mobile on line advice – phone / internet Education: • citizen education – HIV in Africa • eLearning Integrated imaging • Integrated dimensions: molecular to whole body • Nationally networked medical equipment • Decision support and quality algorithms Genomics Clinical hot spots (borne out by recent SCT survey in Scotland): • Unscheduled care • Diabetes and long term conditions • Paediatrics • Oncology • Cardiology • Psychiatry www.healthsysconsult.co.uk The Future Biogenetically engineered stem cell mice! Gene targeting Nobel Prize Winners for Medicine 2007 Sir Martin Evans, Mario Capecchi, Oliver Smithies Lord Ara Darzi’s Vision for London •Walk In Treatment Centres •Diagnostics in the High Street •Improved outcomes for Stroke Patients Patients Partners in the healthcare process www.healthsysconsult.co.uk Where are the challenges?? Not the technology ------------------- The People www.healthsysconsult.co.uk HealthSystem Transformation The reasonable man adapts himself to the world; The unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man !!! George Bernard Shaw (1856– 1950) Via Prof Jean Claude Healy World Health Organization September 2005 www.healthsysconsult.co.uk Philosophical Thought Are we the Culpable Generation ? Take Action Now! www.healthsysconsult.co.uk eHealth UK eHealth Association www.ukeha.org.uk International Society for Telemedicine and eHealth www.ISfT.net THANK YOU!!!! Professor Ricky J Richardson [email protected] Mobile +44 7785 231 762 www.healthsysconsult.co.uk