[Please note that the views presented by individual contributors are not necessarily representative of the views of ATCA, which is neutral. ATCA conducts collective Socratic dialogue on global opportunities and threats.]

We are grateful to Professor Ricky Richardson for his submission to ATCA, "Entering the Citizen-centric Bio Intelligence Age -- The Asymmetric Role of eHealth in Healthcare Systems Transformation worldwide."

Dear DK and Colleagues

Re: Entering the Citizen-centric Bio Intelligence Age -- The Asymmetric Role of eHealth in Healthcare Systems Transformation worldwide

The Asymmetric Role of eHealth

The term eHealth is being used increasingly as a generic expression to refer to any form of IT enabled health system reform. eHealth addresses both changes in the access of healthcare information and services as well as the wider dissemination of healthcare related skills and specialist expertise into the community, into the home, and ultimately to the individual. This transformation -- enabled by eHealth -- challenges the traditional roles of hospitals and clinics where healthcare exchange has always taken place previously. The next phase includes the use of mobile devices to provide a user-friendly interface and a conduit for healthcare providers to bring healthcare services directly into the personal space of the world citizen.

NHS (National Health Service) Connecting for Health in England is arguably the largest single eHealth project on the planet but future developments are likely to be in the domain of mobile applications and services personally configured and delivered directly to each member of the community according to his/her health related needs.

We are entering the Bio Intelligence Age, where there is convergence of the biological sciences, physical and engineering sciences and information technology. The unravelling and understanding of the human genome will allow us to analyse the genetic fingerprint either before or at birth and thus predict some of the health risk throughout the lifetime of the individual. Biomathematics is now being applied to the science of medicine.

The demographic changes, which are a global phenomenon, with an increasing population of senior citizens reaching 65 years of age and beyond is unmasking chronic and non-communicable diseases, which are swamping current healthcare services and consuming between 60-70% of national healthcare budgets. This problem is going to get worse.

In developed counties, there is now between 16-20% of the population over 65, but this trend can be partially balanced by falling birth rates. In developing countries, however, like Mexico, there is both an increasing number of over 65 year olds and the birth rate continues to rise. This trend will place an increasing burden on healthcare systems in the years to come, thus begging the question as to who will support the health and welfare systems of the world, in the future.

We have not yet achieved full integration of IT into healthcare services around the world. The manufacturing and the financial services industries adopted IT over a period of 5-10 years during the 80s and 90s respectively. In the healthcare sector, we are just emerging out of the phase when networks are being developed, but complete IT integration will follow rapidly. The term eHealth is widely misunderstood.

It is best defined by Professor Jean Claude Healy of the World Health Organisation (WHO), who says, "eHealth is the instrument for productivity gains in the context of existing healthcare systems, but also provides the backbone for the future citizen centred environment."

We are truly at the dawn of the age of citizen centric healthcare systems. In future, the only healthcare plan will be yours. eHealth can conveniently be allocated into four major domains:

The first domain embraces those clinical applications, which include individual electronic health records, Tele-consultation and the use of video conferencing, clinical decision making support software, vital signs monitoring services for those with chronic disease, Tele-homecare, the emerging field of ambulatory eHealth and the wearing of smart clothing, such as eWear for continuous monitoring of vital sign parameters, the deployment of national ePrescribing and eBooking systems, eNursing and National Picture Archiving Communication Systems (PACS).

The second domain addresses the use of eLearning tools and the worldwide web to deliver personalised healthcare professional continuing education. As the half life of medical knowledge shrinks, it is important for all those working in the healthcare sector to keep their skills and knowledge base, current.

The third domain addresses public health education and information. There is an under-use of media channels to inform citizens to increase self help in relation to healthcare matters and consequently change healthcare demand profiles. The impact of appropriate healthcare knowledge imparted to the individual citizen will reduce the demand on healthcare systems for conditions which could be self treated or perhaps treated in the community environment by increasing the involvement of pharmacists, for example, in the health knowledge pool.

The fourth domain to explore is the use of aggregated individual electronic healthcare records, which capture longitudinal healthcare events for each individual citizen. By aggregating key elements of the data, one could achieve population based tracking of population based health trends in real time, leading to advance prediction and anticipation of hostile disease trends and thus initiate prevention strategies.

Perhaps the biggest impact of these new models of healthcare access and delivery in the immediate future, will be on the primary care teams. Increasingly, patients will arrive for a consultation with the family doctor, already well informed about their condition with opinions, (possibly strong opinions), about management and treatment options.

Patient web communities have already been set up, where strangers with similar medical conditions communicate with each other and therefore add to the care pathway. I wonder if the family doctor will eventually become a “wellness guardian” and there will be a separate service geared to respond to acute problems possibly through a call centre model, such as NHS Direct.

It is important to understand that Telemedicine and eHealth are only one of a number of drivers, which are impacting on healthcare delivery and thus changing healthcare models:

. There is a universal search for cost containment as healthcare costs spiral out of control.

. The demographic changes are impacting heavily, especially unmasking patients with chronic disease.

. There is the increasing ability to provide both diagnostic and treatment services on an ambulatory basis.

. Disease patterns are changing globally.

. Globalisation is enabling us to share resources across international borders and this applies to healthcare.

. Epicentres of medical excellence are emerging with specialist expertise, such as cardiac centres or oncology, which can now be spread regionally or indeed globally through eHealth.

The differing time zones could be used to advantage with radiologists, for example, living in India, who are awake during office hours, being able to provide primary readings for hospitals in the UK during the night, thus removing the need to hire expensive UK radiologists to work or be on call during the night hours.

The issues in Europe are focused on an ageing population and the spiralling costs of looking after those older citizens with chronic disease. Countries who have recently joined the European Community have very different levels of service delivery and healthcare outcomes. Given the ability to share healthcare resources across borders using eHealth, it may be possible to substantially improve levels of care in a number of newly joined countries. This may impact adversely on those European member states who currently enjoy high standards of healthcare provision.

There is a universal realisation that the present healthcare models are unsustainable in financial terms and thus need radical rearrangement. The solutions are to drive the interface point of care outwards and out of current buildings (hospitals & clinics) and to use eHealth as a platform in order to achieve this transformation. It will be necessary to migrate both patients and healthcare professionals across borders and to reconfigure the professional eHealthcare team as well as to reconfigure the infrastructures involved.

Conclusion

. The challenges for the future are not technological, but are focused upon persuading colleagues who work within the healthcare sector to embrace the new technologies, applications and services and to consider how this might change the way they practice and work.

. The patients need to move away from a fixation around their local hospital and consider improved means of looking after their own health and disease processes.

. The adoption of eHealth and the consequent health system transformation is not an easy journey.

. There are sufficient examples, however, from around the world that alternative approaches to healthcare delivery are workable and are now imperative if we are to continue to enjoy high standards of healthcare provision in our respective countries.

. Our children and grandchildren deserve better healthcare provision than we currently enjoy today.

Best

Ricky Richardson

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Professor Ricky J Richardson is an internationally acknowledged authority on the emerging fields of eHealth and Telemedicine. He was Chairman of the UK eHealth Association from 1999–2006 and he is now Life President. He served as Chairman of the Pan European eHealth Working Group of The European Health Telematics Association (EHTEL) from 1999 to 2003. EHTEL is a European Commission funded body -- mandated to promote and to implement eHealth and Telemedicine activities across the whole of the European Community. He served on the governing Board of EHTEL from 2001–2003. He currently serves as one of the founding board of directors of the European eHealth Forum. He was elected Vice-President of the International Society for Telemedicine and eHealth – ISfTeH – in September 2003. Professor Richardson is a Fellow of the Royal College of Physicians, a Fellow of the Royal College of Paediatrics and Child Health, a Fellow of the Royal Society of Medicine and a Fellow of the Royal Society of Tropical Medicine. He was appointed as Visiting Professor in eHealth to Imperial College, London, in February 2004. He was appointed to the UK Focus Group of The Royal Academy of Engineering in May 2005. He serves as one of the judges of Medical Futures, a national award scheme to recognise innovation in Healthcare.

In 1986, Prof Richardson was appointed Honorary Consultant Physician at Great Ormond Street Hospital for Children, a position he held until October 2005. He was founding chairman of The Great Ormond Street Hospital for Children’s Telemedicine and eHealth Committee (2001-2004). He is a general paediatrician with a special clinical interest in children with specific learning and behavioural difficulties. He is Group Clinical Director at HealthSystems Group Limited. Prof Richardson also acts as senior eHealth advisor to several large commercial organisations who are establishing global eHealth strategies. He has worked for Save the Children Fund -- a UK based global charity -- in Burkina Fasso, West Africa and Nicaragua, Central America. In 1983, he had conferred on him, the title of Dato (The Most Honourable Order of the Crown of Brunei) by His Majesty The Sultan of Brunei, for his services to the children of Negara Brunei Darussalam. On leaving Brunei in 1985, he spent two years in Muscat in the Sultanate of Oman as Senior Paediatric Consultant and advisor to the Ministry of Health. In 1986, he returned to the United Kingdom to take up an academic position in the University of London firstly as Lecturer and then as Senior Lecturer in International Child Health, and he was appointed Sub-Dean (Clinical) of the Institute of Child Health. During this period, he performed numerous overseas consultancies for international aid agencies, including UNICEF, UNWRA, the Overseas Development Administration (ODA), The British Council and Save the Children Fund. In 1990, he co-founded WhizzKidz, a children’s charity that has become the largest supplier of mobility aids and specialist services to disabled children outside of the NHS (National Health Service).

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We look forward to your further thoughts, observations and views. Thank you.

Best wishes

For and on behalf of DK Matai, Chairman, Asymmetric Threats Contingency Alliance (ATCA)

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ATCA: The Asymmetric Threats Contingency Alliance is a philanthropic expert initiative founded in 2001 to understand and to address complex global challenges. ATCA conducts collective Socratic dialogue on global opportunities and threats arising from climate chaos, radical poverty, organised crime, extremism, informatics, nanotechnology, robotics, genetics, artificial intelligence and financial systems. Present membership of ATCA is by invitation only and has over 5,000 distinguished members: including several from the House of Lords, House of Commons, EU Parliament, US Congress & Senate, G10's Senior Government officials and over 1,500 CEOs from financial institutions, scientific corporates and voluntary organisations as well as over 750 Professors from academic centres of excellence worldwide.

The views presented by individual contributors are not necessarily representative of the views of ATCA, which is neutral. Please do not forward or use the material circulated without permission and full attribution.

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intentBlog:

The Citizen-centric Bio Intelligence Age

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