| Doctors are starting to redesign the way they | | | | images. The consultation itself can be described in |
| work to link better with patients and to use the | | | | both computer language and clinical terms as |
| newly available multi-media technologies. This is an | | | | consisting of three information processes ? data |
| important process that will undoubtedly accelerate | | | | capture (history and examination), data analysis |
| over the next 20 years. There is a need to | | | | (diagnosis), and business planning (treatment). |
| substantially redesign many of the traditional | | | | What we in healthcare need to do is start thinking |
| processes used to practice medicine - and move | | | | like bankers, and focus on providing our services |
| to new ways of delivering health services, using | | | | in a more consumer friendly way. As we do this, |
| what I call ATM Healthcare. | | | | doctors need to follow two core principles. The |
| What, then, is ATM Healthcare? | | | | first is the complementarity principle - computers |
| When we think of the term ATM, most of us | | | | do well, what humans do badly, and vice versa. |
| think of banks. The acronym ATM has entered | | | | Computers never forget, and are great at |
| our language so completely that many people | | | | scheduling, remembering and reminding, but |
| don't even know what the letters stand for - | | | | humans are much better at data analysis and |
| they just know that undertaking an ATM | | | | decision making. So computers should be able to |
| transaction allows money to be drawn direct from | | | | do many simple health transactions, remember |
| their bank account, not from a credit account, and | | | | and order prescriptions and lab tests, schedule |
| that they can do this at a special ATM machine | | | | appointments, and provide preventative health |
| usually in the street, or at a store checkout. ATM | | | | information. The second principle is the importance |
| stands for Automated Teller Machine and is simply | | | | of redesigning business processes before |
| a direct electronic entry to your bank and your | | | | introducing new technologies. There are a lot of |
| accounts. And it is very simple, convenient and | | | | similarities between banking and the practice of |
| consumer friendly. ATM has made banks and | | | | medicine. And doctors can learn from bankers in |
| bank accounts much more accessible to | | | | this area. There is no reason why we should not |
| customers, wherever and whenever they want. | | | | introduce ATM Healthcare, in just the same way |
| At the same time they have made the work of | | | | as bankers have introduced ATM Banking. |
| banks more efficient while dramatically cutting the | | | | What would ATM Healthcare look like? |
| cost of bank transactions to a few cents from an | | | | Firstly, lets assume that, like banking, ATM |
| average of $10-15 per face to face transaction | | | | Healthcare is going to be used for relatively |
| with a teller. This has happened because ATM | | | | straightforward consultations in many specialities, |
| machines now manage most of the simple bank | | | | and will not replace the complicated face to face |
| transactions that used to take up a lot of the | | | | consultation or intervention that makes up about |
| time of tellers. This frees up bank staff to spend | | | | 20% of overall medical consultations, and will |
| more time on complicated transactions where | | | | always remain the health "gold standard" |
| human expertise is required. Who can now | | | | consultation. We already have most of the tools |
| imagine a bank without widespread ATM facilities? | | | | of ATM Healthcare at our disposal. Electronic |
| And all this has happened in just a few years. | | | | Medical Records, lab results and x-ray images are |
| Computer scientists think of ATM in a very | | | | the health equivalent of bank statements. |
| different way. For them ATM is a technical term | | | | Telemedicine - video consulting either in real time |
| describing how data can be passed across an | | | | (synchronous), or delayed time (asynchronous) - |
| electronic network. Here ATM stands for a | | | | is now a proven technology, is already available in |
| protocol called Asynchronous Transfer Mode. This | | | | some supermarket clinics, and is the equivalent of |
| protocol was designed as a way of merging old | | | | the teller machine. Email and wireless telephony |
| telephone networks with more modern | | | | provide more mobile access to providers, and the |
| packet-switched computer networks in order to | | | | whole internet is an amazing educational and clinical |
| deliver data, voice, and video over the same | | | | communication platform that is already delivering |
| channel. In other words it allows all sorts of | | | | all sorts of ATM Healthcare. We have lots of |
| differing data, from varying data sources, to be | | | | systems to combine different types of data and |
| delivered at the same time. | | | | present them simultaneously to doctors and |
| So what have these two types of ATM have to | | | | patients, just as per the computer scientists |
| do with healthcare? | | | | version of ATM. |
| Think of the obvious parallels. | | | | Patients need to encourage doctors to think of |
| The doctor-patient consultation is in many ways | | | | ways of redesigning their practice processes to |
| similar to the traditional bank interaction with a | | | | make better use of available multimedia |
| teller. It is confidential, about 80% of consultations | | | | technologies so that they can continue to provide |
| are relatively simple, and if complications arise, a | | | | better and more available care. I am sure this will |
| second person can be called in to give specialist | | | | happen, especially as more of the younger |
| advice. There are also parallels with the computer | | | | generations start receiving care. They will demand |
| scientist ATM, because this consultation nowadays | | | | that doctors use these technologies, and |
| involves typically several different types of data - | | | | increasingly change their ways, and hopefully use |
| voice, lab results, paper and electronic documents | | | | the example of banking as we move increasingly |
| (health records), and increasingly video and digital | | | | to ATM Healthcare. |