Healthcare@Everywhere in the 21st Century - From Inpatient and Outpatient Settings to Everywhere

Shepherdstown 24 October 2006This article takes a look at the person centered healthcare world of 2020 that will take integrative medicine to the next level. It discusses eHealthcare and Medical Informatics systems and their evolution from being focused on inpatient and outpatient services to providing healthcare services anywhere a person may be - at work, home or play. This article attempts to deliver an overview of some major developments one should be aware of as you prepare to navigate effectively through the next several decades.


The following are some of the innovations that are highlighted:

  • Smart eHealth Record Systems
  • eHealth Advisors (eHAL)
  • Complementary and Alternative Medicine (CAM)
  • Genetic Information Systems & BioRepositories
  • Wearable Intelligence Technology Systems (WITS)
  • eHealthcare & Telehealth

Forces Driving the Need for Innovation and Collaboration

Meeting the needs of people in healthcare is becoming an ever more challenging proposition as costs rise, reimbursement goes down, quality accountability goes up and demands for new treatments increase. Healthcare professionals, politicians and patients are realizing that the current healthcare system, despite all its strengths, is not where it needs to be and must transform.

Simply put, the current system must evolve from a doctor-centered production system to a person-centered, holistic integrated healthcare system supported by advanced medical informatics solutions. The fact of the matter is that each of us is the primary healthcare provider for ourselves - not some doctor. In many ways, people have become their own ConsumerMD, supported by the information systems, technologies and techniques that have emerged and enabled self care.

Some Leading Challenges and Drivers of Change

  • Explosion of Medical Science Knowledge and Technologies - Medical knowledge doubles every couple of years and no doctor can stay on top of things.
  • Human Made Epidemic of Medical Errors - Medical errors have continued to rise as a result of health system complexity and many other factors.
  • Threats of Disasters and Epidemics - Threats of natural or terrorist driven disaster, outbreaks of avian flu or CA-MRSA, and other communicable diseases looms over us.
  • Rising Cost of Healthcare - The cost of healthcare as percentage of United States GNP continues to increase.
  • Live Long and Prosper - The fundamental demand by people is to be properly treated, cared for, cured, and live as long as possible.
  • Unlimited Demand, Finite Resources - Healthcare involves potentially unlimited demands for finite resources. Billions of people across the planet have no access to even the most basic of healthcare services.
  • The Internet and the Rise of Sophisticated Consumers - The Internet has delivered medical knowledge to the fingertips of any person connected. Online health and medical information is making people more aware and more empowered.
  • Person-Directed Care - The responsibility for healthcare costs continues to shift to the consumer.
  • No Access to Affordable Insurance - Because 40 million or more Americans have no health insurance, many conditions are not addressed until it's more costly or too late.
  • Outdated and Uninformed Care - 50 percent of patients' treatment or diagnosis is not based on the most current medical evidence, and 20 to 30 percent of patients receive improper care.
  • Care for the Aging Population - This will be a cornerstone of many acute and chronic disease states for the "Baby Boomers". Given this group's desire to remain young, there will be a robust market for prevention and health maintenance products and services.
  • Self Care or "My Care" - Self care has been a fact of life since the beginning of time. Only in the industrial age of medicine did the myth that "doctors knows best" become widespread. In the "information age" of medicine, the empowered person will seek help from a wide range of professionals and healers to meet their healthcare needs.
  • Here Come the Baby Boomers - The first baby boomers turned 60 in 2006 and the last will be turning 60 around 2020. The baby boomer generation is one of the first that realized that the establishment or the doctor doesn't always know best. This generation also realizes that maintaining health and overcoming illness may require a more integrated, holistic approach than what is currently offered by many providers.

Transforming into a Person Centered Healthcare System

During the next 15 years, the "consumer directed" movement of the early 21st century will evolve and more fully recognize that in healthcare, people do more than consume a product. The healthcare industry will realize that people are not simply patients to be defined by their disease or condition. The healthcare industry will realize that healing and supporting optimum health depends on a "person centered" philosophy that recognizes that people, not physicians, are their own true primary healthcare providers. There will also be a recognition that the whole person must be treated - mind, body and spirit.

As we continue to move forward and attempt to transform the system, we must remember that healthcare is a very personal "knowledge based" service. Unfortunately, at this point in time, people and clinicians are finding that they are drowning in information. People and clinicians don't have the intelligent interfaces that deliver the information they really need when they need it. Over the next decade, the number and kind of healthcare coaches or "infomediaries" will expand rapidly. These healthcare coaches will help a person navigate a complex medical field and seek out the high quality advanced treatment options best suited to meet the healthcare needs of the individual.

Over time, public health officials and doctors operating in the emerging virtual world will become more sophisticated, as they monitor people's health through data mining of electronic health record (EHR) systems and monitoring of real-time physiological changes reported by wearable and embedded sensors.

In the next decade, we will also see many health services that in the past were provided by human professionals be converted into easy-to-access, cost effective artificial intelligence programs that are embedded in a PDA, iPod or some other mobile device. Over the next several decades, the direction of change will lead to Health@Everywhere.

Person Centered Healthcare

In healthcare, people are more than just consumers or patients. A person must take responsibility for his or her own health and leverage all the knowledge and resources available. In the future, the person with acute and chronic conditions will access the best care and quality through the integration and communication of multiple systems that leverage intelligent software agents that have artificial intelligence, networks of care professionals and multiple medicine modalities. Person centered healthcare will include multimedia electronic health records (EHR), personal health records (PHR), operating in conjunction with knowledge based systems we might refer to as an eHealth Advisor interfaced to an eHealth Advisor Network.

The following highlights reflect driving medical and technology forces healthcare executives ought to pay attention to as they unfold over the next decade.

Smart eHealth Record Systems for Providers and People

As of 2006, it appears that less than 20 percent of healthcare provider organizations have acquired and implemented an electronic health record (EHR) system. By 2020, however, we predict that the situation and numbers will be reversed. It is anticipated that more than 80 percent of healthcare provider organizations, large and small, will have acquired and implemented EHRs. They will include multimedia medical records that include both textual data and medical images. The EHRs in use will be interoperable, standards based and many will be Open Solutions that are supported by an international network of companies and community of users and developers, e.g. WorldVistA EHR, OSCAR, OpenEMR.

As of 2006, the development and implementation of personal health records (PHR) are still in the very early stages. However, by 2020, we predict that more than 80 percent of the people in the United States will have begun using PHRs in one form or another. These web-based, encrypted applications will provide people with online educational materials, interactive tools for physician communication and wellness, and storage banks for personal health data that includes genomic information and clinical images.

eHealth Advisor Live (eHAL)

We predict that medical science, technology and personal empowerment will come together in the next 20 years to create a service that we call the eHealth Advisor Live or eHAL. The first HAL was the ubiquitous computer that guided the mission and maintained the life support systems in the movie "2001: A Space Odyessy". The eHealth Advisor Live (eHAL), will include a series of health and medical programs and services embedded in a mobile anywhere device that will be always connected to the Internet2 grid. Think of eHAL as a highly evolved, digital assistant with exponentially more computing power than today's personal computer, but available in a mobile device the size of video iPod or smaller. This eHealth Advisor artificial intelligence service and system could be worn, held in a pocket, put on a belt or even attached to sunglasses, with a visual display on the lenses and an audio feed for the ear in the frame. It could be a knowledge source, a decision support advisor, health coach and much more. Medical Alliances ( is just one of several companies pursuing variations of this conceptual solution.

Complementary & Alternative Medicine (CAM) and EHR Systems

Complementary and Alternative Medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine. Patients are increasingly turning to CAM in order to enhance their health and well-being. CAM includes acupuncture, chiropractic medicine, osteopathic medicine, the use of herbal remedies and other practices, as augmentations to more conventional medical treatments. The marketplace clearly reflects this growing acceptance of complementary medicine by many patients and a growing number of healthcare providers. Over this next decade, look for automated CAM software modules to emerge that will be integrated into electronic health record (EHR) and eHAL systems.

By gathering and integrating healthcare information associated with the application of CAM procedures into a patient's electronic health record (EHR), more accurate measurements of outcomes can be generated. Best practices can them emerge showing which complementary medical practices are most effective when coupled with conventional medical treatments of specific disorders. The National Center for Complementary & Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on CAM and is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.

Wearable Intelligent Technology Systems (WITS)

Wearable Information Technology devices are rapidly evolving to wearable "Intelligent Technology" Systems (WITS). Current and emerging developments in wireless communications, integrated with developments in pervasive computing and wearable technologies, will have a radical impact on future healthcare delivery systems. It is anticipated that wearable computing will start to become a routine part of healthcare delivery and patient self-management by 2020.

Although wearable computers have already started to enter healthcare delivery environments, wearable systems for both physicians and patients will more fully emerge over the next decade. Wearable computers for physicians will allow them to treat patients and complete their rounds, while connected via wireless networks to computerized patient records. Wearable computers are already allowing physicians to remotely observe patients' vital signs and monitor progress of surgery from outside of the operating room using handheld devices.

As nanotechnology continues to evolve, the integration of micro sensors and computing technologies into wearable medical devices worn by patients for monitoring, diagnosis, and treatment of illnesses will become commonplace. Data from the wearable medical devices will feed into EHR and PHR systems.

Genomic Information Systems & BioRepositories

By 2020, the first generation of genomic information systems interfaced to EHRs will have been deployed. Genomic software applications and biorepositories will become a standard component of any sophisticated and increasingly smart EHR or PHR system by the end of the coming decade.

Over the next two decades, a goal for genomics will be to transform knowledge about the human genome into improvements in clinical practice, moving it from bench, to bedside, to beside a patient anywhere. Many of the government agencies and private clinical research enterprises engaged in developing genomic information systems are embracing collaborative ventures and open source solutions. Collaboration within this community of genetic researchers, biomedical drug developers and clinicians is essential if substantial progress is to be made over the near term.

eHealthcare, TeleMedicine, and More

The "e" in eHealthcare stands for electronic and emerging technologies that support better care and quality medical care for people and societies. The dual meaning for "e" better represents that the fact that emerging technologies in such areas as artificial intelligence, self generating software programs and other human-computer interface sciences will play significant roles in the tailored and personalized delivery of these services in the year 2020.

Today's telecommunications and televideo technologies have enabled great strides forward in telemedicine over the past decade, e.g. TeleRadiology, TeleDermatology, TeleConsultations. The goals of TeleMedicine are to improve care, reduce the number of visits to actual doctors and providers, and allow patients to be seen and treated at locations of their own choosing, thus lowering the per unit cost of care while delivering high quality care conveniently. At present, patients with chronic diseases are normally required to visit outpatient facilities for periodic monitoring and treatment management. In many cases, however, the preferred place of monitoring and care would be the patient's home. Work continues to proceed to integrate TeleMedicine data into Electronic Health Record (EHR) and Personal Health Record (PHR) systems.

By 2020, Telemedicine will have moved indelibly into our home and be a major player in moving us into the coming age of Health@Everywhere.


The next 10-20 years will be exciting times in the field of medical informatics as many innovative solutions emerge and are put into practice. In this article we took a quick look at the evolution of eHealthcare and Medical Informatics systems and the evolution from today's inpatient and outpatient focused services to the person centered healthcare world of 2020. This article also attempted to deliver an overview of some major developments one should be aware of as you prepare to navigate effectively through the next several decades. The authors believe that understanding and focusing on the following key strategies - Collaboration, Open Solutions, and Innovation - will be crucial for healthcare executives as they explore and integrate the new technologies into the Medical Informatics systems of 2020 that will be expected to provide Health@Everywhere.

The authors delve deeper into this area in their upcoming book entitled "Medical Informatics 2020" to be published by Jones & Bartlett in late 2006. See


Douglas Goldstein is a "Practical Futurist", Author and President of Medical Alliances, Inc. He guides leading health care organizations in clinical and business performance improvement through intelligent use of technology, knowledge management and 'Distinctive Innovation.' He can be reached at

Peter Groen was the former Director of the Health IT Sharing (HITS) program within the Veterans Health Administration at the U.S. Department of Veterans Affairs. He is now on the faculty of the Computer & Information Sciences Department at Shepherd University in West Virginia. He can be reached at

Peter Groen, Douglas Goldstein

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