Healthcare Informatics and Technology Investors
Healthcare Informatics and Technology Investors


About Team Role Theory

History & Research

Reliability & Validity

Dr. Meredith Belbin

Behavior vs. Personality



Better Care in the 21st Century: Virtual Hospitals in the Home
Executive Summary of Project for Texas Instruments, “A Better Life Today and Tomorrow: Advancing Home Healthcare Through Technology”

By Leo J. Borrell, M.D.
Health Care Equity Investors
4150 Wsetheimer, Suite 103

A new millennium is approaching that will have a direct impact on the way health care is administered to a large segment of the population. Due to new breakthroughs in technology, patients that are now being short-changed by the managed care system will soon have access to more advanced, more cost-effective forms of health care that will virtually bring the diagnostic and monitoring capabilities of the hospital into the comfort of their own homes. Though some medical procedures - such as surgery - will always have to be performed in a hospital, the philosophical shift to disease management and preventative medicine may greatly reduce the number of procedures that will be required.

(Table I: Summary of Factors Influencing the Future of Healthcare)





The aging US population

The shifting Economy

Larger knowledge base of medical professionals

Team decision making and remote education

The chaotic change in family structure

Problems caused by managed care

Reduction of costs of technology more available

Development of an integrated health system

Fragmentation of the US population

Emergence of new expensive treatment

Advances in telecommunication

Shift from cost of care to value of care and out-comes

”Right To Life” now focuses on death with dignity and care

Competition on a global scale

Telemedicine, which became a reality through the space program in the 1960’s to monitor the life functions of the astronauts in space, has gradually expanded to the general population as a result of new technologies. These include miniaturization of the sensor, videophones, interactive cable, wireless communication, and the Internet, which allow physicians to monitor the progress of patients in their homes. In the next few years, advances in technology will facilitate the production of smaller and less costly home-model versions of the diagnostic and therapeutic equipment found in hospitals. Consequently, patients’ families will be able to conduct diagnostic tests themselves in their homes. The benefits of this include early detection of potentially life-threatening diseases, and fewer hospital visits for chronically ill patients.

Another area in which up-and-coming technologies can aid the healthcare profession is information management. The 21st century has already been dubbed The Age of Knowledge. Physicians today have four times as much knowledge as they did in the early 1980’s. This is partially due to the vast amount of long-term outcome studies conducted in the past twenty years. Today, part of the diagnosis process involves comparative analysis using the wealth of information collected in these studies. In order to process all this information, so that it can be useful and effective, the management system must be organized and must meet doctors’ changing needs.

In the past, management information systems (MIS) focused on data storage and retrieval. With the advent of telemedicine, which utilizes remote diagnosis, and consultation and monitoring, data exchange is becoming more important. Doctors need to be able to give and receive information about patients’ cases, while constantly updating their medical histories. New Information Processing Systems are quickly replacing the old MIS, and will soon be able to integrate all phases of the home healthcare industry. The technology that is making this possible is Digital Signal Processing (DSP). DSP, originally designed for hand held calculators and wireless technology (such as mobile phones), is able to fulfill this need, because it offers a reprogrammable chip. This function is invaluable, because it allows the constant updating of patient files, and facilitates the tracking of their progress, as well as complex data processing and analysis, which makes possible the beginning of wide acceptance of Telemedicine.

(Table II: Telemedicine Advances)


Legal & Regulatory

Coverage & Payment Policy

Accountable models adopted By 100% of Telemedicine Networks (0-3 Years)

Other providers to practice electronically across lines (0-3 Years)

Expansion of telemedicine to correctional institutions (0-3 Years)

Integrated systems cost of under $2000 (3-6 Years)

Testbeds demonstrate security and data (3-6 Years)

Consultations, home health, store & forward with interactive video (3-6 Years)

Touch-screen menu system, Under 15 low-cost sensors (6-15 Years)

National licensure for all health care providers to practice electronically (95%) (6-15 Years)

Initial standards set a reasonable range for utilization (3-6 years)

This is of the utmost importance for today’s busy doctors who need to stay connected to their patients and their families. HCIS will experience explosive growth. It is predicted that revenues which are now $10 billion will reach $67 billion in 15 years.

(Table III: Evolution & Revolution of HCIS)

Revenue $10 Billion

Central Enterprise
Managed Care and Medical Applications
Core Delivery System Application
Management Services

Revenue $27 Billion


Monitoring and Sensors Home Care Diagnostic
Core Delivery System Applications
Central Enterprise Applications & Vendors
Managed Care & Medical Managed Application

Revenue $67 Billion

Core Delivery System Automation of Physician Practices Home Care

Central Enterprises

Applications & Vendors

Automation of Home Care & Long Term Care Providers


Disease Prevention

The future of healthcare will be greatly influenced by the fact that the “Baby-Boomer” generation is quickly approaching retirement age. Therefore, home healthcare is becoming an ever-increasing segment of the total healthcare market. Even now, the over-65 group is the fastest growing proportion of our society. It also has the greatest expendable income and is more knowledgeable about healthcare than any other generation of seniors before. This, and a great desire to maintain their independence, has created a great demand (which will grow even larger in the next five to ten years) for more comprehensive home healthcare products and services. Some categories of healthcare products have already been created which allow individuals more control over their healthcare. Some examples include:

1) Security and Privacy Devices: These devices use voiceprints to record personal health information, a feature that affords privacy and accountability.

2) Digital Hearing Devices: These integrate voice, digital and data information, which fosters reassurance in patients by improving compliance.

3) Smart Cards: These act like credit cards, while also being able to integrate medical records with financial information.

Whether they are doctors, nurses, or patients and their families, all participants in the healthcare system have different sets of values that are important to each particular group. These values depend on factors that impact and effect the participants’ abilities to deliver, or receive, care. These factors form a chain of values, which can be confounded by other, intervening factors (such as discontinuities in the healthcare system). As the shift from hospital-and-clinic-based to home-based health care progresses, there will be a reorganization in the value chains of each group (doctors, nurses, patients and families). The diagram below represents a Patient’s/Family’s Value Chain when receiving hospital services.

Table IV
Patient Value Chain

Value Chain

Get to and From Hospital
Financial Situation
Deal With Stress
May not have Support at Home
Few “in-hospital” support systems
Find Out Patient Status
 Difficult to Talk to Attending Physician
 Conflicting Statements from Multiple Sources
Unfamiliar Vocabulary & Concepts
Pay Bills
 Bills are Difficult to Understand
 Insurance is Difficult to Understand
Insufficient Resources
Give Post-Discharge Care
Loss of Income While Visiting
Little Help Available
Unfamiliar, Complex Activities


The implications for this shift towards more technology in healthcare, especially home healthcare, are that it provides opportunities for high tech companies to enter into the medical market. In the next five to ten years there will be a much greater demand for healthcare products that can be used in the home, as well as new technology to meet society’s changing needs. Companies can opt for a low risk venture, by developing products that can be used right now; or, if they want to become leaders and gain dominance in the market, they can assess future needs, and try to utilize new technological knowledge to come out with complex systems. Either way, the first step for any company wanting to enter the market is to establish a clear set of goals. Strong, yet flexible management, and a solid financial backing is also important, as is a cohesive company team that shares a common vision. However, for a future oriented company, the possibilities are endless - and society will also benefit.

Complete Bibliography Available Upon Request

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4. Rand Reprints:

4a. DiMatteo, M.R.; Sherbourne, C.D.; Hays, R.D.; et al. Physicians’ Characteristics Influence Patients’ Adherence to Medical Treatment. Rand Reprint originally published in Health Psychology; 1993; 12(2): 93-102

5. Gottlieb, S.; The Next Paradigm in Health Care. Editor’s Note. JAMA. 1997; 278(17)

6. Sandia National Laboratories Report. Strategies for the Future: The Role of Technology in Reducing Health Costs. October, 1996

7. Levy, E.; Levy, P.; Le Pen, C.; and Basdevant, A.; The Economic Cost of Obesity:

16a. The French Situation. Correspondence: E. Levy Legos, Universite Paris- Dauphine, Place du Marcechal-de Tassigny, 75755 Paris Cedex 16, France.

16b. Marketing A Corporate: Giant Tackles Obesity Head On. The Bariatrician Summer, 1995; 18-20.

8. *21st Century Home Care - Back to the Future. Olsten Health Services. 1997. Internet.

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11. Rosenbluth, J.M.; Ederer, J.D.; Knepper, M.W.; et al. Healthcare on the Line: Major Trends and Outlook for the Healthcare Information Services Industry.; Volpe, Weltry & Company Equity Research, March 7, 1997.

12. Rosen, E.; Mobile Telemedicine Arrives. Telemedicine Today.; October 1997.

13. Alemi, F. and Stephens, R.C.; Computer Services for Patients: Descriptions of Systems and Summary of Finding.; Medical Care. 34(10): OS1-OS9.

14. Blaiss, M.S.; Outcomes Analysis in Asthma; JAMA; 1997. 278(22): 1874-1879

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16. Kirton, M., ed.; Adaptors and Innovators: Styles of Creativity and Problem Solving. London, England. Routledge; 1994.

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18. Sarason, S.B.; Work, Aging, and Social Change: Professionals and the One Life-One Career Imperative. New York, NY. The Free Press, 1997.

If you wish to purchase this report in its complete from for $100, please contact Dr. Borrell.