The document discusses decentralization of care delivery through emerging technologies. It notes that three quarters of the global population lives in developing nations, representing a large potential market. However, most medical device developers are located in developed nations. New technologies are converging medical devices and IT, allowing electronic medical records and remote patient monitoring. This permits decentralized care delivery outside hospitals through portable devices and telemedicine. Telemedicine uses technology to provide medical services from a distance, expanding access. It is anticipated this will increase care delivery by non-physicians under physician supervision.

1. Decentralization of care delivery
In the 2011 Human Development Report of the United Nations more than three quarters of the population
lives in lowresource developing nations. This means that the potential market for medical technologies in
developing nations is about five times larger than that in developed nations (1)
.
However, the majority of medical device developers and manufacturers are located in, and primarily
serve, developed countries and they are largely unaware of how to overcome the many barriers, from
financial to technical, to making these devices available in developing nations (1, 2)
.
The convergence of medical devices and information technology (IT) is likely to result in the
development of a number of technological health-care innovations in the future. A striking example that is
already emerging is the area of electronic medical records (EMRs), which, through the integration of
medical devices and IT, will be able to store and transmit data gathered electronically from clinical notes,
diagnostic equipment, patient monitoring systems, alarms and other sources via computer networks. The
plan of increasing its effectiveness will also base on the design to permit efficient transfer of patient data
between various health-care professionals and facilities where a patient has received care, as well as
between the point of care, such as emergency care personnel at an accident site and a remote health-care
facility (3)
Various kinds of self-contained, portable technologies will permit more patient care to be delivered
outside the traditional hospital setting. Clinicians can use this technology to examine patients in the field
and then take the collected data back to a regional clinic or central hospital for detailed analysis.
Currently available health-care technologies, such as mechanical ventilators and imaging systems will
allow delivery of some advanced level of care in the field.
The use of telemedicine has also grown in recent years, especially in developing countries (4)
. It will
continue to expand as the chronic disease burden grows in both industrialized and developing nations.
However, this will occur only if there are sufficient numbers of appropriately trained clinicians (which
there are not at present) to use the technology as adjuncts to and facilitators of patient care (5)
.
Telemedicine electronically provides medical information and services at a distance, especially for
patients who would otherwise not have access to care (6)
. The introduction of new technologies that permit
decentralized delivery of medical care at increasingly advanced levels can also result in expanded use of
telemedicine (7)
. Telemedicine can be expected to be rapidly integrated with new developments in medical
technology, such as remote portable devices and patient monitoring equipment, as well as with
nonmedical technology, such as “smart phones”, handheld computers, and high-speed Internet services to
accommodate heavy data transfer (8)
. A potential benefit of this technology is that it would allow

2. healthcare personnel in the field to adjust a patient’s medication or modify treatment in real time after
consultation with a remotely located specialist, and after review of the latest patient information (9)
.
Telemedicine will also allow rural and other medically underserved areas in all countries, rich and poor,
to benefit from electronic consultation with trained physicians and specialists (10)
. It is anticipated that this
will result in far more health care being delivered by non-physician healthcare providers working at a
distance in consultation with, and often under the direction of, physicians (11)
.
The use of the Internet expands and the need increases for such consultations in the developed world in
different fields such as radiology, neurology (especially for the evaluation of stroke patients in the
emergency department), pathology, and psychiatry. Although still largely in the research phase,
telemedicine holds the potential to allow surgeons to perform surgery remotely through the use of robotic
assistance and advanced communication systems (12)
.
It is significant to note that the content of this paper is developed from a technologically advanced
nation’s perspective such as the United States, and may or may not be directly applicable to different
contexts. However, the diffusion of new health technologies and the trends described in this paper may be
more relevant for informational purposes, to gauge some recent developments.
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