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Richardson Consulting UK LtdRichardson Consulting UK Ltd
The British Embassy The British Embassy Seoul, Korea Seoul, Korea
““eeHealth; The Road AheadHealth; The Road Ahead
Dr Ricky J Richardson BSc MBBSDr Ricky J Richardson BSc MBBS MRCP(UK) FRCP FRCPCH DCH DTM&HMRCP(UK) FRCP FRCPCH DCH DTM&H
Chairman - UK Telemedicine AssociationChairman - UK Telemedicine AssociationChairman - Thematic Working Group 2 Chairman - Thematic Working Group 2
e-health & Telemedicine - EHTEL - European Commissione-health & Telemedicine - EHTEL - European CommissionChairman and CEO - Richardson Consulting UK Limited Chairman and CEO - Richardson Consulting UK Limited
Consultant Physician - Great Ormond Street Hospital for ChildrenConsultant Physician - Great Ormond Street Hospital for Children
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Who will be the Who will be the primary care primary care
physician of the physician of the future?future?
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Patient !The Patient !
Richardson Consulting UK LtdRichardson Consulting UK Ltd
What is What is TeleHealth?TeleHealth?
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The ATM of The ATM of HealthcareHealthcare
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Traditional Healthcare Delivery Traditional Healthcare Delivery ModelModel
The Patient Community - Bottom of the pile!!
PhysicalMovementofPatients
3° HealthCare
2° HealthCare
1° HealthCare
Teaching Hospitals
Regional Hospitals
District General Hospitals
General Practitioners
Unchanged for 6000 years - circa 3000 BC!
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Paradigm ShiftThe Paradigm ShiftThe Seven Drivers Forcing ChangeThe Seven Drivers Forcing Change
• Obligatory search for cost containmentObligatory search for cost containment
• Changing demographicsChanging demographics
• Peripheralisation of health care deliveryPeripheralisation of health care delivery
• Changing disease patternsChanging disease patterns
• Impact of information technology including IT Impact of information technology including IT support for clinical decisions and support for clinical decisions and TelemedicineTelemedicine
• More informed and expectant patients More informed and expectant patients C-HealthC-Health
• The well-being factor –The well-being factor – responsibility shift into responsibility shift into patients hands - patients hands - The Wellness ParadigmThe Wellness Paradigm
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Economic IssuesThe Economic Issues
Cost Cost ToleranceTolerance
Day Care SurgeryDay Care SurgeryAmbulatory Diagnostic Ambulatory Diagnostic ClinicsClinicsPrimary/Preventative CarePrimary/Preventative CareThe well-being factor The well-being factor
TeleHealthTeleHealthPartnerships betweenPartnerships betweenPublic & Private SectorsPublic & Private Sectors
Change in HealthcareChange in HealthcareDelivery MechanismsDelivery Mechanisms
19501950 2000200019901990
EurosEuros
20102010
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The well-being factor
PRIMARY TELERADIOLOGYPRIMARY TELERADIOLOGYAND TELEPATHOLOGYAND TELEPATHOLOGY
eeHealth &Health &TelemedicineTelemedicine
Clusters of Clusters of Specialists withSpecialists withGlobal AccessGlobal Access
Allied HealthCare Professionals
Primary HealthCare The ‘Super’ Primary Care Physician
CommunityHospitals
(Acute)
CommunityHospitals
(Non-acute)
Freestanding Diagnostic Centres
HomeHomeCareCare
HealthKiosks
DayCareSurgery
MaternityAcute
Trauma
The Paradigm ShiftThe Paradigm Shift
??
Direct Access to specialistsDirect Access to specialistsWWWWWW IDTVIDTV IDTVIDTV WWWWWW
The Informed Wired upInformed Wired up Citizen Community
C-HealthC-Health
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Paradigm ShiftThe Paradigm ShiftThe ImpactThe Impact
•• Healthcare practices - changing rolesHealthcare practices - changing roles•• Healthcare trainingHealthcare training•• Financial remuneration/rewardsFinancial remuneration/rewards•• Healthcare vocationHealthcare vocation
WILL WE NEED DOCTORS AT ALL INWILL WE NEED DOCTORS AT ALL IN
PRIMARY CARE IN THE YEAR 2050 ?PRIMARY CARE IN THE YEAR 2050 ?
Richardson Consulting UK LtdRichardson Consulting UK Ltd
•• The Informed Patient (s)The Informed Patient (s) •• Family and friendsFamily and friends•• PharmacistsPharmacists•• Medical Auxiliaries / Medical Auxiliaries /
Community NursesCommunity Nurses•• A “Super” Primary A “Super” Primary
Care Physician?Care Physician?
Will the family doctor become Will the family doctor become ““The Wellness Guardian-Caretaker”?The Wellness Guardian-Caretaker”?
The Paradigm ShiftThe Paradigm ShiftWho will be the Who will be the PrimaryPrimary Care Care
Team of the Future?Team of the Future?
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Impact of Globalisation The Impact of Globalisation on Healthcare deliveryon Healthcare delivery
•• Healthcare Services move into the Retail Healthcare Services move into the Retail Environment (Shopping Mall medicine)Environment (Shopping Mall medicine)
• • C-health: - Health-on-line WebsitesC-health: - Health-on-line Websites• • District General and Regional Hospitals District General and Regional Hospitals
become become obsoleteobsolete as a concept as a concept • • Emergence of Emergence of EpicentersEpicenters of of
Medical ExcellenceMedical Excellence
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Impact of Globalisation The Impact of Globalisation on Healthcare deliveryon Healthcare delivery
Patients in the locality
Old MarketsOld Markets New MarketsNew MarketsThe Global Patient CommunityShipping Mercantile Cruise ships (SeaMed)Airline IndustryHotel ResortsMultinational Corporations (Shell /Amoco etc)The MilitarySpace Travellers
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Airline Industry Operational ModelAirline Industry Operational Model
Telemedicine EquipmentTelemedicine Equipment
A&E DepartmentA&E Department Call-CentreCall-CentreCommunicationsCommunications
Data
Global NetworkGlobal Networkof participating of participating
hospitalshospitals
Co-ordination Co-ordination of Serviceof Service
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Patient/Consumer The Patient/Consumer Health InformationHealth Information
Your own LifestyleYour own Lifestyle Your GeneticsYour Genetics
Human Genome ProjectHuman Genome ProjectChoosing DeathstyleChoosing Deathstyle
Health Cure & CareHealth Cure & Care
Information On:-• Hygiene• Nutrition• Addictions• Fitness
• Your Electronic Health Record - EHR
• Conditions & Concerns• Quality of HC• Diseases & Treatment
More Money is spent in the USA on complimentary More Money is spent in the USA on complimentary medicine than “western” medicinemedicine than “western” medicine
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Health on the NetHealth on the Net More time spent online More time spent online
on Healthcare than Pornography!on Healthcare than Pornography!June 1999June 1999
26,00026,000 health related websites available health related websites available33m 33m US citizens used the US citizens used the net for health advice in ‘98net for health advice in ‘9827%27% of female users & of female users & 15%15% of males look at of males look at medical information at medical information at least once per week least once per week (Source BMJ 13/11/99)(Source BMJ 13/11/99)
Primary Hits (August 1999)Primary Hits (August 1999)drkoop.com (No. 76) - 3,474,000drkoop.com (No. 76) - 3,474,000
Richardson Consulting UK LtdRichardson Consulting UK Ltd
0
100
200
300
400
500
600
1994 1996 1998 2000 2002 2004 2006
On
Lin
e p
op
ula
tion,
mill
ions
Advanced Communications EngineeringAdvanced Communications Engineering
How many people on-line?How many people on-line?
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The The data data wave wave goes goes mobilemobile
Advanced Communications EngineeringAdvanced Communications Engineering
Richardson Consulting UK LtdRichardson Consulting UK Ltd
• • Interactive Video Conferencing - 1980Interactive Video Conferencing - 1980
• • Tele-Radiology, USA - 1990Tele-Radiology, USA - 1990
• • International Telemedicine - 1994International Telemedicine - 1994
• • The Telemedicine Blueprint, Malaysia - The Telemedicine Blueprint, Malaysia - 19971997
• • Telemedicine “Comes of Age” - 1998 -Telemedicine “Comes of Age” - 1998 - TeleHealth ? e-Health Citizen-TeleHealth ? e-Health Citizen-
Health?Health?
• • Telemedicine becomes “Medicine” - 1999Telemedicine becomes “Medicine” - 1999
TelemedicineTelemedicineThe story so farThe story so far
Richardson Consulting UK LtdRichardson Consulting UK Ltd
• • Hospitals become a thing of the past - 2006?Hospitals become a thing of the past - 2006?
TelemedicineTelemedicineThe story so farThe story so far
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Integration of ITIntegration of ITinto Business Sectorsinto Business Sectors
Inte
gra
tion
of
ITIn
teg
rati
on
of
IT
IT as a gadgetTrojan horse: networks, …Full Integration of IT into Business (Organisational, Legal) Re-engineering of the system
19801980 19901990 20002000 Jean-Claude HealyJean-Claude HealyMay 2000May 2000
(Banks) (Health…)ManufacturingManufacturing Business ServicesBusiness Services Public ServicesPublic Services
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Technology driven Disappointment
Healthcare Professionals: HELP!!!!!Sit on the fence or Resist “I told you so !” Accept the inevitable and
want control control
GlobalisationGlobalisationHealthcare Economists Healthcare Economists Patient PowerPatient PowerThe Medical ProfessionThe Medical ProfessionThe World Wide WebThe World Wide WebNew TechnologiesNew Technologiese.g. Mobile Videophonese.g. Mobile Videophones
19801980 19901990 December 2000December 2000
ICT Solutions inICT Solutions in Healthcare delivery Healthcare delivery
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Telemedicine MarketThe Telemedicine Market (1)(1)
USAUSA
1997 - $643 Million 1997 - $643 Million
2002 - $3000 Million2002 - $3000 Million
EuropeEurope
Euro 50 Million Euro 50 Million
Euro 542 MillionEuro 542 Million
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Telemedicine Market The Telemedicine Market (2)(2)
What about the rest of the world?What about the rest of the world?
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Four Flagship ApplicationsFour Flagship Applications
• • Tele-ConsultationTele-Consultation
• • Tele-ContinuingTele-Continuing Medical Medical Education for Health Education for Health Professionals Professionals
• • Mass Customised Mass Customised Personalised Information Personalised Information and Education and Education
• • Lifetime Health PlanLifetime Health Plan
Concurrent implementationConcurrent implementation leads to reform leads to reform
The Telemedicine BlueprintThe Telemedicine BlueprintMalaysiaMalaysia
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Centum City Telemedicine ProjectCentum City Telemedicine Project
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Centum City Telemedicine Centum City Telemedicine ProjectProject
Land based PopulationLand based Population• Pusan City ResidentsPusan City Residents• North Korea with Ministry of HealthNorth Korea with Ministry of Health• Centum City PopulationCentum City Population
•ResidentsResidents•Daily WorkersDaily Workers•Visitors/TouristsVisitors/Tourists
•Korean nationalsKorean nationals•International Patients - Medical TourismInternational Patients - Medical Tourism
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Centum City Telemedicine Centum City Telemedicine ProjectProject
Mobile PopulationMobile Population
•Mercantile ShippingMercantile Shipping•Ship ownersShip owners•Seamans UnionsSeamans Unions
•Cruise LinesCruise Lines - Star Cruises- Star Cruises
•Airlines Airlines - Korean Air- Korean Air
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Centum City Telemedicine Centum City Telemedicine ProjectProject
Medical TourismMedical Tourism
• 2 hours by air for 2 billion people2 hours by air for 2 billion people• 1% with disposable income = 20 million1% with disposable income = 20 million
•Cardiac - Cancer - Mental HealthCardiac - Cancer - Mental Health•Costs can be competitiveCosts can be competitive•Popular Tourist Resort for familiesPopular Tourist Resort for families
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Centum City Telemedicine ProjectCentum City Telemedicine ProjectMedical TourismMedical Tourism
USAUSA
EUROPEEUROPE
AUSTRALIAAUSTRALIA
(For 24hr medical coverage)
Telemedicine links
The SpokesThe Spokes
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The New TechnologiesThe New TechnologiesVideophonesVideophones
HospitalMinor Injury UnitMinor Injury Unit
X-Ray Camera BedUltrasound Scanner
Camcorder
Videophone
Videophone
Group Conference System
Motion Media TechnologyMotion Media Technology
ISDN/InterNet
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Eyesite 300 Home Care systemEyesite 300 Home Care system4 remote cameras/devices
Remote care & monitoring of patients - hospitals - homes - anywhereRemote care & monitoring of patients - hospitals - homes - anywhereIn emergencies…. it can be triggered by a panic call button In emergencies…. it can be triggered by a panic call button
CarerCarer
HomeHome
Motion Media TechnologyMotion Media Technology
Comms
Richardson Consulting UK LtdRichardson Consulting UK Ltd
CommunicationsCommunicationsSystem OverviewSystem Overview
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Thematic Working Group 2Thematic Working Group 2EHTELEHTEL
• • To make medical servicesTo make medical services - wheresoever- wheresoever sourcedsourced - ubiquitously available across Europe- ubiquitously available across Europe
• • To promote e-health & Telemedicine across To promote e-health & Telemedicine across Europe at all levelsEurope at all levels
• • To identify To identify barriersbarriers to to e-health & Telemedicine e-health & Telemedicine and use all means to and use all means to overcome them overcome them
• • To identify and promote To identify and promote technologies & solutions technologies & solutions to achieve this aimto achieve this aim
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Thematic Working Group 2Thematic Working Group 2Activities (2000)Activities (2000)
MarchMarch - - TWG2 EstablishedTWG2 Established- Chair Appointed- Chair Appointed
AprilApril - - Membership Assembled Membership Assembled (50 - September 2000(50 - September 2000))- Draft Action Plan Submitted- Draft Action Plan Submitted- Draft Budget Submitted- Draft Budget Submitted- Preparation for Pro-EHTEL Negotiations- Preparation for Pro-EHTEL Negotiations
May 9th May 9th - First Meeting - DTI (UK) London- First Meeting - DTI (UK) London- Action Plan agreed - for implementation - Action Plan agreed - for implementation - Budget Approved- Budget Approved- Treasurer Appointed - Dr Stephan Schug (DK)- Treasurer Appointed - Dr Stephan Schug (DK)
- - DTI (UK) offer to provide Secretariat RoleDTI (UK) offer to provide Secretariat Role
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Thematic Working Group 2Thematic Working Group 2Activities (2000)Activities (2000)October/NovemberOctober/November
- - Website Development Defined and Agreed and Content providedWebsite Development Defined and Agreed and Content provided- Phase Two Action Plan Defined and Budget set- Phase Two Action Plan Defined and Budget set- PRO-EHTEL Funding Secured, Supplemented by Industry- PRO-EHTEL Funding Secured, Supplemented by Industry- Agreements with Industry Partners on Physical Demonstration sites- Agreements with Industry Partners on Physical Demonstration sites- Promotion of e-Health/Telemedicine at all levels throughout Europe- Promotion of e-Health/Telemedicine at all levels throughout Europe
• Ministers of HealthMinisters of Health• Private SectorPrivate Sector• Telemedicine e-Health ConferencesTelemedicine e-Health Conferences• Key HealthCare Decision MakersKey HealthCare Decision Makers
- Articles written and published on e-Health in European Journals - Articles written and published on e-Health in European Journals - Promotion of European e-Health and Telemedicine beyond Europe- Promotion of European e-Health and Telemedicine beyond Europe
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Thematic Working Group 2Thematic Working Group 2Activities (2001 and Beyond)Activities (2001 and Beyond)January 2001 - July 2003 - PRO-EHTELJanuary 2001 - July 2003 - PRO-EHTEL- - Further Development of Virtual Demonstration WebsiteFurther Development of Virtual Demonstration Website- Establishment of Three (3) Physical Demonstration Sites- Establishment of Three (3) Physical Demonstration Sites- Active Promotion of e-Health and Telemedicine across Europe- Active Promotion of e-Health and Telemedicine across Europe- Growing List of Industry Partners become members- Growing List of Industry Partners become members
of EHTEL/TWG2of EHTEL/TWG2- TWG2/EHTEL acts as a Core Central Resource for:- TWG2/EHTEL acts as a Core Central Resource for:
• European CommissionEuropean Commission• Governments of European Member StatesGovernments of European Member States• Other Parties interested in European Medical ServicesOther Parties interested in European Medical Services
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Healthcare DeliveryHealthcare Deliveryin the new Millenniumin the new Millennium
Where are we going?Where are we going?• • The Multi-media Electronic Health RecordThe Multi-media Electronic Health Record• • Total Hospital Information SystemsTotal Hospital Information Systems • • HomeCare Monitoring for the HomeCare Monitoring for the
elderly/post inpatient careelderly/post inpatient care• • Medical services move into the Medical services move into the
Retail EnvironmentRetail Environment• • A more holistic approach to A more holistic approach to
healthcare deliveryhealthcare delivery -- Traditional Medicine}Traditional Medicine}- Preventive Medicine} At Primary care level- Preventive Medicine} At Primary care level- Self Treating Patients} - Self Treating Patients} “The Wellness “The Wellness
Guardian”Guardian”- Curative Medicine}- Curative Medicine}
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Future environmentFuture environmente-COMMERCEe-COMMERCE
C-HEALTHC-HEALTH
ISDN CABLE
LAN-WAN WIRELESS NETWORKS
Health ContactHealth Contact CENTRECENTRE
e.g.NHS DIRECTe.g.NHS DIRECT
Drivers of changeDrivers of change
MEDICAL DEVICES & VITAL SIGNSMONITORING
FIXED &MOBILE VIDEO
PRODUCTS
ELECTRONIC HEALTHRECORD
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The most robust economy in decades is being conducted in the riskiest environment ever
This year 35 million businesses passed along confidential information to 2 million people who had no business seeing it
Government Health Warning!Government Health Warning!
Richardson Consulting UK LtdRichardson Consulting UK Ltd
YES the internet YES the internet isis insecure insecure
Would Would you trust you trust an an electronic electronic message message that that came to came to you from you from an an unknown unknown company company in in Colombia, Colombia, Moscow, Moscow, or China?or China?
Lack of trust in an openLack of trust in an open
system is preventing growthsystem is preventing growth
It doesn’t have to be that wayIt doesn’t have to be that way
Richardson Consulting UK LtdRichardson Consulting UK Ltd
These folks operate e-health in the most These folks operate e-health in the most litigious society on earthlitigious society on earth
They protect They protect their business their business
with standards with standards based security based security
protocolsprotocols
They can’t They can’t afford to take afford to take
any risksany risks
……and neither and neither can youcan you
Richardson Consulting UK LtdRichardson Consulting UK Ltd
This technology requiresTrusted Service
Providers to manage it
International e-health standards have been
developed for: -
Credential checkingAuthenticationRights managementAccessSigningCertification Audit
There is plenty of technology There is plenty of technology that enables Internet securitythat enables Internet security
de la Rue / Presideode la Rue / Presideo
Richardson Consulting UK LtdRichardson Consulting UK Ltd
TeleHealthTeleHealthRemaining IssuesRemaining Issues
• • Universal languageUniversal language
• • International - intergalactic? – International - intergalactic? –
medical licensingmedical licensing
• • Medico-legal liabilityMedico-legal liability
• • Litigation: changing attitudesLitigation: changing attitudes
• • International (cross border) remunerationInternational (cross border) remuneration
• • The speed of change in the IT worldThe speed of change in the IT world
• • How will we train the physicians for How will we train the physicians for
tomorrow’s world????????tomorrow’s world????????
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Developing WorldThe Developing World
South AfricaSouth Africa 2000 New cases HIV 2000 New cases HIV Every dayEvery day
34 million cases infected34 million cases infected 1 million are children1 million are children
11 million have died11 million have died 5,500 funerals a day (7 x 747s)5,500 funerals a day (7 x 747s)
Zanzibar Zanzibar Hospitals with no telephone, Hospitals with no telephone, no sheets, no medicinesno sheets, no medicines
HOW CAN WE PLAY OUR PART?HOW CAN WE PLAY OUR PART?
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Developing World The Developing World Can leap-frog the traditional evolutionary processCan leap-frog the traditional evolutionary process
ChinaChina - - The Golden Health ProjectThe Golden Health ProjectMalaysiaMalaysia -- The Telemedicine Blue PrintThe Telemedicine Blue PrintAfricaAfrica -- ? Take some responsibility ?? Take some responsibility ?
3000 BC 2000 AD Time
The Community
PhysicalMovement
ofPatients
3° HealthCare
2° HealthCare
1° HealthCare
The Informed Community
Clusters ofClusters ofSpecialistsSpecialists
?
Allied HealthCare Professionals
1° HealthCare The ‘Super’ Primary Care Physician
CottageHospitals
(Acute)
CommunityHospitals(Non-acute)
HomeCare
HealthKiosks
day-careSurgery
FreestandingDiagnostic
Centres
MaternityAcute
Trauma
Telemedicine
PrimaryTeleRadiology
and TelePathology
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Healthcare Delivery TrendsHealthcare Delivery Trends
Global NetworkedHealthcare
Consumer pressuresConsumer pressures
Information Information technologytechnology
Delivery Delivery mechanismsmechanisms
Richardson Consulting UK LtdRichardson Consulting UK Ltd
TeleHealthTeleHealthThe Major ConsequencesThe Major Consequences
• • Improvement of skills at primary care levelImprovement of skills at primary care level
• • what do we do with new skills?what do we do with new skills?
• • KEEP CARE LOCALKEEP CARE LOCAL
• • The InterNet becomes the platformThe InterNet becomes the platform
•• multi-media health records - by emailmulti-media health records - by email
• • Constant Physiological Constant Physiological
Monitoring – Monitoring – HomecareHomecare
• • Access to global Epi-centres of Access to global Epi-centres of
medical expertisemedical expertise
Richardson Consulting UK LtdRichardson Consulting UK Ltd
Technology and Skill Technology and Skill TransferTransfer
Passively – Use of a global telemedicine Passively – Use of a global telemedicine networknetwork
Pro-actively – Global CME programmePro-actively – Global CME programme
Mass Public Health InformationMass Public Health Information
Health on-line WebsitesHealth on-line Websites
Richardson Consulting UK LtdRichardson Consulting UK Ltd
The Watershed Generation GapThe Watershed Generation Gap
HUMAN NEURO-PHYSIOLOGY IS CHANGINGHUMAN NEURO-PHYSIOLOGY IS CHANGINGMary LobascherMary Lobascher 2000
USUS
The seekersThe seekers
and findersand finders
OUR CHILDRENOUR CHILDREN
The filterersThe filterers
and applyersand applyers