21st century?", OECD Futures Studies, Paris, March 1994. Remote teaching or guidance and education, for medical staff, students and patients or for those under treatment or special care such as expectant mothers, widening the reach of teaching and avoiding travel. Increased efficiency, through electronic document management (EDM) for the major overheads in patient clinical, and above all health insurance and payments, paperwork (public and private). E-commerce and supply chain management (medical EDI) for ordering supplies with better inventory control, plus capital savings and lower security risks INFRASTRUCTURE TO 2030: TELECOM, LAND TRANSPORT, WATER AND ELECTRICITY - ISBN 92-64-02398-4 © OECD 2006 2. TELECOMS INFRASTRUCTURE TO 2030 for stores of drugs. Moreover, an electronic market worldwide in medicines could also drive down prices, especially as bulk buying with comparison of world prices becomes universal. Creation of a single integrated health care system, in which patient records, health insurance and payments, and information such as laboratory reports, admissions, beds free, etc. are available to each type of medical operator in the system, on an authorised, secure basis. Telemedicine can bring together the GP, clinic, nursing home for the aged, hospitals and external specialists with outpatients (the patient at home) and the ambulance on the road. The maximum savings introduced by telemedicine might appear to be in OECD countries with overburdened health budgets seeking a higher quality of care at lower cost. However the major applications may be in those countries with poor or stretched health infrastructures - the NICs. One study in northwest Russia outlines this case. 87 It found using remote consultations that the expenditure on in-patient treatment can be reduced by half by means of shortening the treatment terms and using small local hospitals with telemedicine links to centres of expertise. This result depends on sharing far more skilled regional centre staff, who have the expertise that is lac