Updated: Feb 1, 97
1. Introduction: the new context

Figure 11: The European Challenge for Telematics Systems.

No new technology would ever be applied to health if it was not intended to improve the quality of care, directly or indirectly. Telematics is no exception. The resources allocated to health care are finite and their growth constrained by the overall organisation of society and the economy. Telematics comes into competition with other more direct approaches to improving the quality of health care.

In the competition for resources, health telematics claims to provide two main benefits: a reduction in the cost of health care and increased competitiveness of the telematics industry. Reduction of costs would come mainly from replacing paper flows by electronic based storage and circulation of information. Increased competitiveness would come from the opening of a new high added-value market for telematics products and services.

Figure 12: Cost-Quality equation, the challenge for telematics for health care.

The cost reduction argument, if substantiated, is the strongest of all. From the point of view of other technologies, it converts telematics from a competitor into an ally. Indeed, any cost reductions will leave additional space for other technologies.

In the following paragraphs and in Figure 13, a collection of facts and figures, which provide the minimum knowledge necessary to understand the required priority for allocation of the resources for developing the Health Telematics Applications market, are presented.

In 1990, 6.6 million persons were employed in health services (excluding the pharmaceutical and medical equipment industries).

Health expenditure was 380 billion ECUs (nearly 8% of GDP), 70% were labour costs. 15% to 20% were generated either by the use of equipment (radiological films, biological tests) or by disposable or pharmaceutical consumption.

Figure 13: The European Union health care system at a glance.

There were: 800 000 practising doctors 156 000 practising dentists 200 000 pharmacists 1 600 000 nurses 3 860 000 "others" (technicians, administrators, clerks, cleaners...) 2 600 000 beds in 15 000 hospitals : 65% 200 beds, 25% between 200 and 400 beds, 10% 400 beds.

Remarkably, most health employment is not in direct care. More than 50% of the total workforce employed in health services (i.e. excluding the medical equipment and pharmaceutical industries) were not involved in "direct" care (i.e. was not a doctor, nurse, dentist or pharmacist). In contrast, the vast majority of today's telematic applications are aimed at direct care, on the assumption that, by reducing paper shuffling they will reduce the percentage of non-direct care employment.

The past phase has seen a move from prototype development to commercial product creation. The emphasis over the years 1991-1994 has been on building prototypes and pilot applications. It required testing for acceptance by the users and demonstration of compliance with regulations and standards. However, part of the effort was oriented towards strategic research related to innovative concepts needed for the next generation of products. The main areas tackled by the projects were : quality assessment, computer-assisted decision making and resource management, image analysis and communications, architecture for a common medical record, integration of telematics between hospital departments or the primary care environment. Industrial involvement was greater than in the exploratory phase.

In addition to these projects and to promote better European co-ordination, concerted actions were running in fields considered as strategic: interchangeable medical records, nursing primary care, teaching and learning, and medical classification systems. Accompanying measures on consensus formation and standardisation promotion as well as on technology assessment helped the diffusion of results to all health care providers.

The political environment was very determinant during that period. During the course of the period 1991-1994 several new political documents reinforced the implementation of the objectives of the programme. The Maastricht Treaty enlarging the Programme's mandate from purely contribution to competitiveness of industry to contributing in addition to "other Commission policies" for the first time allowed to put emphasis on the health content of the programme while obviously keeping industrial interest in mind. This fact largely facilitated the mobilisation of users in the medical field. this mobilisation is of course crucial for product acceptance.

The White Paper on Growth, Competitiveness and Employment created the climate for the transition between the third and the fourth framework: from technology driven to consortia of private industry and user groups moving towards markets. The activities carried out during the second half of the subprogramme duration, assured a gradual transition.

Figure 14: General and specific driving interests converging towards AIM.

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