Updated: Feb 1, 97
3. Technical basis: Workprogramme, domains and tasks

3.1. The technical content

"The objective of this area is that of stimulating the development of harmonised applications of information and communication technologies in health care and the development of a European health care information infrastructure taking into account the needs of users and technological opportunities.

The activities will depend on the needs of users and on the requirements of transnational exchange of electronic information. They will concentrate on interoperability of national systems, the establishment of standards, user acceptability, data integrity and confidentiality. The selection of activities will depend on strategic options within both the European health care sector and European telematics sector.

Work in this area will be carried out along three main lines, making use of the exploratory work of the AIM programme (Advanced Informatics in Medicine) and in close co-operation with other Community Programmes.

The nature of research and technological development activities will depend to a large extent on user needs and the general constraints associated with the transnational nature of the information infrastructure required. This transnational aspect requires compliance with three principles: integration (notably the emergence of standards); modularity, to facilitate adaptation to different types of needs, and data security. The research and technological development activities will depend on the assessment of technological needs in the light of the main factors affecting the development of health care. They will also depend on the strategic options for European telematic services in the sector. Essential problems such as confidentiality and data protection will be given high priority."

The Council Decision also indicated the technical content of the programme. The activities were expected to fall into one or more of the 11 domains listed in Figure 16.

Figure 16: Technical domains foreseen in the Council Decision.

Alphanumeric data and text coding standards Images and biosignals with coding standards Integrated medical instrumentation and devices Knowledge based and decision support systems Medical use of multi-media workstation Health care communication systems Telemedical systems and archiving systems Modularity and integration of medical and health information systems Regulatory tools and incentives (medical, legal, ethical, economic and social) Technologies and services for the handicapped and elderly Inter-hospital telematics for increased security in distance care and improved management of staff and specialised equipment.

3.2. The Work Plan for AIM 1991-1994

Figure 17: Strategic goals foreseen in the Council Decision

the creation of a coherent European infrastructure for health care information, with full commitment from clinical, industrial and administrative interests, integration, modularity and standardisation in equipment, software, and terminology, enabling information of all types to be shared, combined and compared, observance of principles pervading all developments in quality of care provided, primacy of the user of the technology, and safeguards to data integrity and personal privacy, follow-through of research results to implementation, involving acceptance by the user who is normally the provider of care but ultimately the patient or individual in the community, and on to commercial exploitation.

These form the common threads running through the whole workplace. Preparatory work summarised in the report from the AIM Requirements Board demonstrated that almost all health care functions can benefit from the constituent technologies of information and communications. The benefits can be obtained:

• At the society level:surveillance of the health environment, promoting public health, prevention of disease
• At the patient level: diagnosis of complaints, treatment and cure, recovery and follow-up, rehabilitation or alleviating disability
• At the general level: education and training, research and development, administration and management, improved quality of the service

3.3. Structure and areas of the Work Plan

.

- Strategies for implementation		(Part I)
- Development of individual technologies		(Part II)
- Validation and integration		(Part III)

These three parts, and their logical interconnection is also presented in Figure 18.

Figure 18: Logical relations between the main components of the workplan.

Part 1 dealt with the strategies for the use of telematics technologies, systems and services, with a contribution to the definition of common functional specifications. This category of R&D concerns the development of the strategies needed to put information technologies in place in health care. Two types of work were involved:

• Identification of user needs, regulatory tools, incentives and criteria for appropriate use of technology in health care,
• Harmonisation of medical and health care management data and technology, common functional specifications, standards and communication protocols.

• Alphanumeric data and coding standards
• Images and biosignals
• Integrated instrumentation and devices
• Knowledge based and decision support systems
• Medical use of multi-media workstations
• Health care communication systems
• Telecommunication systems for medicine
• Modularity and integration of medical and health information and archiving systems
• Technologies and services for the handicapped and elderly.

Part III focused on validation and integration. The category of work covered by this part of the plan deals with developments that are emerging from the research stage or where the research is sufficiently advanced, and it tests and prepares for them to be put in place in the user community and the market. Within this action, this is done in two ways:

• Pilots for integrating medical equipment and information systems
• Applications for validation.

3.4. Main technical domains tackled by the projects

• Alphanumeric Data and Text Coding Standards
• Medical Multimedia Workstations and Images
• Knowledge Based and Decision Support Systems
• Rehabilitation
• Integrated Instrumentation and Biosignal Handling
• Application Framework for Telemedicine
• Regulatory Tools and Quality Assessment

• systems which communicate information and medical services (Telemedicine),
• computer-assisted decision making and resource management,
• image analysis and communications,
• architecture for a common medical record,
• integration of telematics between the hospital departments or the primary care environment
• quality assessment.

Some of the projects put major emphasis on the validation, integration and adoption aspects. This phase of the Programme appropriately showed more involvement in the implementation aspects and concern for the underlying strategies.

The pre-competitive nature of the Programme allowed the R & D projects to proceed only as far as validation (trials, demonstrators and pilots). Some projects showed a proper set-up to allow further progress to implementation and commercialisation. But naturally, clinical and/or technical validation is not by itself a guarantee to be able to reach the market.

Some projects addressed primarily aspects related to the improvement of quality of life. They focused on important medical domains crossing national borders (EMDIS, TELEGASTRO, cancer and cardiology applications), and were primarily oriented towards putting existing technologies to work, without necessarily relying on innovative technological developments. The same applies for other projects dealing primarily with regulation and medical quality control (QUICHE, PROCAS).

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