Health Telematics (AIM) Final Report


	Updated: Feb 1, 97
Executive Summary

The research and technological development (R&TD) activities of Advanced Informatics in Medicine (AIM) were conceived in the mid-80's. It was then realised that the largest public sector in the EC, i.e. the health care sector with 8-10 % of GNP, was introducing informatics and communication tools somewhat lacking in co-ordination, even at local and regional level. This left the sector fragmented, hard to access for European vendors, and difficult to use as a base for world market expansion. Managerial and clinical systems were invented locally from scratch or bought from available products, without considering the peculiarities of the European health delivery systems. The investments therefore led to disappointments. Digitised diagnostic and therapeutic equipment was increasingly imported from the USA or Japan. The latter has taken a leading role, particularly in medical imaging.

An exploratory AIM action ran from 1988 to 1990 to encourage co-ordination in the EC of health care developments. It coincided with major pushes for more rapid uptake of informatics and communication technologies by the health sector, stemming from radical changes in the care delivery systems of many Member States. The needs which the completion of the internal market would impose to bring data and services to the patient irrespective of his actual location emphasised this. Notable examples of relying on telematics were coming from the other side of the Atlantic. In the USA, in October 1992 it had been decided that major improvements in patient data communication and reimbursement schemes based on modern telematics would be implemented gradually from 1994.

The activities within the 3rd Framework Programme had a budget of 97 million ECU. This was seen as probably the minimum financial volume to keep the interest of commercial actors in a user driven programme. According to the Council Decision the objective was "to stimulate the development of harmonised applications of information and communication technologies in health care and to develop a European health care information infrastructure taking into account the needs of users and technological opportunities". An ad-hoc work programme was approved, with input from experts all across Europe, defining in a very detailed and comprehensive way, the number and type of tasks to be covered.

User acceptability, data confidentiality and security were key items. The added value of a European platform for collaboration amongst researchers, industry, telecom service providers, health care providers and purchasers should improve cost effectiveness and ensure the quality of health care and increase the competitiveness of European vendors. AIM started-off from 1992 with an initial set of 37 cost-shared projects for up to 3 years, with about 300 partners, 5 concerted actions with more than 100 participants, and 2 accompanying measures securing the links to industry, telecom services, health care providers, research institutions, and CEN, the European standardisation organisation. CEN TC-251, technical committee for medical informatics was created with AIM as a decisive catalyst. This collaboration model has been studied intensively by USA and Japan since then.

In successive call-for-tender, an additional number of projects, concerted actions and accompanying measures were selected, covering a broader or deeper number of tasks included in the work programme. In addition, some specific studies were committed to enlarge the understanding of selected key aspects related to the implementation of health informatics and telematics, the requirements to respect and difficulties to overcome. In total, around 50 contracts were produced during the period of reference between the European Commission services and a wide scope of organisations of all types from Europe which led to the production of an extensive panoply of results for which this report accounts.

The main domains tackled by the projects were: formatting of comparable medical, managerial and financial data and files for on-line communication or data cards and other off-line media; communication protocols for medical images and biosignals; development and connection of multipurpose and multimedia workstations (voice, images, text, graphics and biosignals); use of modern dedicated telecom services; establishment of shared databases for patient services, quality assessment and expert advise; framework for telemedicine; data confidentiality, safety and security. The emphasis then switched to system integration, pilot projects and demonstrators and validation to comply with regulations to make an input to standardisation. Projects were in direct contact with a vast number of users ranging from bone marrow transplant organisations to regional and national health authorities, and large international professional organisations.

These health care R&TD activities within the TELEMATICS programme did benefit from results of other European programmes and initiatives, bringing existing and emerging technologies into work in the specific environment. It was a particular challenge to help develop affordable workstations for hospitals, primary care and even home use, and interconnect them in local and regional clusters and beyond. The goal for the future, well represented by the Health Sector of the TELEMATICS APPLICATIONS programme 1994-1998, would be to carry on from the previous phase results, and develop at local level the necessary organisational and technical tools for "seamless care", and on the national and international level to provide rapid information about individual patients or grouped data and to share services across borders.

Projects carried out their work mainly from 1992 through 1994, with most of them producing their final reports and some of them attaining their completion, in 1995. The main outcomes, in terms of its projects and other results, were presented at a major conference that took place in Lisbon in December 1994, with the support of the Portuguese Ministry of Health and the national PTT, symbolising the sort of synergy that AIM and health telematics had helped attain. An important number of publications, conferences and events along the period of reference have also helped in the dissemination of results and creation of awareness.

This Final Report is structured in two volumes, which are complementary and can be used to some extent, separately. Volume 1, General Overview, contains all documents of reference describing the general background, the rationale, the global context of other European Union policies, the work programme contents and tasks, the main areas of work, and details on country and institutional participation. It contains brief descriptions of all individual projects, mentioning objectives and key results. In addition, a full Partners Directory, provides contact details to the so-called "AIM community". This volume is intended for a broad audience, including professionals, users, and decision makers. On the other hand, Volume 2, comprises only individual project information, but at a higher technical level. This volume is intended for a more specifically oriented audience.

At the time when the Health Care sector R&TD and deployment activities within the TELEMATICS APPLICATIONS programme are well under way, the programme management wants to express its gratitude to all the organisations and individuals that have applied their enthusiasm and professional skills, as well as their valuable resources to help the 3rd Framework Programme projects dealing with TELEMATICS APPLICATIONS for health attain successful results.



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Executive Summary