Updated: Feb 1, 97
Introduction

In a broader perspective the telematics programme was one of the three pillars through which the European Communities assumed its strong commitment on information and communications technologies. The first and largest pillar was the ESPRIT programme, dealing with information technology and microelectronics. The second pillar was the RACE initiative, dealing with research on advanced communications, broad-band transmission, etc. Finally, the third pillar was formed by the Telematics family, i.e. AIM, DELTA, DRIVE, ORA, ENS (respectively dealing with medicine, education, road transport, rural areas and administrations). The telematics area could also be seen as a spin-off from RACE as the R&D work undertaken was much more closely oriented to the specific vertical sectors and to the applications.

Figure 1: European Communities Third Framework Programme 1991 - 1994:
Information & Communication Technologies; budget expressed in millions of ecus

The sub-programme was assisted by the valuable advice and recommendations of the Telematics Management Committee (TMC) and the Working Party of national representatives (WP-Health Care). One of the suggestions taken in the first stage after the launching of the new projects, was the setting up of additional concerted actions and accompanying measures, that led to the establishment of 5 concerted actions during 1992. A number of supplementary workshops were also convened. The most important consensus instrument, the concertation meetings, also showed its strength in bringing researchers, providers and industry including SMEs, together. In few words, the terms of reference and the situation at the beginning of the programme in 1992 was as presented in Figure 2.

Figure 2: Telematics in health care (AIM) 1991-94:
Terms of reference and sub-programme situation in 1992

Area 3: Telematic systems in areas of general interest, 3rd FP Objective: (According to Council Decision of 1991) To stimulate the development of harmonised applications of Information and Communication Technologies in Health Care. To develop a European Health Care Information Infrastructure taking into account the needs of users and the technological opportunities. Indicative Budget: 97 MECU for projects, Concerted Actions and Accompanying Measures Proposals Received: 200+ from all member states requesting about 700 MECU as EC contribution Recommended Actions: 37 R&D Projects; 6 Concerted Actions and Accompanying Measures to secure Consensus Building, User Acceptance, Industrial Involvement, etc

The opportunity was not missed, as a certain number of new projects and other actions with the aim of validation, pointed the way to the next century for the health care professions, the service providers and industry alike. The health care providers proved being eager to show the way sponsoring projects or even participating by providing test bed facilities and sharing know-how.

The rationale of the AIM programme was based on inputs from different sources: industry, telecommunication service providers, academic research and health care professionals in Member States. Health care providers have accepted and introduced the new technologies at a slower pace than other domains. The European health care sector appeared to be as a very fragmented market, and an effort was needed to increase the competitiveness of the European industry, by advancing the technical basis of products and services, and getting European creations marketable by European companies on a world scale. The technological developments in informatics and communication technologies, when properly adjusted to the specific demands of the health care sector, offer the opportunity to process and extract the relevant information from the rapidly increasing amount of patient data and to communicate this information effectively wherever needed. The above situation and roles of main actors at time zero configured a tripartite scenario, formed by research - industry - health service providers and purchasers, as depicted in Figure 3:

However, the experience with the exploratory action, and further consultation, showed that there was a need to move toward a different situation, including the telecom and network services providers as shown in Figure 4. The reason is that in many cases the information and telecommunications industry was insufficiently aware of the opportunities and potentials presented by the AIM Programme. At the same time, ironically, this industry was looking for new markets to exploit the emerging ISDN and Broad band Communications Networks and Services. In this context health care is considered certainly promising. Similarly also the opportunities for making national policy agencies aware of the possibilities might not have been fully exploited.

Nevertheless, it is worth mentioning that in both conceptual schemes the users would be placed at the very centre of the whole endeavour, which later on would form the basis for the concepts prevailing in the fourth framework programme, then on defined as a user-oriented programme.

Figure 4: A four-party scenario in medical informatics and telematics,
of research - industry - health service - telecom and service providers.

The need to take into consideration all the above areas that are part of the health sector, had a clear consequence in the necessity to address the whole of the life-cycle of data related to patient care and health care provision in general, as sketched in Figure 5. The AIM and telematics for health care initiatives made a serious attempt to cover all of those areas, or at least to provide the basic concepts and tools to enable its appropriate management.

In the last decade information technologies had played a decisive role in the dramatic developments not only in diagnosis, treatment, surveillance, and rehabilitation of patients, but also on the side of the more collective aspects of health care and health preservation such as clinical trials, epidemiology, prevention and health education. Today most laboratories and equipment are digitised; modern intensive care is based on computer-assisted analysis of bio-signals. Integrated health care information systems provide decision support to those responsible for the management of care delivery on a daily basis, as resources data can be captured, processed and related to different types of services. Computer based booking systems were also established and better quality of care would be possible, amongst other improvements. The health telematics programme coincided with major pushes for rapid uptake by the health care sector of those technologies stemming from radical changes introduced in the care delivery systems of many Member States. With the completion of the Internal Market the arising need is to bring data and services to the patient irrespective of his/her actual location. In line with the above, Figure 6 presents the elements related to the health policy scenario and some of its terms of reference, which influences the potential of health informatics and telematics, and its appropriate deployment.

Figure 6: health policy scenario and elements influencing the potential of
health informatics and telematics.

The shift in health care delivery principles can be characterised as decentralisation of authority in the planning and execution, and by separation of purchase and provision. Rapid communication of comparable data has been perceived universally as the cornerstone for this development. The health problems of industrialised societies are very complex, and the costs of health care are very high, which leads to conflicts between the expectations of people and the service that can be widely provided. Telematic systems should, therefore contribute to improve the quality of health care, its efficiency and cost/effectiveness. Almost all health care functions can benefit from information and communication technologies. It is expected that this emphasis will be increasingly justified as the trend continues away from institutional treatment into home or ambulatory care, and as the boundaries between institutional and home care becomes less rigid, by taking advantage of the use of telematics.

The need for establishing conceptual models, developing workstations, working on a common medical terminology, coding and classification was addressed with great success in the AIM Exploratory Action (1989-90). In the following phase a strong element was added of further integration of systems by highlighting the medical workstation interconnectivity, development of bridges to a broad-band communication network with health care specific added services, telemedicine and interactive, shared databases. Providing efficient communication of medical information and knowledge, the new technologies offer means to further unify Europe by providing tools to interconnect the respective health information systems, and to improve the overall quality of the service, by improving the efficiency of diagnosis and treatment, increasing awareness and knowledge of health care, and widening access to better services.

In practical terms, the European Communities, through the AIM and health telematics initiatives, made a serious move in line with the above objectives. Within its given legal and budgetary framework, it produced important changes in the above described scenarios and markets, through its main-stream operations: the research and development projects. The process is sketched in the Figure 7 and described in more detail in successive chapters.

Figure 7: Summary of programme life-cycle.

Projects were assessed on a technical basis every year, with the support of independent external experts. Only few projects were fully stopped as a consequence of the latter, and some others had to adjust managerial and or technical issues that needed improvement. Most projects completed successfully their work and achieved most of their objectives. The results were presented at the Final Conference in Lisbon in December 1994, were an exhibit displayed the practical achievements of each contract. The conference, with the title "Health in the New Communications Age" opened the way for the continuation of activities under the 4th Framework Programme 1994-98.

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