Updated: Feb 1, 97
EPISTOL

Contract No:   76251 Total cost:   130 KECU EC contribution:   130 KECU No of partners:   8 No of countries:   7 Duration:   12 months

Contact: Prof. Adolfo Steiger Garção Campus da Faculdada de Ciencias e Tecnologia/UNL Quinta da Torre P-2825 Monte da Caparia, Portugal Tel.: +351-1-295.44.64 / 77.87 Fax: +351-1-295.77.86

Overview

Purpose and objectives

To some extent, this is an area which has been covered by the AIM 1991 - 1994 Programme. To aid the planning of future programmes in health telematics, namely the coming Health Telematics Programme of the Fourth Framework Programme for Research and Technological Development, the EPISTOL project was set up to clarify the impact, in the near future, of knowledge based systems and techniques for the health sector, and provide recommendations with respect to the research and development required in this period.

The EPISTOL project started in the beginning of 1993 and was included, as a strategic study, in the accompanying measures of AIM, based on a contract between the EC and UNINOVA, Portugal. The activity was further supported by the MEDIS Institute in Munich, who also used the results of the study in the planning of the future phases of the German MEDWIS Programme. The planning of this action encompassed a number of phases an events:

A Core Group of specialists was appointed. It consisted of six invited experts representing research, users, and industry plus the convenor from UNINOVA. Most of the members represented current AIM projects or had some other connection with the AIM programme. The main task of this group was the preparation of a Scenario Report, edited by the convenor with the approval from the Core Group members, with a vision on the future use of knowledge based systems in the health sector, and recommendations about the research and development that needs to be done in this period.

The scenario report was presented at a three days working conference organised in Munich by the MEDIS Institute on 28-30 June 1993. The meeting was attended by the Core Group, and by over 20 invited experts, representing research, industry, service providers, users, administration and the legal aspects. They were appointed by the Core Group after consultation with UNINOVA, MEDIS, and the AIM Office of the CEC.

During the morning sessions of this workshop the convenor of the Core Group presented the Scenario Report and each expert presented a short paper with his/her own vision of the future, as a supplement and /or comment to the scenario report. These presentations were further used as guidelines for the afternoon discussions, divided in 4 specialised working groups, each with a rapporteur and a specific topic but with multidisciplinary participants.

The following topics were discussed:

1. The role of knowledge based systems in clinical practice;
2. How will knowledge based techniques be incorporated into commercial products;
3. Trends in knowledge based research that will enable its use in routine applications;
4. Distributed knowledge based systems and telematics in a changing health care environment.

The rapporteurs produced written reports summarising these discussions. After the conference all participants had the opportunity to review their papers and submit a new version. The Core Group also reviewed their scenario report in light of the new input and ideas, and completed it with recommendations regarding R&D work in the field.

An invitation was distributed to many relevant persons to participate in an open seminar held in Brussels on 19 November 1993, chaired by the CEC. Anybody expressing interest in participating received the draft document and was requested to submit a short position paper in advance of the seminar. These comments should include viewpoints on the use of knowledge based systems and techniques in the health sector 5-10 years from now and the necessary R&D work leading up to this use.

At the seminar the Core Group presented the revised Scenario Report, the rapporteurs from the working groups of the Munich workshop presented the groups' findings and a member of the Core Group presented an extract from the papers of the same workshop. Following these speeches a panel with the members of the Core Group was the centre of a general debate for the rest of the day.

Results

The report identifies potential users of decision support in Healthcare, which include not only doctors, but also nurses, Healthcare administrators, as well as patients. It then addresses their requirements and expectations with respect to knowledge based decision support, and discusses the need to integrate such systems and techniques with the Healthcare environment and their routine practices. Some topics are discussed in more depth, namely the change in emphasis from diagnostic support into more general patient management support, the emergence of clinical guidelines developed for this purpose as well as the need to support, the emergence of clinical guidelines developed for this purpose as well as the need to support their development and management, the integration with medical data sources (e.g. electronic patient records) and knowledge sources (e.g. literature and patient databases), and the need for adequate interfaces with the users and with other, local or remote, information systems.

From the industry perspective, the report discusses the value that knowledge based decision support systems may have for the users, seen as purchasers of these systems. It identifies the industrial sectors whose expertise should be combined to enable the development of commercial knowledge based systems, namely Healthcare information systems suppliers, medical equipment industries, scientific and education publishers, value-added network operators, and pharmaceutical companies. It identifies opportunities for these industries to co-operate in the development of more innovative knowledge based products to extend their traditional product lines. It finally addresses some aspects of engineering of knowledge based applications in Healthcare, to facilitate integration in current products, areas needing research for future products development and competing technologies that must be taken into account.

The report suggests that knowledge based systems research should focus in the problems of integration with the Healthcare environment and discusses priorities for research in the next decade. These include: efforts towards the standardisation of terminologies and ontologies and translation between existing standards; refocussing reasoning methods from pure diagnosis into broader planning, incorporating diagnosis, treatment and monitoring; support to the management and development of patient management guidelines, co-ordination of these research efforts with the development of patient management guidelines; co-ordination of these research efforts with the development of structured patient records; research into advanced architectures that allow sharing and reuse of medical knowledge, to ease the problems of knowledge acquisition and validation; integration of knowledge based techniques with telematics and multimedia technology to provide adequate user interfaces to these patient records (with a view on their management) and other Healthcare services; and finally the need to develop metrics and methodologies to assess the value and impact of knowledge based decision support systems.

The main conclusions of these complementary perspectives are summarised in the final chapter which ends with a number of recommendations regarding the planning of future research and development of knowledge based systems and techniques in the Health sector for the next decade.

List of Participants

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