Updated: Feb 1, 97
ISAAC

Project Code:   A2013 Project value:   5749 KECU EC contribution:   3003 KECU No of partners:   7 No of countries:   7 Duration:   36 months

Contact: Mr Stefano Bertelli Prisma Informatica S.p.A. 11 Piazza di Bellosguardo Villa dell'Ombrellino I-50124 Firenze, Italy Tel.: +39-55-22.90.18 / 30.21 Fax: +39-55-22.90.20

Overview

Purpose and objectives

ISAAC has the goal of prototyping a system which gives adequate support to the requirements of a local information processing environment and of the needs of integration with other components of the Health Care System. The project is very much concerned on the design of a useful and usable medical workstation for day-to-day patient care and on the definition of an Integration Architecture dealing with the PHC environment.

ISAAC is a strategic project in the framework of General Practice and, more broadly, of Primary Health Care (PHC) with the main goal being to develop information technology and telematics support in this key area of the Health Care Systems in European Countries.

ISAAC is the extension of a previous project (ADAM) which was part of the AIM exploratory phase. It is from these initial results that ISAAC is developing a fully integrated environment to support the functions of Primary Care.

Overall objectives:

• Contribute to the organisation, understanding and standardisation of General Practice (GP) functions in Europe
• Strengthening the promoting and impeding factors in the diffusion of IT&T systems in PHC
• Prototyping a system giving adequate support to the requirements of a local information processing environment and to the links required to other levels of the Health Care System (system integration).

There were two major action lines:

1. The set up of a Functional Reference Model (FRM) focused upon the information needs of the General Practice environment. In addition to contributing to a European Reference Model for the development of Information Processing System in the Primary Care and General Practice area, the ISAAC FRM provides the guide-lines for the design and implementation of the ISAAC environment.

2. The definition of a global architecture of the ISAAC environment. A generalised application development environment was specified, giving standard criteria for the implementation of information processing applications in the Primary Care and General Practice area.

1. Development of a GP Workstation environment on the basis of high modularity and configurability, able to support at a local level the medical activities of both the General Practitioner and the Practice Team (nursing, administrative and technical staff). A special emphasis is put on the definition of the most suitable Human-Computer Interface.

2. Integration of the GP workstation with the other services supplied by the Health System both at primary and secondary care level through the development of an integration system architecture able to support the exchange of information among the different actors (horizontal communication between the different practitioners, patients and statutory/non statutory agencies in primary and community care-vertical communication with hospitals, labs and other secondary care facilities).

3. Address the requirements of transfer/storage of the patient re-cord on a portable media such as a data card which could easily follow the patient and be readily available in case of emergency.

4. Definition of tools assisting in the health education of the patient and supporting the continuing medical training and tutoring needs.

Results

The IAB is a group of experts in the field of Primary Health Care (representatives from: UEMO-Union Européenne des Médecins Omnipraticiens; General Practitioners Associations of several European countries; Nurses Association; WHO/EURO PHC Advisoring and CEN TC251. The IAB collaborated with the team during the project lifetime, looking at the project periodic results, supporting the completion and validation of the Functional Reference Model and contributing to evaluate the environment acceptance.

The test and validation of the project results was performed in five pilot sites: Florence-I, Pombal-P, Athens-GR, Luebeck-D, Rotterdam-NL. The set up of these pilots, involving General Practitioners, Secondary Care facilities and patients, strengthened the follow-through from research results to the commercial exploitation. Finally, worked in connection with regional health providers acting as sponsoring partner so as to ensure that the project R&D effort in telematics in HC is properly co-ordinated with health care strategies.

The Functional Reference Model of General Practice (FRM) has allowed the study and comparison of the structure, the goal and the organisation of General Practice in different European Countries, both EU members and not. The ISAAC Functional Reference Model (FRNI) for general practice includes a theoretical framework relating health and health care policies to the core elements of health services (providers, functions and settings) and to the results (health care and health outcomes) of providing services. A list of general practitioner's activities, contemplating the direct provision of health services and other activities related with keeping up professional competence and service quality, completes the Model.

The architecture has allowed the definition of the framework for the development of General Practice applications, providing guide-lines and advice for:

• the type of functionalities that this system has to provide
• the design phase of the different components
• the implementation phase of the different components

The modules implemented are:

• a medical data base able to satisfy GP needs (Problem-oriented, SOAP, use of medical classifications, clinical patient record management, possibility to carry out preventive care and epidemiological research, patient education).
• ISA: integration system with existing remote applications (hospitals, laboratories, etc.)
• Medical EDI: module for the use of the EDIFACT standard for data communication with the clinical analysis laboratory connection with the local laboratory equipment (ECG)
• Epidemiology: tool for the execution of epidemiological researches
• Education: tools for GP training and patient education

The demonstrator installed in the pilot site of Pombal (Portugal) includes:

1. an administrative station for the handling of personal details and administrative data of patients
2. a medical station used by GPs for the handling of the clinical patient record
3. the connection with the application of Pombal hospital.

The link of user requirements to IT support is provided by the ISAAC architecture; it gives guidelines and recommendations for the design and implementation of systems suited to the requirements of General Practice.

Finally the ISAAC Accreditation List states the detailed requirements IT systems have to fulfil in order to be compliant to user needs.

The ISAAC partners are mainly SMEs; thus the major effort in the future will be put in the commercial exploitation of the results.

The main streams of exploitation will be:

Commercial; the ISAAC system will be engineered to fit the requirements of Southern Europe countries (not mature markets) were it will be commercialised. In more mature markets (like UK and The Netherlands) partners will provide services and consultancy to other producers already on the market.

Participation to national initiatives; partners will participate to national projects for the informatisation of Primary Health Care and will be involved in national committee for the definition of national guidelines for the informatisation of PHC.

4th Framework; results achieved so far will be integrated with other projects of the current framework in order to contribute to the goals of the next research framework.

List of Deliverables

Year 1

• Interim deliverable, Programme Line Rationale (3/R/P)
• Functional reference model (6/R/P)
• Design guidelines (7/R/R)
• Medical Classification (6/R/P)
• Clinical Database Prototype - Rel. 0 (8/P/P)
• Global architecture & Design guidelines (12/R/P)
• Human Computer Interface & Medical Images Management (12/S/P)
• Integration Security Mechanisms (12/R/P)
• Quality Assurance within ISAAC project (12/R/P)

Year 2

• ISAAC prototype REL 0.1 (2/P/P)
• Integration architecture (4/S/P)
• Functional reference Model 1st Revision (6/R/P)
• Medical & Drug Database (7/S/P)
• Medical Workstation - Rel. 1 Human Computer Interface Implementation (9/P/R)
• Laboratory Equipment Connection (10/S/P)
• Medical Workstation - Rel. 2 Medical & Drug Database (11/P/R)
• Diagnosis & Treatment Support (11/R/P)
• Medical Workstation Security Mechanisms (12/R/P)
• Quality assurance within ISAAC project revised (12/R/P)

Year 3

• Medical EDI Specification (1/S/P)
• Medical Workstation - Rel. 3 Connection with Laboratory Equipment (3/P/R)
• Epidemiology & Clinical Trial (1/S/P)
• Report on patient data card medical record & Security mechanisms (1/R/P)
• Health care integration tools rel.1 (3/P/R)
• Tools specification (5/S/P)
• Medical Workstation rel. 5, Epidemiology & Clinical Trial (7/P/R)
• Functional Reference Model - Final Revision (6/R/P)
• Health care Integration tools - rel 2 - Medical EDI (9/P/R)
• Patient data card Customisation (12/P/R)
• Tools implementation (12/P/R)
• ISAAC Final Prototype (12/P/R)
• Quality Assurance within ISAAC Project - Final revision (12/R/P)

List of Participants

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