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Updated: Sep 17, 97 |
2. Overall Description of the project | |
Under the Third Framework Programme the European Commission, specifically DG XIIIC, gave a substantial boost to interest and activity in this area by means of a series of co-funded projects. The resulting co-operation and exchange of ideas created progressively a fairly coherent group of people involved in health telematics research, development and implementation in Europe, known familiarly as the « AIM Community ». The AIM Programme marked a milestone at its final conference, held in Lisbon in December 1994, when a wide range of key issues were discussed and analysed against the backcloth of a major exhibition of health telematics products.
In parallel with these events, a number of major reports appeared which marked the strategic importance of these developments. In 1994 two key documents were produced by the Commission, the so-called Delors White Book and the Bangemann Report on the Global Information Society. Another important document in this context was the Green Paper, which concentrated attention on issues such as technology deployment. These three publications represented both an acknowledgement of, and a contribution to, the impact of the new information and communication technologies. Broadly speaking, they sketched a transition to the 21st century founded upon innovative information-based scenarios, where technology deployment, dissemination and access would become catalysts in the socio-economic development of Europe. These three publications and the recent G7 Meeting have served to highlight the need for accurate, up-to-date data, readily available in a digestible form, on the information infra-structure and intercountry co-operation, on the regulatory framework, and on the consequences of the information society for the economy and employment as well as for society and lifestyle.
The purpose of the proposed Sectorial Support Action is the creation of a European Health Telematics Observatory (EHTO), which will collect, analyse and make available in a coherent and user-friendly form a wide range of information on developments in the field of health telematics, using a range of methods and tools varying from traditional publications and workshops to multi-media services.
It is intended that the Observatory should fulfil a number of different objectives which seem logically to fit together.
- Firstly, the consortium will undertake a scientific analysis of the Health Telematics Sub-Programme aimed at monitoring its execution and achievements against selected criteria, as well as its socio-economic impact and cost-effectiveness.
- Secondly, it is proposed to keep a continuously accompaniment of developments and achievements that will occur in the health telematics market in Europe, Canada, the United States, Japan and other countries of strategic interest.
- Thirdly, the Observatory will undertake dissemination and promotion activities aimed at making available information on best practice using a variety of technological approaches in particular Internet using World Wide Web, and theme-specific workshops and conferences electronically supported.
Finally, the observatory will provide facilities for the demonstration of health telematics prototypes and products.
In a broad sense, the EHTO Sectorial Support Action intends to give projects the mechanisms to support the tasks they will undertake, which are described in Area-C of the Work Programme, namely HC 5.1 to 5.8, HC 2.4 and HC 2.5
Moreover, most of the activities to be developed within the Observatory are certainly of crucial importance to the Telematics Programme, particularly to Area E (applied to health) :SU 3.1 to 3.13, SU 2.2 to 2.4, SU 1.1 to 1.4, SU 4.1 to 4.4
At the present time there is a plethora of information available on a whole variety of health telematics issues, but much of this is difficult to find and to use in a coherent and organised way. It is widely scattered in the files of different types of organisation, and may be known only to one or two experts within a particular country or sector.
Available evidence seems to suggest that the potential clients for this type of information are very heterogeneous. They include national and local health authorities, health service managers and health professionals, universities, scientific societies, professional associations, health insurance organisations, European industry including hardware and software manufacturers, system integrators, information system vendors (including SME’s), telecom operators and Value Added Network Service providers. Various other groups related to the European Union, including European Commissioners and Parliamentarians, Commission staff and participants in Commission programmes also require information on health telematics developments.
The needs of these users are multi-faceted and include for example information from :
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However it is plain that for the majority of potential users, not only is « hard » information on most of these subjects difficult to find, but in its raw form it is somewhat indigestible and often difficult to use. Information broken down into suitable subsets has far greater relevance to users’ needs. Responding to this requirement will be a major aim of the European Health Telematics Observatory.
The Observatory’s activities can be divided into a number of major work areas :
Figure 1: STRATEGIC ACTIVITIES OF THE EUROPEAN HEALTH TELEMATICS OBSERVATORY (E.H.T.O.)
One of the activities of the Observatory is a regular publication of a "Journal" giving a series of snapshots of the current health telematics environment and its likely evolution. This activity will build on work already carried out by a number of projects under the Third Framework Programme, including pre-existing reports and surveys. This information will be supplemented by a series of twelve interviews with leading personalities in the field, and news on relevant events at world-wide level.
At a very early stage, in parallel with the activities relating to the physical establishment of the Observatory, the partners will begin to make the necessary arrangements to secure inputs to the knowledge base. This will involve the setting up of effective systems to ensure the regular supply of information in the sectors identified as relevant.
Guidelines will be drafted for distribution to all identified information sources, so that the material presented will be relatively homogeneous, and suitably packaged e.g. using HTML format and a predefined presentation standard, in order to reflect the needs of the different types of potential enquirer.
Information handling will constitute an important part of the activity of the Observatory. It will involve the following tasks :
So far as document analysis is concerned, a number of potentially useful analytical categories, corresponding with a number of interested parties, can readily be identified :
Figure 2
To ensure that the information collected and disseminated by the European Health Telematics Observatory corresponds to the real needs of the health care sector, three groups (health policy makers, end-users, industry) will be constituted. These will give their views on issues concerning the organisation of the Observatory and on the type of information which they consider to be useful and relevant. The health policy group will consist of representatives of national/regional health authorities and social insurance organisations, while the end users will represent the health professions. The third group will bring together representatives of industry (including small and medium enterprises and the telecom operators).
It is also planned to assess ">E.H.T.O. users’ requirements on a wider basis by carrying out surveys of their requirements. Here the objective is to find out directly from all types of potential E.H.T.O. users what type of information, broken down into what categories, would be most useful to them, so as to orientate the information collection and analysis appropriately.
The Observatory will use Internet tools to disseminate information to the users.
Internet is a world wide network consisting of systems that are able to communicate through a common protocol-suite called TCP/IP. Each connection to the Internet has a world-wide unique address called the Internet address (or IP-address).
Internet offers a communication highway for connected systems. The use of Internet can be broken down into 3 main areas:
1) At the lowest level it offers ‘bearer’ services based on TCP/IP. This means that applications running on one system can exchange information with a peer application on another system provided they respect exchange protocol agreements.
2) Internet allows the exchange of information between individuals. Several mail exchange protocols (e.g. P.O.P., Post Office Protocol) allow the exchange of mail between individuals.
3) Internet allows the set-up of information resources that can be accessed by several groups simultaneously. Several mechanisms are available to this end, ranging from basic ones, such as FTP (file transfer protocol, used to ‘dump’ and retrieve information from servers with a known address), to navigation tools that enable an intelligent, transparent search of many systems attached to Internet; Examples of these are: Archie, Wais, Gopher and the latest development: WWW.
World Wide Web, also called WWW or simply the ‘Web’ is a protocol that allows the setting-up of a distributed information system. A host is then referred to as a Web server, a client is often called a Web browser. The Web is based on 2 groups of protocols: HTTP and HTML.
HTTP (HyperText Transfer Protocol) is the protocol that allows the exchange of the information between a Web server and a Web client.
HTML (HyperText Mark-up Language) is the syntax that is used for defining the content and layout of the information provided on the Internet. HTML has two important features: it allows links and it allows multiple media to be mixed in the same document, which is reflected in the term ‘hypermedia’
A WWW document contains ‘anchors’ (these are document elements such as words, sentences, icons) that can be clicked on when using the browsers. These links refer to other documents on any connected machine. A document is identified by a URL, or Universal Resource Locator. The browser automatically retrieves the document as indicated by the URL (the URL contains the protocol to be used, the name of the host, and the directory where the document is located). A link can even refer to an application residing on the same or on another Web server. As a result, WWW allows the seamless integration of other navigation tools (such as Gopher) and applications (such as FTP or E-mail).
Each server on the Web contains a ‘Home’ page. The home-page is the equivalent of a shop-window. It gives the client, besides the name of the shop a quick overview of the articles available in that shop. The Home page serves as a ‘business-card’ for the Web Server Site. The home page contains links to other information available on that site and may even contain links to other sites.
Internet as such and especially the HTTP protocol are not designed for maximum security. Most information available on Internet however, is not of a very sensitive nature. HTTP is certainly not fit for retrieving sensitive, identifiable patient information !
Mechanisms exist however to provide some basic access control. This allows restricted access to users who know the access code (or password).
If additional security is needed, enhanced user authentication or even fire-wall-like protective measures have to be taken. The goal of WWW however is to disseminate information, which is reflected in the security features of the HTTP protocol.
A Web server can be used to gather information from connected users. It is however recommended that the information be ‘moderated’ before allowing it to be retrieved by other clients. This moderation will consist of a number of steps:
- the integrity and authenticity of the information has to be checked in order to avoid accidental and incidental changes, or masquerading by the submitting party. Several solutions, ranging from personal contact to electronic signatures can provide the security services required.
- the information has to be analysed, and categorised in order to give it a place in the information hierarchy of the site. This allows the creation of links. Which should be determined by domain experts.
- If the information is not provided in HTML format, the conversion to HTML format has to be carried out, if the information is to be provided as a HTML document. It is possible to present the same document in different formats (e.g. HTML, plain text, Word or WordPerfect document,. . .).
Figure 3: Moderation Process
The observatory will disseminate the information referred to, using a variety of channels of which WWW (World Wide Web) will be the most advanced one. Wherever possible indexing and hierarchy information needed by other access methods (such as gopher, wais, archie, …) will be provided. WWW however will provide seamless access to all health care telematics resources, whatever access protocol is needed. As part of the service, a health care telematics newsgroup may be established and individuals can be automatically mailed depending on their group profile.
A system will be established to enable users to ask questions about the Observatory and about health care telematics in general. The questions will be logged and used to compile a FAQ (Frequently Asked Questions) -list that will be available at the EHTO Server through WWW, gopher or FTP. Questions, remarks and feedback mail addresses of experts appointed by EHTO will be provided.
It is proposed to develop for each health telematics project a forum (listserv) which would be available for end-users by subscription and which should favour information exchange between projects and end-users. In addition the Observatory will constitute a horizontal electronic forum facilitating transversal exchanges of information between different types of end-user. In order to avoid information overload, each electronic forum will be moderated by the Observatory.
Figure 4
The following broad categories of information will constitute the base of the Health Telematics Observatory’s information/knowledge base :
Information from Health Telematics Projects : here the support of the Commission will be sought to ensure the cooperation of the projects. It is intended to include the best of the Third Framework Programme results within the Observatory’s information/knowledge base together with all public deliverables from the Fourth Framework Programme Health Telematics projects. Systematic information will be collected on the objectives of the projects and on their development. The information obtained will be carefully analysed against certain identified criteria, for example in relation to medical, health policy, technological, industrial, economic, societal, quality, adaptability, ethical and standardisation aspects.
Information from Horizontal Actions : a number of health telematics projects are in the process of developing specific expertise in areas of key interest for health telematics users and service providers. These include technology assessment, developments in education, legal and ethical aspects and quality issues. Complementary activities are taking place within the Member States. The Observatory will establish close links with these projects, and with teams working at national level to ensure appropriate inputs to the Observatory, and with a view to promoting the dissemination of their findings.
Information from Other Related Commission Programmes : a number of other Directorates General of the Commission (for example III, V and XII) or programmes (such as ESPRIT, ACTS, ENS, IDA, and BIOMED) have links with the field of health telematics. Additional information, related for example to EUREKA and COST, or concerning funding available under European Structural Funds, the European Regional Development Fund or the European Investment Bank, can be of importance both to users and to service providers, and will form another useful aspect of the Observatory information service.
State of the Art in Health Telematics in Europe : building on work already carried out by a number of projects under the Third Framework Programme, quantitative and qualitative information will be collected on health telematics development in the countries of the European Union. A comparative assessment of the situation at the beginning and the end of the Health Telematics Programme will be carried out in order to evaluate progress.
Information on Standardisation : Research and development and standardisation go hand in hand. The one influences the other e.g. health telematics projects and their deliverables serve as input for standards bodies (such as CEN TC 251 and EWOS EG/MED in Europe). The standards making bodies in their turn make R & D projects aware of the existence of available standards in order to avoid duplication or the production of incompatible solutions. Both research and development and standardisation will undoubtedly stimulate cross-fertilisation through their complementarity and be of great importance to all future health telematics efforts in Europe.
Information on all existing standards and on standards in the course of development will be deposited with the Observatory. A link will be established with the CEN TC 251 WWW server. Through CEN, liaison will be ensured with the United States (ANSI HISPP), Japan (MEDIS-DC), Canada and Australia.
An interesting aspect of the Observatory’s work will be the demonstration, using appropriate technology, of the prototypes and products developed within the health telematics domain. Full industrial sponsorship has been obtained for the demo-site (premises, equipment and telefom infrastructure)
The availability of demonstrations (combined with a wide range of information in a readily accessible and user-friendly form) should permit the user community to obtain both factual and evaluative information. This should, on the one hand, assist the user community in the development of their communications networks (see ‘deployment’ under ‘Strategic Role’ of the Observatory), and on the other hand help European industry to assess market potential more accurately.
The initial demo site architecture will be designed taking full account of the requirements of the Health Telematics projects. A technological window where the most recent telematics equipment will be available. It is intended to develop telecommunication links between the EHTO Demo Site and national satellite demo sites (see ‘Health Telematics Promotion Mechanisms’). This will represent yet another way in which E.H.T.O. will offer interested parties from outside the consortium the opportunity of being involved and of playing an active part in the promotion activities within their own regions.
The basic infrastructure is shown in the next figure. It has three layers. The first allows the use of several communication channels and services, ranging from basic, such as a dial-up connection to high speed such as ATM. This allows simulations of both readily available infrastructures and of state-of-the-art solutions. Telecom operators will be important industrial sponsors for this type of service.
The second layer shows the common infrastructure, that consists of a number of network topologies and servers.
The infrastructure will evolve in accordance with the requirements expressed by the users of the Demo Site. Functionalities such as a Web server, communications- and databases server can already be filled in. The common infrastructure will be centrally managed and controlled by EHTO through network tools.
The upper layer consists of the application specific elements. Diverse platforms are looked for, hence the inclusion of PC, MAC and Unix workstations. If necessary, application specific servers will be added to the Demo Site network infrastructure.
Figure 5
The Observatory by virtue of its multi-faceted approach to health telematics, will rapidly constitute a European pole of information and activity and a starting point for health telematics deployment. Diffusion of the information collected is the raison d’ętre of the Observatory.
Access to the information/knowledge base will be complemented by an additional promotion activity: a regular feature of the Observatory’s activities will be theme-specific workshops and conferences, which may have a cascade effect (national, regional). The choice of subjectmatter for these workshops will be determined after consultation between the partners, based upon the results of enquiries among members of the Strategic Board and among the Healthcare Telematics Projects.
The Observatory’s daily activities will include the provision of an Information Help Desk to answer enquiries, a reception desk for visitors and demonstrations.
Figure 6: EHTO - DISSEMINATION
The European Health Telematics Observatory will represent an unrivalled source of health telematics information, carefully analysed and classified. Equipped with a Demonstration Site, itself the hub of a group of satellite centres, it will bring together in theme-specific workshops and cascade conferences the entire range of actors from the health telematics sector, including top policy makers. As a result of this central position, the Observatory will have an important role to play in the development of health telematics strategy, in the context of the Health Telematics Programme and other initiatives. The health policy and industrial strategy groups will play a leading part in this process.
The Observatory’s daily activities will include the provision of an Information Help Desk to answer enquiries, a reception desk for visitors, assistance during meetings and demonstrations and public relations.
Another important aspect of its activity will be the establishment and maintenance of working relations with the various Directorates General of the Commission.
A number of stages can be clearly distinguished in the setting up of the Observatory.
Figure 7
Three key issues may be seen as underpinning the success of the proposed European Health Telematics Observatory.
The first is undoubtedly the support of the Commission in terms of general recognition and backing. More specifically, it will be important for the Commission to encourage the Health Telematics projects to deposit their deliverables and other essential documents and material with the Observatory.
Secondly, it will be important to secure support and sponsorship from European industry, something which should be possible, provided the usefulness of the information resource is properly explained.
Finally, the support of Health Ministries will be essential if the Observatory is to establish a clear role for itself.
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