Updated: Sep 17, 97
SECTION 2: Initial Perspectives on Telematics for Healthcare

2.1 The TELMED Project Brief and Objectives

• incidence and current status of telematics for healthcare
  • implementation of telematics applications in health care, by geographical and sectoral distribution
  • incidence of trans-national and trans-regional applications
  • obstacles to implementation

• socio-economic impacts
  • impact on national healthcare structures
  • organisational impacts (work organisation, training needs)
  • access to healthcare
  • quality and costs of healthcare

• future prospects
  • future demand (level and type)
  • types of initiatives required
  • barriers & constraints to development and implementation

The brief specifically excludes certain areas of healthcare (and telematics) provision, notably:

• Health policy and legislation on diseases
• Health promotion
• Disabled and elderly
• Diffusion of R&D (in terms of technological platforms)
• Implications of EU R&D projects, except those involving applications developed in Third Framework programmes, for example AIM, that are currently providing 'real' products and services to 'real' users

The research approach adopted by the project in relation to achieving the project goals and objectives is summarised in Figure A.

As the Figure shows, the project addresses the impact of telematics on healthcare provision in Europe through a number of inter-related research activities designed to progressively expand understandings about state of the art. These activities focus on three main elements: an initial critical literature review; an audit of the sectoral and geographical distribution of applications; in-depth case studies of selected applications drawn from the applications audit. An ongoing on-line Forum engaging domain experts in continuous dialogue with the project and its outputs provides a monitoring and critical review of the evolving state of the art developed by TELMED. Drawing on the results of these activities, an interpretative impacts assessment based on 'soft systems analysis' is carried out to enable insights to be gained on the current impacts and potential implications for healthcare in Europe associated with telematics.

Both the project brief and the initial approach used in TELMED reflect a particular 'world view' of the domain. The two main characteristics of this 'world view' can be identified as:

• An assumption of relative 'market maturity' within the domain, one that has been driven by the evolving 'information society', and in which the efforts and effects of previous EU RTD programmes, such as ESPRIT, BRITE and AIM have played a 'shaping' role
• An assumption that, as a result of this relative market maturity, impacts at the macro socio-cultural level are discernible and measurable

2.2 Main Findings of the 'State of the Art Review'

i) Current provision:

• a mismatch between expectations about the development and implementation of telematics for healthcare and the reality in terms of 'real' applications and interventions
• little evidence of the large-scale co-ordinated strategic development of telematics healthcare systems in Europe, outside the environment of EU RTD Programmes
• that development and implementation appeared to be fragmented, small scale and primarily driven by experimental and pilot projects underpinned by EU RTD, as illustrated by a quote from one domain expert: "Health Informatics has been developed in great part by small teams in University hospitals and University research centres"
• the bulk of working applications activity was concentrated in these areas:
  • the expansion of EDI for healthcare
  • hospital administration systems
  • electronic patient records and smart cards
• In terms of geographical spread, there were signs of sectoral differentiation, with:
  • EDI most extensively developed in northern Europe
  • In Southern European states and in isolated areas of Northern Europe telediagnosis and remote telecare was more extensively developed
  • Smart cards were concentrated in France and in Germany
• the geographical and sectoral differentiation reflects political culture (e.g. in the UK, the introduction of 'national business goals' for the National Health Service)
• education and training in the use of telematics services for health was running at a very low level of investment

ii) Impacts:

• Very little attention is being paid to measuring the socio-cultural effects of telematics in healthcare, and to organisational change
• At the macro-level of societal structure and change, research is patchy and speculative. There is some evidence of changes in alliances, partnerships and socio-political structures in the provision of health care services. There is some evidence of a lack of investment in 'telehealth' (the adoption of telematics in primary and community health care) relative to areas such as hospital information systems, teleradiology and telepathology
• There was little evidence to be found relating to impacts at the institutional level. There is some suggestion of displacement effects associated with the introduction, for example, of hospital information systems, reflected in a reduction in organisational support for care processes

iii) Main constraints to future growth:

• technical problems associated with infrastructure provision
• standardisation and interoperability problems
• confidentiality and legal problems
• cross-cultural and transferability constraints
• financial constraints
• lack of education and training in new technologies
• organisational and institutional barriers

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