Present appraisal of WWW tools and first open call for further tools for telematics in healthcare

Jean-Claude Healy
European Commission, DG XIII.C.4
Brussels, Belgium
jhealy@dg13.cec.be

Since more than ten years, the European Union has identified the Health Sector as a key sector for the application of Telematics and has promoted a lot of initiatives roughly merged around the previously so-called Advanced Informatics in Medicine Programme (AIM).

In the context of the present 4th Framework Programme (1994-99), a Telematics Applications Programme has been implemented. This programme is subdivided in subprogrammes on Education, Transport, Urban and Rural Areas; Research, Administration and Healthcare. The new culture of this programme, compared to the previous one, is multimedia and user-oriented. For the preparation of the Telematics Applications for Health sub-programme, a group of European healthcare experts has identified 5 main areas and a workplan has been elaborated. It concerns: Multimedia medical records, telematics for health professionals, telemedicine, telematics for the citizens and specific support issues. After the 15 December 1994 call, we received more than 260 proposals and 70 have been selected for funding. The contracts are now under negotiation and the first projects will start in December 1995 for a 2,3 or 4 years period. According to the workplan, these projects are clustered in 7 groups of ten projects each, and each group is in charge of the various target populations (healthcare professionals, healthcare managers, healthcare authorities, citizens etc.). For each target some specific indicators are developed, in terms of product, market, usefulness and cost/benefits etc. The 1995 situation of these indicators is requested and the future envisaged.

In close connection with the R&D initiatives, the EU has received the mandate from the G7 Ministerial Conference held in Brussels in February this year, to co-ordinate the health G7 initiatives for the promotion of the Global Information Society. Six sub-projects have been selected for feasibility studies on public health, cancer, cardiovascular diseases, telemedicine, enabling mechanisms and data cards. Each sub-project is promoted by a specific state or by the EU. The main global conference is planned in December of this year.

We can now develop some analysis of these basic elements:

Firstly we note a very rapid change in the attitude of the healthcare professionals regarding Medical Informatics: in less than ten years, we moved from less than 10% to more than 80% of GPs using computers and networks. The causes are very ambiguous: for some of them it is due to the very strong initiatives of the healthcare authorities (UK for example), for others there is the necessity recognised by the medical associations for the follow-up of the patients, for others some pragmatic approach of data transfer from the laboratory to the office, etc. So now we face the fact that the computer is a full partner of the medical professionals and we have a demand.
Secondly, we have a lack of offered updated services: During the past 10 years, we had a lot of experiences, trials, feasibility studies, tests and so on, but in fact, the technology was not sufficiently mature for the medical users: their constraints are very high in terms of quality of images, speed, memory, confidentiality etc. The more recent efficient systems and the now low-cost investment and use change the dream into reality.
On the other hand, the standardisation of the protocols as proposed by CEN, the European regulations for the copyrights and data protection associated with the specific deontological rules proposed by the national medical authorities appear as the underground (??), as a platform for new efficient and agreed (common??) services. We have a demand, we have now a European platform for action.
Thirdly, what about the offer? Everybody here knows the healthcare services on WWW: Oncolinks, Virtual Hospital and others. Everybody knows the enormous world-wide demand for it, but let me develop some remarks:
- For a normal GP or a patient or a European citizen using a normal computer connected to a normal telecom network, the access to some US services is very difficult in the afternoon and, by definition, the "Health doesn't want to wait": the professional and social acceptance of the product is restricted by the fact. A real promotion of the services imposes a real upgrading of the access facilities for everybody.
- When we zoom now on the content of the offered services, the citizen looking for some information for his own self-training is sometimes disappointed by the static approach: few services are really interactive, asking you: What is your weight? What did you eat this morning? How many hours did you spend on developing physical exercise last week, etc.

A lot of services are the computerised translation of the previous written document and don't use the new paradigm of the interactivity and so, the real interest of the on-line networks. It would be good to remember some conclusions described ten years ago when in France the X25 system, Minitel, had been promoted at national level. Two variables are of key importance: one is the lifetime of the information, the other being the personalization of the message. The real interest of the various multimedia tools is in connection with these elements.

As a conclusion, you can say: really the time has come now for a real industry of medical informatics. I am sure that the today meeting will be a step for this purpose.

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