European Commission advanced informatics in medicine (AIM) Program DG13, Lisbon, 6th-10th December 1994
Director, Sowerby Unit for Primary Care Informatics, University of Newcastle
The purpose of the meeting was to report back on the AIM 3rd Framework and give a platform to the European Commission to put forward its ideas for the AIM 4th Framework. The meeting consisted of two parallel lectures and an exhibition of all the 3rd Framework Projects. The lectures were generally well attended, although I found some difficulty using the radio translation service, as having English coming in one ear and another language in another makes it quite difficult to concentrate. The exhibition was constantly full with people looking at each other's work and debating the results.
There was also an element of identifying useful partners for the 4th Framework. It must be said that an interesting feature of this meeting was that there were always small huddles of people whispering and negotiating collaborations. There was one Primary Health Care morning in which much of the concerted action was presented. Unfortunately, this was in a room which was half the capacity that was necessary, had a very noisy air-conditioning system, and I was at the back. Having said this, the meeting was useful in identifying individuals to contact at a later date. It was also interesting to hear the Commission's view that, in the 4th Framework, there should only be one large Primary Health Care Project. However, since the meeting I have had conflicting reports on this.
I give below brief comments on the 3rd Framework Projects, based on the lectures, the exhibition and conversations over beers! They are in no particular order:
PRIMSHIFT
The main participants in this project were Tony Randall (Oxford) and Leslie Boydell (Belfast). This project was a qualitative assessment of general practitioners' views of computing and their future requirements. The project covered all states. It consisted of structured interviews which were then transcribed and translated into English. All of these interviews are now in a freeform database and have been coded by Tony Randall. The final report should be ready in March 1995.
EPIC
This project looked at community health records and collaborative working. The clinical scenarios that it used were antenatal care and elderly care. There was a positive response within the Commission about this.
The GALEN stand within the exhibition was by far the busiest stand. GALEN is a terminology server project and there were several interesting prototypes. It is clear that GALEN is taking SMK (Structured Meta-Knowledge) further and it is going to be important for predictive data entry and coding for the medical record. There is still work to be done on both its semantic structure and the vocabulary content; however, the work done so far is impressive and I am sure the Commission will fund it as a 4th Framework follow-on project.
Dilemma
This project was run by Colin Gordon and has made some landmark discoveries in the implementation of clinical guidelines, particularly from the respect of ACT management. There is an interesting prototype which has been created in conjunction with AAH Meditel.
Isaac
Isaac got off to a slow start with problems with project management. It was aiming to create a general practice medical record system. The project has produced some nice prototypes, but it is unlikely that there are many lessons from this project for the UK.
GEHR
Based at Barts, this project aimed to discover the underlying structure of interdisciplinary health record, starting from scratch. The project doesn't seem to have pushed the frontiers of collaborative health records any further than what currently exists in the literature, perhaps because it has spent a lot of time on prototypes and creating its own vocabulary and not enough effort in looking at user requirements (this is a risk that is consistent with all AIM projects due to the Commission's demands). However, they did display some interesting object models of the record that need further in-depth analysis.
Nucleus & Shine
Both these projects are based on the Common Basic Specification.
Openlabs
This project looked at communication between clinicians, clinical information systems and laboratory information systems. I was impressed by their prototypes which must have had good underlying user requirements specifications. I think there are lessons from this project for our EDIFACT lab link work.
The Telematics Applications Programme aims to promote the competitiveness of European industry, help improve the efficiency of services of public interest, and stimulate job creation through the development of new telematics systems and services.
The new Programme, while based on the experience gained under Framework III, has a considerably wider scope and has shifted its focus from data to multimedia telematics, in line with technological advances and the development of new markets and user expectations. As well as playing its part in maintaining and increasing the competitiveness of European industry in both Union and global markets - the primary objective of the Union's industrial policy - the Programme aims to support other elements of EU policy: the creation of new jobs, promoting new forms of work organisation, improving the quality of life and the quality of the environment, and improving the efficiency and cost-effectiveness of public services.
The new Telematics Applications Programme will pay even greater attention to the views of users and of those with responsibility for specifying, commissioning, funding and achieving the use of the systems that derive from the projects. The starting point for all R&D work will be an analysis of user needs and market research studies, and users will be associated at each stage of a project's life, from initial planning right through to validation in a real-life environment. Validation itself will receive a greater priority, and more emphasis will be placed on publicising and disseminating the results of the programme, including standards, procurement recommendations, and "best practice" guidelines for designing, setting up and running telematics-based systems. The common factors, or generic content, of telematics applications will be maximised whenever possible, with the aim of building up a body of tools and techniques that can be re-used and economically deployed in a variety of sectors. With the programme concentrating its resources on fewer projects, priority will be given to those that are likely to produce generic results of this nature.
For more information about the 4th Framework, please contact:
Dr Ian Purves
Tel: +44 (0)191 222 7884, Fax: +44 (0)191 222 6043, email: Ian.Purves@newcastle.ac.uk
A conference on The Global Information Society as held on 25th-26th February, reflecting a growing recognition of the benefits that information technologies - 'telematics' - can bring to society. In health care, telematics offers the possibility of mastering increasingly complex health issues through allowing rapid access to appropriate information and knowledge. A series of six health-related project proposals were discussed at the conference, focusing in particular on the fight against major diseases, on establishing global health networks and the development of world-wide networks for controlling public health hazards and infectious disease control.
Further information is available from the Department of Health's International Relations Unit: contact Anne Hackett, 0171 210 5898
Many readers will have attended this year's Health Computing 1995 conference at Harrogate in March. As always, a friendly, busy, bustling, stimulating event in the new improved conference centre - gone are the tents of yesteryear!
In terms of political importance for primary care, the most vital address was that of Dr Fleur Fisher, Head of Ethics, Science and Information at the BMA. She outlined the impact of information on healthcare; she stressed that good information management is crucial to the development of primary care; she highlighted the cultural change which has occurred in practices as a result of the acceptance of clinical audit - which relies on high quality data. She also reminded the audience that a joint bid by the BMA and the RCN for the proposed National Clinical Audit Information and Dissemination Centre had been successful, and work would be progressing rapidly. This recognition by the Department of Health of the importance of information in health care led her to outline the central role which will be played by general practice data in planning for the NHS of tomorrow, and about the importance of education about information and informatics at all levels: doctors, other health care professionals, indeed all workers in the NHS. So far, so optimistic for primary care. However, she expressed some concern about the 'marketing' and resourcing of the IM&T Strategy in primary care, and had major misgivings about the much-heralded NHS-Wide Network and the potential security and confidentiality problems which may ensue. It was clear from her address that the BMA considers that a great deal more consultation with the profession must take place before they will be convinced about the safety of electronic transfer of clinical data.
The PHCSG President, Glyn Hayes, gave a 'user specification' of the kind of computer systems which clinicians want to use. He outlined some of the difficulties clinicians experience with computers: the need to learn new skills, the extra time they take, certainly while learning, the potential interference with the doctor-patient relationship, the cost, the worries over confidentiality. To overcome these hurdles, systems should be easy to use (by having uncluttered screens, minimising keystrokes, and having fast response). They should also offer added value, for example by allowing flexible search-and-report facilities: they would not be used if they were merely another but similar way of recording data. The structure should reflect 'clinical reality' or should be flexible enough to structure data entered 'free-form'. They should be comprehensive enough to satisfy even the most obsessional data recorder. They should offer prescribing support (drug names, type, formulation, pack sizes, doses, contraindications, interactions, cost). They should offer decision support. They should offer interactive protocols, allowing tailored structured data entry based on predetermined guidelines, with safety ranges, automatic decision support, online information and printouts for patients all built in. The only thing Glyn didn't tell us was how much all this was going to cost!
Voice input seems to be the latest fashion - after seeing the IBM version at the Cambridge conference last September, I decided to compare it with Brian Higginson's demonstration of voice input to the medical record. In his practice, he used voice input mainly for referral letters. A letter template is gradually built up by 'speaking in' patient admin details (name, address, DoB, etc.), consultant and hospital details, then using basic mail merge functions for various standard letters. For example, in referring a patient with diabetes, the clinician voice inputs the test readings to the diabetes template. It occurred to me that this would be better done by voice-inputting the data directly to the clinical database and mail-merging from there… The Dragon software used seemed slow, and 'discrete speech' is required, as with the IBM version. Other developers, for example Philips, are trying to incorporate natural speech input into the medical record. The technology is still in its infancy, and clinicians will want to experiment to see what does and does not work for them.
Despite fighting with a blown CPU internal power supply for two hours in the middle of the night, Mike Bainbridge and Neill Jones still managed to produce a fine demonstration for a packed house of the possibilities of the Internet, even though they had to contend with the inability of the hotel to provide an outside line to the suite used for the demonstration. In the end, they had to ring Reception, ask for the line, and then connect the modem to it! They gave an outline of what the Internet is, where it came from, and what you can do with Ping, Finger, Telnet, FTP, Netscape, etc. Then came a demonstration of among other things, the winning lottery numbers of the week, ordering a pizza, and even some medical sites: The Virtual Hospital of Iowa, chest X-rays showing lungs in various states of disrepair, the child with croup (with movie and sound), etc. The demonstration was very well received by the standing-room-only audience, many of whom were still there almost an hour after the scheduled end on the session. It was one of the highlights of the conference.