HEALTH TELEMATICS IN THE FIFTH FRAMEWORK PROGRAMME

Health Telematics in the Fifth Framework Programme

Policies with regard to research in information society technologies and applications to be conducted at the European Union level in the beginning of the next millennium are in full preparation. The Commission's proposal concerning the Fifth Framework Programme of the European Community for Research and Development has been issued and the draft proposals for Specific Programmes are being finalised. As part of that exercise a Health Care Strategic Requirements Board was established to produce a strategy for health telematics in the 5th Framework Program. The Board was chaired by Prof. Jean-Claude Healy, the head of the Health Telematics office in the European Commission.

According to its report the objective of the new programme action should be to speed up the ongoing building of community based, distributed healthcare IT infrastructure in the member states and to help to make this activity a European industrial activity with a global scope. This mission should be accomplished by funding R&D in system integration including regional demonstration sites and fostering competence development by facilitating networking of SMEs.

In the following the Executive summary of that report is reproduced. The full report is available for downloading at http://www.ehto.be/

The vision: 'citizen-centred care'

European healthcare is currently undergoing a series of changes of the paradigm with a shift from healthcare institution-centred care to citizen-centred care. Its prime feature is a new emphasis on continuity of services supporting health promotion and maintenance. The new paradigm includes the informed citizen caring for his own health and stakeholders responsible for the continuity of health services within a region. The vision implies a decentralised health care where services with evidence based effectiveness are accessible to all and are provided in a way in which the organisational boundaries are invisible to the citizen. Information and communication technologies (ICT) support information distribution and sharing between health promotion, primary health care, hospital services, rehabilitation, home care and other relevant service modalities. ICT supports proximity health services by providing citizens an increasingly direct access to specialised national or European health and medical knowledge.

New models of healthcare employing ICT innovatively will help authorities to provide more services for the ageing population with the available resources. Pan-European actions will transform these trends into opportunities for the European ICT industry. Competitive products from small and medium-sized enterprises remove information management-related obstacles and further strengthen those areas where European health care systems already demonstrate excellence.

Trends

The most significant underlying trends in the EU contributing to the rising demand or the rising cost of services are:

an ageing population leading to more chronic and degenerative diseases
a changing epidemiological landscape, i.e. "new" diseases added to the resistance and resurgence of "old" diseases
improvements in medical technology leading to more possibilities of diagnostic and therapeutic action
supply pressures e.g. from new and costly medical technologies
increasing expectations and demands of citizens for more and better services in terms of quality and accessibility
a growing willingness to pay for health privately.

Themes addressed

The actions suggested address the thematic and horizontal programmes of the 5th Framework Programme, i.e. "Creating a User-friendly Information Society" including the R&D of generic technologies, and promoting Innovation and participation of SME's. This report also includes suggestions to improve and adapt the management methods of the programme.

Objectives and focus

The objectives which the information society technologies and applications must be able to sustain in the new 'citizen-centred care' paradigm are:

support health maintenance (i.e. lifestyle and disease prevention);
ensure effectiveness, efficiency and continuity of care (i.e. diagnosis, therapy and rehabilitation);
inform the citizen.

Other requirements include ensuring and improving access to care and enhancing the quality of care. Future actions will be focused on:

investing in system integration, enabling technologies and service infrastructure at the application level;
enabling deployment through large-scale demonstrators;
using existing standards and develop new ones in global co-operation with major stakeholders;
creating incentives for large companies to become driving forces in alliance with SMEs;
fostering competence development by facilitating networking of small and medium-sized enterprises
initiating research for future health improving and cost saving innovative applications.

Mission and users

The mission of the action programme is to speed up the ongoing building of community based, distributed healthcare IT infrastructure in the member states and to help to make this activity a European industrial one with a global scope. The mission will be accomplished by funding R&D in system integration including regional demonstration sites and fostering competence development by facilitating networking of SMEs.

The primary direct user of the results of the R&D projects is industry, i.e. providers of IT systems, system integrators, medical device manufacturers, pharmaceutical industry, telecom operators, emerging new service providers, etc. In addition, the national competence centres for IT in health will also use the results directly. The results implemented mainly by the industry in their new products will then be used by the large end-user groups, such as healthcare professionals, healthcare providers, authorities, third party payers, researchers, libraries, training and education institutions as well as by citizens and patients.

Main action lines

Research, technology development and demonstration should be concentrated on systems, services and applications and organised around the following three main issues:

Community based application level systems integration and interoperability including large-scale demonstration in a regional setting
- services for the citizen;
- virtual health care services (virtual services mean in this context telematically accessible remote or distributed services);
- mobile services.
Virtual healthcare telematics competence centre:
- continuous competence development
European healthcare application and services market development.

R & D actions

Research and development actions of the programme should be focused to support the main action line 1 above, i.e. specifically to systems, services and applications for the continuity of health care in the regional setting in the following areas:

interoperability of applications;
access to health services, continuity of care and user interfaces;
health management (evidence based medicine, population health management, process management)

Accompanying measures should be launched in accordance with the action lines 1 - 3 in the following areas:

dissemination of the results of large-scale demonstration activities;
studies on the conditions of sustainability of R & D actions.

As a secondary focus, when resources permit, R & D should be supported in the following areas:

Tools for healthcare professionals and researchers:
- interoperable multimedia applications for integrating diagnosis and therapy;
- telemedicine multimedia applications in the fields of international care;
- intelligent environments for professionals
- telematics systems to support biomedical and epidemiological research.
Systems for aggregating data from financial and service applications:
- indicators and applications for monitoring and benchmarking efficiency, effectiveness and health gain
- applications for exploiting epidemiological and other data for targeting health promotion, education and disease prevention (data mining)
- applications for the surveillance of the health of the population.

Programme management

The Board suggests that the project selection process is developed into a two-phase process, in which the consortia selected in the first phase would be offered a contract covering the cost to write the full proposal.

The project management should be converted from routine control measures to proactive monitoring and developing added value to the project portfolio.