Past, present, and future perspectives for medical data integration in European health care policy

Brussels 28 March 2000Closing speaker of the MediMedia workshop on medical imaging was Dr. Luciano Beolchi from the European Commission, DG Information Society, who presented an overview of the past perspectives and also drew a comparison with the present and future European policy regarding the field of medical imaging. In the past twelve years, the European Commission has devoted almost one fifth to one fourth of its available budget and effort to the medical imaging area. From 1991 to 1994, this capital has been invested in general projects whereas from 1994 to 1998 more specific applications were targeted. For the present 1999-2002 period, nine out of 28 medical imaging proposals have been approved.

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In the first period, the focus was mainly put on image processing. The scientific results were quite satisfying but hardly yielded any commercial products. In the following phase, the attention shifted to imaging modalities for particular medical specialities, such as thorax surgery, gastro-enterology, ophthalmology, and so on. In this phase, the MediMedia initiative presented itself a an opportunity to achieve further integration. Today, medical imaging still constitutes an important part of the EC programme. Seen over the entire time span, 48 out of 269 projects were dedicated to medical imaging.

In 1997, it was thought that functionalities, including system independence, multi-sources in a common environment, and user-friendly interfaces, were required in an integration system. All this seems quite obvious to us now, as stated Dr. Beolchi, but at that time, it was not all that evident. It was equally assumed that the market was ready to accept services, provided by scientific societies, partnerships, pharmaceutical industry, and associations, but this proved to be a plan too ambitious to realise. Communication and standards were considered the basics to build a MediMedia search engine as a common structure for interoperability. The idea was to put together different projects, taking images from various sources.

If one draws a cross to picture the enterprise on top and the department at the bottom, consumers to the left and products to the right, Dr. Beolchi can place the Picture Archival and Communication Systems (PACS) in the corner consumers/departments, Radiology Information Systems (RIS) in the square products/departments, and the Electronic Health Record (EHR) in the angle products/enterprise. In this distribution graph, one corner remains empty however, it is the consumers/enterprise relationship in the market's point of view. The result of putting together PACS, RIS and EHR in the hospital work flow system focuses too much on the production, enterprise, and department sides, while neglecting the role of the consumer.

The future of medical imaging is still on the desk and the concept is not very clear, according to Dr. Beolchi. We have moved from industrial quality with the invention and refinement of image captors and contrast media over the years 1895 to 1995, towards major informatics quality in the period 1995-2000, by introducing image processing, standards, and communication. We are now striving for integration and interoperability to acquire clinical quality beyond 2000 with pattern recognition, and 4D and 5D imaging. Time is the description of change, as Aristotle pointed out. Currently, we are facing the big challenge to install this concept into the computer to make the machine understand what time means exactly.

Back in 1997, it was believed that technology would develop itself according to the issues of Internet/Intranet communication, Java portability, and XML packaging. Today, we see that this has worked, as Dr. Beolchi showed. We also thought that medical image processing would evolve in the direction of pattern recognition but we were wrong in the sense that it has not developed so quickly. As for the image file from the level of structure and complexity, it was assumed that HTML would not be sufficient so XML was selected to cope with this problem. At present, it is working successfully. Instead of looking at imaging as a modalities' concept, it was considered as a service within an enterprise system.

Dr. Beolchi pictured the future in a few words. The strategy in the past has been quite acceptable. The future is more complicated. Today, MediMedia is an application which is functioning but it should be expanded according to the evolving technology. Some strategic technological parts are still missing in MediMedia. Dr. Beolchi finds that the content has not the embodiment to turn MediMedia into the world success which was expected. A great deal of work is left to be done in the future. For a complete project description, we refer to the VMW April 2000 article MediMedia provides common gateway to multi-modal medical images in European databases.


Leslie Versweyveld

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