At this stage, nearly a decade of RTD work has been done in the field of human-computer interaction which resulted in demonstration networks, followed by pro-active technical developments addressing unified user interfaces, such as digital libraries and universal browsers. The IS4ALL project was set up to raise awareness for design, methodology, and engineering practices but needed to find an application area and specific contexts of use to demonstrate the relevance of universal access tools. The choice fell on health care delivery in the hospital, ward, and patient home environment for which meaningful scenarios are developed. The emergence of new technologies including desktop, mobile devices and network attachable terminals provides the project partners with interactive application domains related to the EPR, according to Dr. Akoumianakis.
Professor De Moor showed how health care is evolving from medical informatics for data storage and processing towards e-health for data communication and integration with mobile, wireless, and intelligent devices. E-health is more than e-health care since the concept also involves e-content and e-commerce. The roles of the e-health actors are changing over time and are dictated by the health care providers, industry, third party payers, citizens, and patients. Important trends are patient empowerment, the economic constraints, evidence based medicine via the Internet, and globalisation through intelligent systems. Seen in this light, universal access will be indispensable in the future.
There are two types of electronic health record, as Professor De Moor stated. The first one is the electronic medical record held by the physician, and the second is a personal health diary kept by the citizen. Both concepts will be linked to obtain an intelligent health record which will have to be updated in a secure network of messages. This will give rise to different tele-somethings in health care such as tele-consulting, tele-monitoring, tele-care, tele-diagnosis, tele-surgery, and tele-education. Via the Internet, global instant publishing and retrieving is possible and sites can be linked and quoted as high quality resources to inform and serve the patients.
The diversity of the actors and their capabilities, the roles and environments, contexts of use, and technologies require a general accessibility, usability, and acceptability of the health information, according to Professor De Moor. The boundaries are fading and the centres are moving from provider to patient. We will need different solutions in the form of application service provider (ASP) models, physician and hospital Web sites, health portals, and so on. As health care becomes more and more patient oriented, the future lies in federated health Web services.
EHTEL Director Hervé Doaré explained that his neutral association is involved in IS4ALL for three main reasons. First of all, "the mouse is not a good tool for the health care provider", it needs to be replaced by something more practical and IS4ALL is working on this issue. Second, EHTEL is able to help IS4ALL by giving recommendations through its five types and pillars of membership, formed by health authorities, health insurance agencies, patient associations, industry and health professionals. Thirdly, the health care market has many niches holding in store a lot of opportunities for SMEs specialised in human-computer interfaces.
The key issues for the design of a workable EPR, as Mr. Doaré sees it, are two elements. The electronic health record is both archiving or static and communicating or dynamic. The biggest challenge is that the EPR has to be shared between the different actors and integrated into a hospital information system. Therefore, a limited number of tools should be adaptable to each possible health care situation but to grasp the context of utilisation is difficult. There is also a need for communication between the health care actors, so one of the key words is interoperability. In addition, the role and rights of the patient still have to be defined. Here, Mr. Doaré marked security and confidentiality as important concepts.
More news about the IS4ALL Seminar is available in this VMW issue's article Practical examples of universal design for health care applications demonstrated in IS4ALL Seminar.