Within the Fourth Framework Programme of the European Commission, a group of ten contractors from both the Information Technology (IT) and telecommunications industry as well as from several health care administrations, have set up a three year project in 1996 to establish a range of Co-operative Health Information Networks (CHINs) in eight European regions. The partners cherish the great ambition to reach hospitals, clinics, doctors and private individuals in both urban and rural areas with a varied set of Health Care Telematic (HCT) services, which may be standardized or region specific. The available tools for inter-regional connectivity range from desk-top video-conferencing over file transfer and e-mail to application sharing. The CHIN concept will be validated through regular feedback from representative user groups.
The idea to build a system of inter-regional health information networks is born out of the analysis of the existing communication and co-operation scenarios between the major players in today's health care scene. The health care communication traffic in fact relates to three different types of information exchange, which are patient records, administrative data and scientific, educational and training resources. These user needs all require their own kind of standards, security measures and integration methods. In the recent past, most of the medical transactions usually were performed via mail, courier and fax. The CHIN project partners now present a client-server platform for the benefit of millions of citizens, compliant with international standards, such as HL7, the medical imaging formats DICOM/MEDICOM, and Electronic Data Interchange or EDI.
The CHIN networks represent a modular and scalable IT-solution for cost-effective delivery of local telemedicine applications with possible interfaces to proprietary software as well as inter-regional medical support. All four major qualities to stimulate the European health care community to make use of a distributed and interdisciplinary health care information system are met by the CHIN initiative. The open platform indeed offers visibility, accessibility, reliability and integration, for metropolitans, such as Berlin and Brussels, but also for remote areas, such as Norrland in Sweden. The project partners have provided each region with one powerful CHIN server, interconnected through ISDN with the different CHIN clients in the area for specific services relating to patient management care, electronic patient record handling and information on public health issues.
For communication with the CHIN server, the PC-based client module has to dispose of a secure Web browser, a medical image and lab result viewer, a videoconferencing system with shared working space, a scanner/camera combination for import of analogue documents and a Meta Patient Record (MPR) interface. The MPR interface supports the traffic of the most diverse patient related information, stored in different formats and distributed over heterogeneous systems, through the Hypertext Markup Language (HTTP) and Hypertext Transfer Protocol (HTTP). The CHIN server keeps track of the data exchange and location. A physician, for instance, can consult the patients' list, select a patient and receive all medical multimedia data related to this person. Images can be displayed by name or icon, thus saving bandwidth capacity and yet allowing the doctor to choose the image he wants to view.
On the inter-regional level, the CHIN server is mainly used for educational purposes and information requests or results. The system retrieves this non-patient related data by means of the Internet Protocol (IP). This kind of services are implemented by a few regions only, although they are offered to all of them. The regional MPR approach will be extended to the administrative and scientific resources, in order to obtain comprehensive, customizable and flexible multimedia health information systems for full integration of both regional and inter-regional data. Appropriate security mechanisms are incorporated to safeguard the confidentiality of sensitive data and to protect the patient's privacy. In this way, the CHIN networks have the potential to act as an efficient provider of regional co-operative health information services. For more details on this project, we refer to the CHIN Web site.