FOREWORDS

ALAIN POMPIDOU

It is an honour and a pleasure to respond to the kind invitation of the Catai-Telemedicine consortium to present the "Handbook of Telemedicine". As a physician, a scientist and an educator, keen on the prospects of technological progress and their influence in the training of the young professionals, I am extremely satisfied to see the birth of an informative and comprehensive publication in the new discipline and practice of telemedicine. As a politician and a Member of the European Parliament I am satisfied to see that this book is the result of a broad collaboration bringing together experts and knowledge from all the corners of Europe, from Norway to Spain, and from the United Kingdom to Austria, attaining a quantum leap with the added value that makes the resulting whole bigger that the simple sum of its parts.

On the verge of the 21st Century, and in view of the economic, social, technological and cultural transformations contained in the term "information society", we shall all -as citizens, professionals, administrators and policy makers- be called on to re-think our views on health matters. The European social protection model has made possible a high degree of coverage of the health needs of the population. Scientific progress, better diagnostic and therapeutic means, as well as healthier life-styles have contributed to "add years to life" and "life to years". On the other hand, patients are changing from a passive role in respect to their own health problems, and are now better informed and willing to assume more responsibilities for their well being and that of their families. There is also a will to access medical and other services that should be much more easily available, in terms of place and time, bringing care closer to household and communities.

In this context, the advent of telemedicine and telecare could not be more opportune. As we enter an era that has also been described as the society of knowledge, it becomes ever more imperative that medical practitioners and other health professionals offer their clients the best existing information about a particular disease affecting them. Time, distance or physical obstacles can no longer justify placing a barrier between a patient’s ailment and the best existing knowledge on how to manage it, wherever in the world it is to be found. And here is where telemedicine can be of higher value, by making it much easier to use expert advice from the hospital specialist to the primary care doctor, or from a doctor to a nurse, or from a world-class specialist to another specialist confronted with particularly complex cases. The ability of telemedicine to offer "just-in-time" help where it is most needed is one of its main assets.

It goes without saying that telemedicine can and should also play an important role there where emergencies, or geographic or other conditions (isolation, bad weather, catastrophes), call for the use of this new model of medical delivery. Another case would be that of underseved populations or regions with a critical shortage of health personnel, as in the case of developing countries.

However, as telemedicine develops, the need for basic accepted principles for its practice becomes evident. Medicine has always been strict in respect to "the practice of the art", and the same should apply for the new and numerous telemedicine and telecare applications. If we accept that telemedicine should be "medicine at a distance", it should have the same requirements as plain medicine: use by qualified personnel, an un-ambiguous legal framework defining the rights and obligations of clients and providers, and well-defined quality standards.

One of our main preoccupation in respect to health informatics and telematics is that the proper protection of patients' health information should be guaranteed at all costs. Confidentiality, integrity and security of medical data affecting the most intimate conditions of a person have to be fully assured, both at the technical and at the legal levels. When travelling through networks, patient information should be made anonymous, and appropriate mechanisms including encryption should be used as required. Medical doctors and other professionals should observe the highest ethical standards in this respect, and a new deontology adapted to the information age might need to be sought.

A major challenge and opportunity opened up by telemedicine is the new vista for training and education. Offering a means to acquire general medical knowledge in itself, telemedicine will also dramatically change the way in which the new generations of doctors, surgeons, and nurses will be trained in the future. The availability of teaching materials, both in traditional support forms like this book, and others in multimedia formats, will be in high demand for that purpose.

In summary, telemedicine and telecare make a reality out of the best promises of information and communication technology for the benefit of patients and citizens. In the era of the massive extension of the Internet they take full advantage of the existing and future connections and tools. It is also the dawn of a golden age of shared knowledge that will be put at the disposal of a much broader base of beneficiaries. If all this can be accomplished with the necessary caution that the introduction of such fantastic changes requires, and with an exacting respect for the person for whom it is intended, it will offer a shining future for the ancient and noble health professions. Let us hope that this book makes a significant contribution in that direction.

Prof. Alain Pompidou
Member of the European Parliament
Chairman of STOA, Scientific and Technological Options Assessment
Strasbourg, June 1998

Prof. Dr. Alain Pompidou Born on 5 April 1942, Paris, France. Member of the European Parliament since 1989. Chairman of STOA - Scientific and Technological Options Assessment. Member of the Committee on Research, Technological Development and Energy of the European Parliament. Chairman of the EP Delegation for relations with Japan. Doctor in medicine and sciences, and professor of histology at René Descartes University, Paris V; specialised in cytogenetics and molecular cytology. Former scientific advisor of the Atomic Energy Commission, of the scientific committee of INSERM, and to the World Health Organisation. Member of the Human Genome organisation (HUGO) Ethics Committee. Member of the Council for Applied Sciences (Academy of Sciences, France). Scientific Advisor of the French Prime Minister (1993-1997). Author of numerous scientific publications and studies. Author of the book "Souviens toi de l’Homme: L’ethique, la vie, la mort", Ed. Fayot, 1989 Address: Faculté de Médicine Cochin 24, rue du Faubourg Saint Jacques, F-75014 Paris

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