Medical doctors are used to rely on technical devices for decision support for diagnosis and choice of treatment. Thus, if a phonocardiogram reveals a heart murmur which the physician did not hear in the stethoscope, he is more likely to mistrust his ear rather than the recording.

Nevertheless, the same doctor will hesitate to use artificial intelligence or decision support from an expert system because of lack of confidence in its reliability except in very selected cases. He will claim that patients and diseases are so individual that a computer system is too crude an instrument to rely on, and right or wrong he might feel that a disagreement between his own judgement and that offered by the software might offer a legal problem, he would prefer to be without. Yet, the development of expert systems in medicine remains a real challenge and actually systems are being successfully used.

The study presented in this book is a successful effort to present a sober assessment of status quo in terms of success factors, market potential and first and foremost identification of the development work that needs to be done. It makes stimulating reading and will guide anyone fascinated by the field. Time is now ripe to really test systems in a variety of situations, also in terms of clinical outcome.

For health telematics it is essential that only useful developments be integrated into the networks services foreseen for the future. It is therefore essential to build on the experience compiled in the book and test systems in real user environments. Together with national programmes and projects, the European Union health telematics programme of the future should be designed to provide the needed testbeds.

Let us try to provide the doctor with a reliable hearing aid when he needs it.

Niels Rossing

Head of Unit

DG XIII/AIM