This presentation discusses the problem involved in providing quality care for patients with Upper GI Cancer throughout a healthcare delivery system. It is argued that appropriate telecommunications technology exists for widespread dissemination of “best clinical practice”, but that it cannot be used effectively at present because of some limiting factors. These include lack of precisely defined aims concerning use of technology, lack of interactive quality control, and insufficient involvement of end-users. Upper gastrointestinal cancer is selected as a model for discussion - since there is wide discrepancy between outcome of therapy in early and late cases, there is evidence that early diagnosis is possible - and there is substantial evidence that it does not take place widely in practice.

Prospects for the future (with special reference to the 4th Framework) are discussed. It is argued that considerable opportunities exist. Future work should build on existing experience in informatics (eg. the “Telegastro” program) and in clinical practice (e.g. the Leeds “outreach” programmes) for (a) widespread dissemination of effective “best” clinical practice; and (b) continuing medical education.