This book marks a transition between two eras in the use of computers for health. Before was the era of small isolated computer clusters, found mainly in hospitals and restricted to administrative functions like staff salaries and patient billing. Now comes the era of world-wide high speed networks of computer networks and its newly heralded social revolution: the INFORMATION SOCIETY. It promises higher quality and more efficient care by an almost instantaneous world-wide availability of information on all aspects of best practices in the domain.

In this context, the conference in Lisbon which is reported in these proceedings, has been a milestone. Its objective was to hasten the pace of implementation of health telematics in Europe. For this purpose, it attempted to give the opportunity to two different worlds to meet: on the one side the world of researchers, developers and leading-edge or innovative users and on the other side, the world of health decision makers and budget providers. It was the first conference of its kind to show more than 50 European Union sponsored research and development projects exhibit and demonstrate, not as stand alone, but integrated in 6 villages under a common theme. It has also attracted local users who would never have travelled to a similar conference outside their own country. As such it is a very good dissemination tool.

When the two years exploratory phase of AIM started in 1988, it was about research on the use of computers in health care, both for the sake of improving the quality of medical practice and for the sake of boosting the competitiveness of European informatics industry. The current phase, under the Third Framework Programme for Research and Development of the European Union, started in 1991. It was no more about computers only, but about the use of new communications tools to enable distant computers and the health professionals around them to work better by communicating more and quicker. This collection of papers summarises what has been achieved so far. It represents work that was selected and funded following the advice of many experts meeting in Brussels from all over Europe. The results shown here are now ready for further selection by market forces.

A glance at the document will show that many different domains have been investigated. In order not to leave any important issue unexplored, no artificial strategy has been imposed on projects. An ecosystems approach - grouping complementary projects into “project lines” around a few common themes - was used to avoid duplication of efforts and fragmentation of results while still allowing for the small amount of redundancy necessary to accommodate for the complexity and the diversity of situations in the health domain.

The next step is to integrate the different projects results into large scale applications that powerful user groups could validate and help bring to the market place. This is the objective of the new Telematics Applications Programme which is now starting within the Fourth Framework Programme of Research and Development of the European Union. In that context, this book should not be seen as an end, but it should be viewed as a new beginning for new ideas. By showing what has been done by the people who did it, it should point at what remains to be done and help find the right partners to do it. It should also contribute to identifying the obstacles which lie ahead and which have prevented the dream of an efficient world-wide rational health information system to come true earlier.

The AIM programme and its followers were built on 3 main premises: first that involving users at the early stages of product definition would enable quicker emergence of widely accepted new innovative services, second that stimulating demand through user involvement at the demonstration phase would hasten development of a latent market, and third that health quality and efficiency would increase as a consequence of a programme to improve business in health telematics applications. By enabling future comparisons of today's expectations with tomorrow's outcomes this book should also be seen as a landmark for long-term assessment of the effectiveness of these premises.

A. Vasconcelos da Cunha and J. Lacombe