The annual EuroRec Working Conference has become the traditional gathering of all the partners involved on the scene of Electronic Health Records (EHRs). Twenty countries, ranging from South to North, from East to West, and from Europe and beyond, have been represented in its 2001 edition.

Naturally, a EuroRec conference follows the overall objectives of the European PROREC initiative: to promote the use of EHRs, in order to support the delivery of good quality health care.

What are the blockages impending the practical and effective implementation of communicating EHRs, both in hospital and in ambulatory care (general practice, ambulatory secondary health care, community care)? The issue has multiple facets that have to be dealt with at the same time.

While the existence of relevant technical specifications is acknowledged as of utmost importance, ahead or beyond the technical concern lie key issues that are of cultural, economic, ethical, and political nature: each one of these specific lines must be paid great attention to.

“Which incentives, which business model, which solutions for communicating EHRs in hospital and ambulatory care?” These key questions have been the thread for a series of specific workshops that have taken place over the two conference days, each one addressing a specific topic:

Does the use of EHRs reveal a cultural gap?

EHRs have to find their right place in the face to face dialogue between patients and health care professionals. To what extent does their introduction bring significant changes in the everyday process of health care delivery? How much does it interfere with the face to face dialogue between patients and health care professionals? Would educational programmes facilitate the transition?

An ethical concern: security, privacy and data protection

The outburst of the telematics era and of the internet raises new fears that privacy might prove increasingly difficult to protect. Confidentiality and security issues are now put on the front line.

How can privacy be protected? How can confidentiality and security issues be dealt with? Which control is granted to patients over the transfer, interchange, and use of their personal health data stored in EHRs? Are there limitations to the concept of a virtual patient record?

An economic concern: are there business models?

For the industry, what can be the return on investment for the development of new communicating EHR products? For the managers, and for the end users, what can be the return on investment for the purchase, learning, and use of communicating EHRs?

Today, in most countries, there is no business model for communicating EHRs, because there is no business model for integrated care (nor for co-ordinated care and continuity of care either).

A political concern: managing the change

Communicating EHRs are at the core of integrated health care networks. How and by whom are they to be organised, implemented, managed and controlled? Beyond the conventional and fashionable speech, is there a true interest in continuity of care?

Which incentives for an enhanced communication process between health care agents, based on EHRs? Eventually, who will pay for it? How, and how much? In most countries, end users still prove unwilling to do so. To support their marketing efforts, the pharmaceutical drugs industry is partly interested in retrieving data that reflect the clinical activities. Are public authorities ready to take the challenge?

The technical concern

What are the current specifications and standards, encompassing terminology and security issues that support EHR communication?

What is the importance of the European pre-standard ENV 13606 “EHRcom” for the future of communication between dissimilar systems?

What is the actual perspective for solutions based on open source developments?

A special “Industry Forum” has also been provided, where selected software developers and vendors have been invited to express their views, and present innovative and performing solutions.

May the speakers, chairpersons, and all those who have brought any contribution of a kind or another to the success of this EuroRec '01 conference, be thanked again here.

Each EuroRec conference gets something special.

Even with the endeavour of the authors of the papers that form this book, the proceedings can in no way be sufficient to capture and recall the exceptional atmosphere of these two days of active work and warm friendship.

Let me grasp this opportunity to invite all the readers of this book to join in the PROREC initiative, and attend the future EuroRec Working Conferences, that will undoubtedly be even greater successes.

They prove the right place to initiate or strengthen partnerships between the various parties whose endeavour concur to the implementation and actual use of top quality EHCR systems throughout Europe. EuroRec conferences represent a special opportunity to meet, to exchange ideas and experiences, to acquire a better knowledge of market trends, new policies at national and European levels, new initiatives, and on-going projects.

We all look forward to meeting you over the coming years.

Dr. François Mennerat MD PhD

Chairman of PROREC-Franee