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The challenge for Europe in the field of information and communications technologies applied to health care is that of addressing positively the problem of the widening gap between the expectations of the citizens of the type of care that can be made available and the limited resources to provide that care. If the expectations of the population are to be fulfilled, it will be necessary to find innovative ways of delivering health services and to do it more efficiently than has yet been the case. Advanced information and communications technologies will be important tools for Member States to achieve the levels of efficiency required. Based on the results of the Community AIM Exploratory Action, further collaborative work is required at EEC level to create an Integrated Health Information Environment (lHE) allowing essentially for integration, modularity and security.

The 21st century is said to be a century of the information society. We should be aware that continuing progress in information processing methodology (IPM) and information and communication technology (ICT) is changing our societies, including medicine and health care. At the start of the third Millennium we should ask ourselves, what progress can we expect from modern IPM/ICT for healthcare in the coming decade, what concerns does the information society have to face, and what steps have to be taken. These questions were addressed by clinicians, researchers and industrial representatives in a panel discussion at the joint conference ISCB-GMDS-99 of the International Society of Clinical Biostatistics and the German Society for Medical Informatics, Biometry and Epidemiology. Important aspects raised by the panelists and in the subsequent discussion were: (1) the main goal of expanding IPM/ICT should be to further improve quality of care, while maintaining reasonable costs; (2) with the support of modern IPM and ICT the boundaries between inpatient and outpatient care will fade away enabling a more efficient, patient-centered health care; (3) cooperation between health-care professionals will increase; there will be different ways of communication between them and with the patient, including modern ICT and the Internet; (4) society must be concerned with achieving equal opportunities in being informed about and in using new ICT; (5) misuse of data will remain a serious problem and can become an obstacle to progress.

Unter dem Eindruck meiner zahlreichen Diskussionen in verschiedenen nationalen und internationalen Gremien werde ich vornehmlich nachfolgend hierauf zuruckgreifen.

The most important rendering methods applied in medical imaging are surface and volume rendering techniques. Each approach has its own advantages and limitations: Fast surface-oriented methods are able to support real-time interaction and manipulation. The underlying representation, however, is dependent on intensive image processing to extract the object surfaces. In contrast, volume visualization is not necessarily based on extensive image processing and interpretation. No data reduction to geometric primitives, such as polygons, is required. Therefore, the process of volume rendering is currently not operating in real time. In order to provide the radiological diagnosis with additional information as well as to enable simulation and preoperative treatment planning we developed a new hybrid rendering method which combines the advantages of surface and volume presentation, and minimizes the limitations of these approaches. We developed a common data representation method for both techniques. A preprocessing module enables the construction of a data volume by interpolation as well as the calculation of object surfaces by semiautomatic image interpretation and surface construction. The hybrid rendering system is based on transparency and texture mapping features. It is embedded in a user-friendly open system which enables the support of new application fields such as virtual reality and stereolithography. The efficiency of our new method is described for 3-D subtraction angiography and the visualization of morpho-functional relationships.

This article first offers a brief introduction to the development of the EC health policy mandate from a competence restricted to health protection at the working place to a wider competence embracing health promotion and disease prevention, albeit still based on the principle of self-responsibility of the Member states. Possible focal points of health reporting within the EC framework are worked out on the basis of suggestions made by the EC commission in respect of priority areas of EC activities in the public health sphere and the commission's own priority criteria. It is then examined whether and to what extent the presently available health databases (especially of WHO and OECD) would cover these requirements. As a result, it is argued, that there is no getting around setting up an own health reporting system that would promote and support the development of an EC public health policy. An important task of such health reporting will be to supply users not only with data but also with adequate knowledge on how to interpret them, in view of the multitude of problems involved in bringing the various national health data under one roof; this cannot be achieved either at short notice or on a medium-term basis. Finally, a few alternatives are given in respect of possible organisational structures of EC health reporting, pointing out decision criteria and practical conditions which would be essential of assessing the usefulness of such organisational setups.

The challenge for Europe in the field of information and communications technologies applied to health care is that of addressing positively the problem of the widening gap between the expectations of the citizens of the type of care that can be made available and the limited resources to provide that care. If the expectations of the population are to be fulfilled, it will be necessary to find innovative ways of delivering health services and to do it more efficiently than has yet been the case. Advanced information and communications technologies will be important tools for Member States to achieve the levels of efficiency required. Based on the results of the Community AIM Exploratory Action, further collaborative work is required at EEC level to create an Integrated Health Information Environment (IHE) allowing essentially for integration, modularity and security.

Both short-term care (blood glucose monitoring) and long-term care (clinical examinations) of diabetes generate an ample amount of data for each patient. Health care in hospitals has to provide services with respect to both demands. The quality of control depends on obtaining the right finding at the right time and taking the individually adequate measures. These repetitive activities follow to a certain extent standardized algorithms and computer-programs are able to support demands like this; however, up to now no attempts have been made to provide useful tools for this environment. DIALIN is a data-bank especially designed for the use in hospitals or outclinics and Camit is a diabetes management system for advanced evaluation of long-term blood glucose monitoring data. The expert-system DIACONS up to now determines diabetes type and adequate initial therapy from data of patients' history alone; it operates on the DIALIN-databank via SQL. DIALIN has proven to be a useful tool for data-processing in hospitals. Camit was well accepted by patients in a feasibility study. DIACONS has been tested with 83 diabetic patients to provide the correct diabetes-type and the proper initial regimen with a precision of 96% compared to the correspondence between two independent experts. The combination of all three systems is a step towards the Munich Medical Information system MAMIS.

In Munchen wurden 1477 (868 Manner und 609 Frauen) Beschaftigte eines Grosindustriebetriebes auf Risikofaktoren koronarer Herzerkrankungen untersucht. Es wurde die Verteilung der ermittelten Risikofaktoren Ubergewicht, Fettstoffwechselstorungen, Diabetes, Zigarettenrauchen Hypertonie, pathologisches Ekg, korperliche Inaktivitat sowie bestimmter somatischer Beschwerden und seelischer Belastungen auf die sozialen Schichten gepruft. Bei beiden Geschlechtern sind Angehorige der oberen Sozialklasse seltener, als es dem Durchschnitt entspricht, mit Gefahrdungsfaktoren behaftet, ausgenommen Zigarettenrauchen bei den Frauen und berufliche Sorgen bei den Mannern. Abgesehen von Hochdruck und Fettstoffwechselstorungen, die bei den Mannern in den Mittelschichten dominieren, und dem Zigarettenrauchen, das bei den Frauen in der obersten Sozialgruppe vorherrscht, haufen sich die Risikofktoren in der untersten Sozialschicht. Unsere Ergebnisse werden diskutiert und mit anderen Studien verglichen.

It should be pointed out that during the interviews most of the experts had positive expectations of ESM. The developers are more generally enthusiastic than the prospective users and affected parties who, especially in respect of the diffusion of ESM into practical application, only show a limited optimism.However, the representatives of the medical profession and the health insurance industry were convinced that ESM might contribute to cost-neutral increases of quality in out-patient and in-patient medicine. But we also understood them to say that they consider other developments in medicine to be overriding, for example, a tendency of general medicine towards a more family-oriented medicine and a reduced emphasis on technology-oriented medicine. In respect of the conception shared by developers as well as potential users that over-enthusiastic expectations should rather be restrained, we consider such a balanced expectation of positive effects of ESM to be adequate to the actual knowledge of the subject.

Gesucht wird eine Methode, mit deren. Hilfe man Entwicklung und Stand einer Wissenschaft beurteilen kann. Diese Informationen sind als Basis einer systematischen Entwicklung der medizinischen Statistik und Datenverarbeitung notwendig. Neben schon existierenden bzw. anderswo vorgeschlagenen Informationssystemen wird eine kontinuierliche bewertende Literaturanalyse vorgeschlagen. An drei Zeitschrift-Jahrgängen aus dejji Bereich der Psychiatrie (2 deutsche und 1 amerikanische) wird versuchsweise eine Literaturanalyse durähgeführt, die unter anderem methodische Aspekte der Datengewinnung, -darstellung und -auswertung; in den Publikationen beurteilt. Die Ergebnisse bestätigen die bewertende Literaturanalyse als brauchbares Instrument zur Beschreibung der Wissenschaftsentwicklung. Es wird deshalb vorgeschlagen, eijie umfassende, bewertende Literaturanalyse zu institutionalisieren und. in ein allgemeines Forschungsplanungs-Informationssystem einzubeziehen.

„Gesund ist, wer zum Gluck keinen Arzt braucht“. Dieses gefliigelte Wort eignet sich sicher nicht zur Definition des Gesundheitszustandes von Neugeborenen, denn sonst waren alle unsere Neugeborenen krank. Andererseits zeigt es aber die haufig geubte Praxis, den Gesundheitszu-stand einer Person indirekt uber den Bedarf an arztlicher Hilfestel-lung zu messen, was allerdings bei sich anderndem Angebot Oder Bedurfnis nicht ohne Probleme bleibt.

In der Bundesrepublik ist das Wissen um die Haufigkeit und um die Gefahren der Hypertonie gering. Informationen daruber, wie viele Hypertoniker von ihrer Krankheit wissen bzw. nicht wissen, sind kaum vorhanden. Daten uber den Behandlungsgrad von Hypertonikern und die Compliance bei der Behandlung von Patienten mit Hypertonie sind selten. Die Munchner-Blutdruck-Studie (MBS) gibt Antworten auf solche Fragen und stellt Basisdaten fur den Aufbau eines Munchner-Blutdruck-Programms (MBP) zur Verfugung. Die MBS ist als Querschnittsstudie (mit Follow-up) konzipiert. 3400 Munchner (30-69 J.) wurden nach Zufallskriterien aus der Einwohnermeldekartei der Stadt ausgewahlt. Sie wurden gebeten, in ein Untersuchungszentrum zu kommen und sich einer standardisierten Befragung, 3 Blutdruckmessungen und Grose- und Gewichtsmessung zu unterziehen. Von 3198 erreichbaren Probanden nahmen 2216 an der Studie teil (etwa 70%).

Wie in anderen Industrienationen so findet auch in Deutschland in diesen Jahren eine intensive Diskussion uber die Kostenentwicklung im Gesundheitswesen statt. Wahrend im grosten Umsatzbereich, den stationaren Leistungen, weitgehend pauschal abgerechnet wird, erfolgt die Abrechnung im ambulanten Sektor auf der Basis der tatsachlich registrierten arztlichen Leistung. Ein Zugang zu diesen Daten konnte erst erfolgen, als jene Daten, die zur Abrechnung benotigt werden, in maschinenlesbarer Form vorlagen.

From 1967 to 1972, 70 patients with aplastic anemia were observed and followed up to death or at least two years. 3 cases of pure red cell anemia, and 2 cases of amegakaryocytic thrombocytopenia are included. Detailed investigation of drugs taken within 6 months before onset of the disease revealed chloramphenicol in 20, butazones in 11 cases. Acute viral hepatitis preceded the hemopoietic failure in 2 patients. In addition to various combinations of anemia, granulocytopenia and thrombocytopenia, monocytes were diminished in 35 and lymphocytes in 12 cases. Acid serum or sucrose tests were consistently negative. The patients were treated by short-term prednisone, long-term androgens and red cell and platelet substitution as needed. 2 years after onset of the disease, 33 per cent were in partial or complete remission, 30 per cent survived without remission, and 35 per cent had decreased. Correlation of various parameters with remission and survival showed the presence of a subgroup at risque, comprising patients with low marrow cellularity and clinically relevant diminution of all three cell lines at the time of diagnosis. Absolute lymphopenia and increase of plasma cells in the bone marrow were of poor prognostic significance. In this subgroup two years after the onset of the disease only 32 percent survivors and 16 per cent remissions were recorded. There was no conclusive evidence for the therapeutic value of prednisone or androgens in our series. The present situation in severe aplastic anemia requires more effective forms of treatment and justifies experimental therapies like bone marrow transplantation.

Altogether 1707 permanently hospitalized patients aged from 40 to 69, from 8 psychiatric hospitals in Germany, were investigated for the occurrence of electrocardiographic signs of coronary heart diseases. ECG changes which indicate a past infarction or a coronary insufficiency with great reliability were found almost not at all in patients under the age of 50, in men aged from 50 to 59 years in 7.0%, and aged from 60-69 in 11.8% of cases. In women of corresponding ages the figures were 3.8 and 10.8% respectively. Compared with a non-psychiatric population, there were suggestions of a slightly higher prevalence of coronary heart diseases in the psychiatric patients.

Anhand der Daten der Munchener Padiatrischen Langsschnittstudie wird die pradiktive Validitat mutterlicher Entwicklungsbeobachtungen im Hinblick auf die kognitive Entwicklung der Kinder mit 5 Jahren untersucht. Im Rahmen dieses Beitrags konnen aufgrund redaktioneller Beschrankungen nur einige Anmerkungen zum gegenwartigen Forschungsstand erfolgen. Ebenso kann das von uns gewahlte Vorgehen bei den Analysen lediglich anhand von Beispielen dargestellt werden.

Im Rahmen meines Vortrages werde ich mich auf methodische Erfordernisse einer wissenschaftlichen Evaluation eines einzelnen Qualitatssicherungsprogramms beschranken. Ich schliese damit aus: Einerseits die umfassende wissenschaftliche Evaluation des Konzepts der Qualitatssicherungsprogramme mit einem systematischen und flachendeckenden Anspruch, andererseits die innerhalb eines Programmes ablaufenden, fur die Durchfuhrung des Programmes selbst notwendigen Ruckkopplungsmechanismen. Besonders wichtig erscheint mir die Unterscheidung zwischen den fur ein Programm notwendigen methodischen Erfordernissen und den fur eine Bewertung notwendigen wissenschaftlichen Begleituntersuchungen. Aufwand, der im Rahmen eines auf breiten Einsatz abzielenden Programms nicht mehr gerechtfertigt werden kann, konnte durchaus im Rahmen einer wissenschaftlichen Evaluation sowohl notwendig als auch finanzierbar sein.

Die z. Z. angewandten Behandlungsmethoden konnen nicht in dem Sinn als Alternativen betrachtet werden, das eine die andere ganzlich uberflussig macht. Des weiteren scheint klar zu sein, das die grostmogliche Anzahl Transplantationen anzustreben ist, auserdem so viele Heimdialysen oder CAPD wie moglich. Da auch die Krankenhausdialyse auf jeden Fall angeboten werden mus, ist zu erortern, welches die ideale Mischung ware. Leider konzentrierten sich die bisher durchgefuhrten okonomischen Analysen fast ausschlieslich auf eine vergleichende Bewertung der einzelnen Behandlungsmethoden. Daraus last sich ableiten — wie Pedersen sehr deutlich aufzeigte -, das derzeit jene Analysen wichtig sind, die das Programm von einem umfassenden Gesichtspunkt aus untersuchen; in der gegebenen Situation und angesichts der grosen Komplexitat scheint dies am ehesten mittels Simulation erreichbar zu sein, worauf Pedersen in seinem Beitrag ebenfalls hingewiesen hat.

Zur Fruherfassung der angeborenen Hypothyreose bei Neugeborenen waren geeignete Verfahren zur Mikrobestimmung von TSH aus auf Filterpapier aufgebrachten Trockenblutproben zu entwickeln. Die Verfahren waren bezuglich ihrer Eignung fur das Massenscreening hinsichtlich ihrer Sensitivitat, Prazision, Reproduzierbarkeit und Automatisierbarkeit zu uberprufen. In einem Methodenvergleich sollten verschiedene kommerzielle Methoden einander gegenubergestellt werden. Die Beurteil ung der diagnostischen Wertigkeit erhohter TSH -Werte sollte uberpruft und ein differentialdiagnostisches Vorgehen fur kontrollbedurftige Werte erarbeitet werden.

Die Ausgabenentwicklung im Bereich der RVO-Kassen je Voll-Mitglied fur den Zeitraum 1975 bis 1983 macht den allgemeinen Kostendruck im Gesundheitswesen deutlich. Ausgedruckt in Anteilen am Bruttosozialprodukt betrugen die Ausgaben im Bereich der Gesetzlichen Krankenversicherung 1970 noch 3,7%, 1980 waren es bereits 6,0%. Die wichtigsten Ausgabenbereiche verhielten sich dabei so, das der Anteil „ambulant-arztlicher Leistungen“ von 1970 21,7% auf 1980 17,1% fiel der Anteil „Arznei-, Heil- und Hilfsmittel“ von 1970 16,8% auf 1980 14,0% fiel und der Anteil, der auf stationar erbrachte Leistungen entfiel, von 1970 23,9% auf 1980 28,3% stieg.

Gesundheitsindices sind Instrumente zur umfassenden Messung des Gesundheitszustandes. Beschrieben werden soll a) der Gesundheitszustand von Individuen zur Beschreibung (z.B. eines Krankheitsverlaufes) zur Bewertung (z.B. eines Medikamentes) zur Planung (z.B. des Pflegeaufwandes) b) der Gesundheitszustand von Gruppen (Patientengruppen, Gemeinden, soziale Schichten usw.) zur Beschreibung, etwa einer Entwicklung zur Bewertung, etwa eines Fruherkennungsprogrammes zur Planung, etwa zur Ermittlung von Prioritaten. (Siehe hierzu R.L.BERG, 1976)

The distribution of some risk factors on different psychiatric diseases in 1726 hospitalized patients were investigated within a prevalence study. To all tested factors there was a contrary behaviour of oligophrenic patients opposite to the group with a schizophrenia, organic and affective psychotics. Hypertension only was found more frequently in non psychotic psychopathia and oligophrenia than in psychosis. Therefore the prevalence of hypertriglyceridemia, hypercholesterinemia, diabetes, specific Ecg-changes, smoking of cigarettes and severe physical inactivity in oligophrenics was less except in all other group of diseases, also in consideration of the different frequency of psychopharmacal treatment. Electrocardiographical signs for coronary heart diseases also show a similar distribution of frequency. Likewise in psychiatric patients seems to be an agreement with the coronary morbidity and the somatic risk factors.

Der Betrachter der aktuellen Situation in der Vorsorge lenkt vor allem sein Augenmerk auf die problematische Lage der gesetzlichen Vorsorgemasnahmen. Die niedrigen Beteiligungsquoten mit rund 26% bei den teilnahmeberechtigten Frauen und etwa 14% der teilnahmeberechtigten Manner, die dabei noch ganz geringen Ausschopfungsraten mit weitgehend unbekanntem, aber sicher nicht vernachlassigtem Anteil der falsch-positiven Befunde sowie die Frage, wie viele dieser “entdeckten” Falle nicht auch ohne dieses Programm entdeckt worden waren, macht die Forderung nach einer methodologisch fundierten Einfuhrung von Vorsorgemasnahmen zwingend.

In Munich, 1477 employees (868 males and 609 females) of a large industrial firm were examined with regard to coronary heart disease risk factors. The known risk factors--overweight, disorders of the lipometabolism, diabetes, cigarette smoking, hypertension, pathologic ECG, physical inactivity--as well as certain somatic complaints and mental stress were checked for their distribution within the various social levels. With the exception of cigarette smoking among women and professional worries among men, in both sexes the members of the upper social group are less burdened with danger factors than the average. Aside from high blood pressure and disorders of the lipometabolism, which predominate in males in the middle layers, and cigarette smoking, which prevails among females in the upper social group, the risk factors pile up in the lowest social level. Our results will be discussed and compared with other studies.

1477 employees of a large industrial firm in Munich (868 males and 609 females, aged 40-59) were examined for coronary heart diseases risk factors. Among males, hypercholesterolemia predominates with a distribution of over 40%. Every fifth male has high blood pressure or is a heavy cigarette smoker. The females under 50 years of age clearly show fewer risk factors, but toward 60 years they exceed the males in frequency of some factors. Among women, too, the top risk factor is cholesterol, followed by overweight and high blood pressure. On the average, about 8% of the men and women have a preclinical or manifest diabetes. About every fifth male examined and every seventh female can be considered as especially endangered by the presence of 3 or more risk factors.

Zahlreiche Untersuchungen der letzten Jahre haben die Bedeutung von Fettstoffwechselstorungen bei der Entstehung arteriosklerotischer Gefaserkrankungen nachgewiesen. Wahrend bei den alteren, prospektiven Untersuchungen [1, 3], wie der Framingham-Studie, die in den 50er Jahren begonnen wurden, vor allem die Rolle der Hypercholesterinamie bei der Entstehung arteriosklerotischer Gefaserkrankungen deutlich wurde, haben neuere Arbeiten [2, 7] ergeben, das den Hyperlipoproteinamien, die vor allem mit einer Triglyceridvermehrung einhergehen, eine gleichgrose, wenn nicht sogar zahlenmasig grosere Bedeutung zukommt.

This paper describes several new visualization and interaction techniques that enable the use of virtual environments for routine medical purposes. A new volume-rendering method supports shaded and transparent visualization of medical image sequences in real-time with an interactive threshold definition. Based on these rendering algorithms two complementary segmentation approaches offer an intuitive assistance for a wide range of requirements in diagnosis and therapy planning. In addition, a hierarchical data representation for geometric surface descriptions guarantees an optimal use of available hardware resources and prevents inaccurate visualization. The combination of the presented techniques empowers the improved human-machine interface of virtual reality to support every interactive task in medical three-dimensional (3-D) image processing, from visualization of unsegmented data volumes up to the simulation of surgical procedures.

The most important rendering methods applied in medical imaging are surface and volume rendering techniques. Each approach has its own advantages and limitations: Fast surface-oriented methods are able to support real-time interaction and manipulation. The underlying representation, however, is dependent on intensive image processing to extract the object surfaces. In contrast, volume visualization is not necessarily based on extensive image processing and interpretation. No data reduction to geometric primitives, such as polygons, is required. Therefore, the process of volume rendering is currently not operating in real time. In order to provide the radiological diagnosis with additional information as well as to enable simulation and preoperative treatment planning we developed a new hybrid rendering method which combines the advantages of surface and volume presentation, and minimizes the limitations of these approaches. We developed a common data representation method for both techniques. A preprocessing module enables the construction of a data volume by interpolation as well as the calculation of object surfaces by semiautomatic image interpretation and surface construction. The hybrid rendering system is based on transparency and texture mapping features. It is embedded in a user-friendly open system which enables the support of new application fields such as virtual reality and stereolithography. The efficiency of our new method is described for 3-D subtraction angiography and the visualization of morpho-functional relationships.