This first "zero" issue of the ACTION Front marks the formal start, in this spring of 1996, of the ACTION project cluster in Health Telematics. Here, we briefly introduce the project, and re-publish a recent article from M. Richonnier, Director, DG XIII. This formed the backbone of his message in a EuroTransMed broadcast on Cancer Telematics, which was made on March 26th as part of the MEDICO programme (a full report on this will appear in a later issue of this newsletter). Subsequent issues will bring you information on progress of the projects, raise issues of concern, and provide news of events and activities of interest.

ACTION is a cluster of projects within the Telematics for Health sub-programme under the theme of assisting the cooperative working of healthcare professionals. This theme applies equally well to research and to practice, and, just as importantly, to the bridge between research and practice. The theme underpins the current moves towards evidence-based medicine and continuous quality improvement; both these goals involve cyclic information flows through various communities of professionals that can be expedited through telematics.

As a concerted cluster of complementary projects, the ACTION projects address different aspects of these information flows. In order to ensure that their results are synergistic, they overlap on a common health domain - that of oncology. They also aim to converge on common models and standards, with the assistance of ACTION's horizontal accompanying measure, called HORIZON, which will coordinate the various activities and and pro-actively research issues of common interest to all the projects.

In a nutshell, the ACTION projects between them address the following aspects:

It is clear that such projects have many issues of common interest, for instance imaging standards, electronic patient records, models for protocols and guidelines HORIZON will coordinate consensus development in these and other areas.

Affiliated to ACTION, and in fact closely related to it, is another horizontal project called Global HORIZON , which, as part of the Global Information Society initiative, is looking at the feasibility of linking together the various respositories of data, information and expertise being accumulated internationally in order to provide the global healthcare community with the best information relevant to cancer.

Further information is given elsewhere in this issue.

Most of the contracts for these ACTION projects started on or near January 1st and, by the time this newletter is published, most will have had their kick-off meetings, and their workprogrammes will be in progress.

The first public event was the EuroTransMed broadcast on March 26th organised by MEDICO, in which Michel Richonnier, head of the Telematics Programme, presented the ACTION programme to an audience of over 200 hospital sites across Europe.

During the processes of care, data may be collected, knowledge generated, and expertise gained. Data may be collected in a research context (e.g. as part of a clinical trial or epidemiological study), for quality assurance or for clinical audit. In any case the data will contribute to evidence for best practice, albeit through different routes. The MACRO project is specifically concerned with the role of telematics in facilitating participation in clinical trials, and the capture, collection and management of data generated during trials, which should ultimately make it easier and cheaper to run large-scale trials specially for rare diseases. A different aspect of speeding up the clinical trials process is addressed by MANSEV, which will trial the use of telematics to facilitate access by regulatory authorities to the vast amounts of data they need to review before approving any drug for trials.

The process by which the findings from research become incorporated into widespread practice is generally long and uncertain. At one level it is necessary for professional groups to achieve consensus on best practice, involving systematic review of findings from the literature, as well as analysis of datasets representing unpublished results. As this involves busy clinicians, this can take a long time. The next level involves the transfer of consensus into practice, which is a highly indeterminate process. Two projects ACTION deal with different aspects of the transfer process. ECOLE/GRIP will apply telematics tools to assist the professionals in achieving consensus more quickly and easily and at lower cost, and help them encapsulate such consensus in the form of best practice guidelines appropriate in different contexts. MEDICO is concerned more with facilitating the on-going professional development of practising clinicians via various telematic channels, using material based where possible on agreed best practice.

The availability of clinical practice guidelines does not in itself guarantee that they will be widely accepted or applied. Acceptance can be made easier by involving the potential users in their development: the cooperative working tools that ECOLE/GRIP will deploy will make this more feasible. Making it easier for clinicians to apply such guidelines in their day-to-day work is the task of PROMPT, which will address the technologies that should be accessible at the clinical workstation to support the clinical decision process. Of course, this brings us round the full circle, as the workstation is ideally where data is captured.

Having approved protocols and guidelines available is however not enough on its own - it is necessary to ensure that the care delivered conforms as closely to the guidelines as possible, particularly where invasive or hazardous procedures are used. CONQUEST is concerned with developing quality assurance and management tools to assist in this, particularly in relation to the use of imaging technologies. It will also support more accurate communication between specialists. In addition, TARGET will facilitate communication between specialist and subsidiary centres, leading to improved treatment planning and better utilization of expensive resources.

As well as accurate communication, the quality of information supplied by other specialists such as pathologists has also to be assured. EUROPATH specifically addresses the use of telematics to improve the quality of pathological information on two axes: enabling effective use of remote expertise, and compiling a reference database of image data and associated clinical information.

Ultimately, the technologies of CONQUEST and EUROPATH will merge with those of PROMPT into the clinical workstation area, as well as with those of MACRO enhancing the level of detail that clinical trials will be able to work with, thus helping to accelerate the overall quality improvement cycle.

As an example, the MARGRITE project covers many aspects of the overall cycle while focussing on a specific, complex, and highly invasive, form of treatment - bone marrow transplant. Building on the 3rd FW project EMDIS, MARGRITE will support vital clinical decisions faced by individual transplant teams by ensuring that the results of all stem cell transplantations performed across Europe are collected, analysed, qualified, and made readily available to them via telematics.

As an accompanying measure, HORIZON has the task of facilitating the coherence of the ACTION cluster.

The individual projects are designed to be standalone and streamlined, in order to minimize the overheads of having too many strong interdependencies which can slow down individual progress; however the logical interrelationships do exist as described above, and HORIZON's role is to track these relationships and dependencies, and to facilitate consensus among the group where needed. It will also maintain and project the cluster identity, particulary with respect to the information flow and quality improvement cycle outlined above. This model will form the basis for planning a major validation trial combining the results of all the ACTION projects.