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Integrated System Architecture for Advanced Primary Care


ISAAC is a strategic project in the framework of General Practice and, more broadly, of Primary Health Care (PHC) with the main goal being to develop information technology and telematics support in this key area of the Health Care Systems in European Countries.
The integrated system architecture for advanced primary care (ISAAC) p a strategic project in the framework of general practice and, more broadly, of p (PHC) involved with the development of information technology and telematics (IT in this key area of the health care systems in European countries.

The achievem so far are:
consolidation of the General Practice Functional Reference Model;
us classifications in PHC;
definition of the global architecture design;
human comp specification and medical images;
quality assurance and development of methods i practice;
security and confidentiality aspects;
implementation of the first prot activities, fundamental for the project, were the establishment of the ISAAC Adv and the set up of the testbed sites where the project results should be tested a pilot sites have different features both in terms of involved services and IT an IAB is a group of experts in the field of PHC who will collaborate with the ISAA the project lifetime, looking at the project periodic results, supporting the co validation of the Functional Reference Model and contributing to the evaluation environmental acceptance through the ISAAC application prototype.
ISAAC is the extension of a previous project (ADAM) which was part of the AIM exploratory phase. It is from these initial results that ISAAC is developing a fully integrated environment to support the functions of Primary Care.

The overall objectives of the project are:

- Contributing to the organisation, understanding and standardisation of General Practice (GP) functions in Europe
- Strengthening the promoting and impeding factors in the diffusion of IT&T systems in PHC
- Prototyping a system giving adequate support to the requirements of a local information processing environment and to the links required to other levels of the Health Care System (system integration).

The project started in January 1992 and is due to be completed in December 1994.

The ISAAC project is carried out by a Consortium involving IT Enterprises leaders in the Health Care sector in various European countries, Scientific Bodies and General Practitioner Associations representatives of the target users of the project results.

With respect to the AIM Workplan ISAAC can be related mainly to task T271-"Telematics for Primary Care" in the "Telecommunication Systems for Medicine" area. Also Task T252 "Human-Machine Interfaces for Health Care Information Systems" in the "Medical use of multimedia workstation" area, is covered by the project.

Technical Approach

Two major action lines have been depicted for the project:

1. The set up of a Functional Reference Model (FRM) focused upon the information needs of the General Practice environment.

In addition to contributing to a European Reference Model for the development of Information Processing System in the Primary Care and General Practice area, the ISAAC FRM provides the guide-lines for the design and implementation of the ISAAC environment.
2. The definition of a global architecture of the ISAAC environment.

A generalised application development environment is being specified, giving standard criteria for the implementation of information processing applications in the Primary Care and General Practice area.

Four main streams of design and implementation are going to be pursued:

1. Development of a GP Workstation environment on the basis of high modularity and configurability, able to support at a local level the medical activities of both the General Practitioner and the Practice Team (nursing, administrative and technical staff). A special emphasis is put on the definition of the most suitable Human-Computer Interface.
2. Integration of the GP workstation with the other services supplied by the Health System both at primary and secondary care level through the development of an integration system architecture able to support the exchange of information among the different actors (horizontal communication between the different practitioners, patients and statutory/non statutory agencies in primary and community care-vertical communication with hospitals, labs and other secondary care facilities).
3. Address the requirements of transfer/storage of the patient re-cord on a portable media such as a data card which could easily follow the patient and be readily available in case of emergency.
4. Definition of tools assisting in the health education of the patient and supporting the continuing medical training and tutoring needs.

Key Issues

The key issue for the project is to contribute to improved patient care, increasing the effectiveness of PHC through the design and development of telematics supports, specifically targeting needs, requirements and trends of this crucial area. Furthermore ISAAC is enhancing co-operation between primary care teams, providers organisations and IT industries to promote concrete initiatives in Primary and Community Care.

Expected Impact

The use of information technologies in general practice and more widely in the PHC field is traditionally lower than in other areas of the Health sector (i.e. hospitals).

In most States, Health Boards and Administrations are putting new demands on PHC workers and there is an emphasis to attempt to move care from the institutions to the community in order to promote prevention and controlling the escalating costs. In fact PHC has the responsibility for the on-going health of individuals, families and population. The General Practitioner is at the hub of PHC services performing a crucial role in the system. The hallmarks of the GP's role are the continuity of care and the holistic approach, encompassing all of the patients needs. The unique feature of the General Practitioner is his potential to be a real health agent practising with a preventive approach and providing care on a patient-oriented basis. He could merge contributions coming from different professionals and better identify strategies to cope with individual or community problems.

ISAAC emphasises the importance of communication and data-flows to and from the GPs and should be considered as a strategic project in the context of the AIM Programme purposes. In particular, ISAAC aims at developing user-relevant technologies, at providing the basis for standards by defining a Reference Model for the General Practice at a European level, for the development of a GP-information processing environment by connecting and integrating primary care providers and services with secondary care ones.

Relationship to Other Project and Actions

In the context of the AIM concertation activities, the project refers to project Line 6 TAF "Telemedicine Application Framework"). Further cross lines contacts have been established with other related projects (Dilemma, Diabcard, Seismed and others). ISAAC is participating in the Concerted Action on Telematics in Primary Health Care.


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Prisma Informatica SpA
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