IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 2, NO. 2, JUNE 1998 89 On the Integration of Healthcare Emergency Systems in Europe: The WETS Project Case Study Francesco Beltrame, Member, IEEE, Piergiulio Maryni, Member, IEEE, and Giorgio Orsi Abstract—The European Union (EU) is characterized by a large number of different emergency healthcare (EHC) systems. In this situation, a common policy for healthcare emergency handling is largely prevented and is a cause of an increase of the costs asso- ciated with such systems all over Europe. There is, hence, a need for a homogenization and integration of healthcare emergency systems in Europe. This turns out to be difficult because of the ethical, political, legal, and technological differences and pecu- liarities of the European scenario and the large investments that would be needed in this sector. The process of integration passes through the identification of the main functionalities—driven by the user needs in their real life conditions—along with the technologies that are best fitted for supporting them. In this paper, several aspects related to these problems are analyzed and a real case study, drawn from the Project “Worldwide Emergency Telemedicine Services” (WETS), supported by the European Commission (DG-XIII), is presented. Within WETS, several pilot sites (in Italy, Spain, Greece, Denmark, and Iceland) consider different aspects of the integration of healthcare emergency systems with particular focus on the sharing of solutions that “traditionally” belong to different environments (i.e., land, air, and sea). The involvement of important hospitals, ship companies, airlines, and emergency health institutions allows us to devote a large part of this two-year project (1998–1999) to validate and demonstrate the results of the development phase in real-life conditions. Some more concrete details are given for the Italian pilot site, where the authors operate. Index Terms— Biomedical engineering, emergency services, healthcare telematics, information technology, medical services, multimedia systems, telemedicine. I. INTRODUCTION I N THE European Union (EU), different types of emergency healthcare (EHC) systems exist in the various member states and sometimes they differ even from region to region. Europe’s long history of regional autonomy, strong national feelings, and heavily defended borders may well account for the diversity of such EHC systems (e.g., EHC systems aboard vessels). This leads to nonhomogeneous emergency medical treatments over the European territory that limits, to some extent, the free circulation of citizens. On the con- trary, European citizens aim for continuity of care and an accessible healthcare service system. Homogeneity and ef- fectiveness enhancement of the very complex topic of the healthcare emergency treatment have been addressed by the latest European Framework Programmes on different levels. Manuscript received April 28, 1998; revised May 30, 1998. F. Beltrame and P. Maryni are with DIST, University of Genoa, 16145 Genoa, Italy (e-mail: francesc@dist.unige.it; pg@dist.unige.it). G. Orsi is with TSD Projects S.r.l., 20139 Milano, Italy. Publisher Item Identifier S 1089-7771(98)06940-4. Moreover, the Fourth Framework Programme (1994–1998) [1] has been focused on a number of EHC scenarios that have been addressed as separate entities. In fact, several projects have been funded by the European Commission, each of them dealing with a particular aspect of the EHC service. The largest group has been funded by the Telematics Applications Program (TAP) of DG XIII/C [2], [3], one of the 18 specific programs constituting the first action of the Fourth Framework Program (1994–1998). Such projects are managed specifically by the Healthcare Telematics Unit C4 [4], and they are conceived according to the following five-step structure: 1) user needs analysis; 2) functional specifications definition and design; 3) prototype/service development; 4) verification; 5) demonstration. Specifically, the enhancement of EHC’s over land, on the one side, and onboard sea vessels, on the other side, did receive particular attention. In this context, European projects such as HECTOR [5] and MERMAID [6], which address, respectively, land and sea emergencies, represent a valuable example of this general strategy. Their main results (in terms of realized products/services) are currently undergoing a large- scale validation phase, but they are still not ready for the market. Within the Fifth Framework Program (1999–2002), the EU will sponsor research and development applications that are able to bring concrete effects at a market level. The aim of future project pilots should not only prove the validity of an idea, but open the way to the implementation and commercial- ization of practical and useful tools, applications, and services. In the field of EHC, the (practical) integration of solutions, suited for different EHC scenarios, into a unique easy-to-use handling framework, turns out to be particularly effective since it leads to systems more appealing for the various European EHC handling institutions and, as a consequence, to a larger market. An integrated solution for EHC management will be more easily accepted and eventually funded by local European authorities. On the basis of the aforementioned conditions, the objective of last-generation Fourth Framework Programme funded projects, such as Worldwide Emergency Telemedicine Services (WETS) [7], is to integrate previous achieved results to design a system able to give global and useful solutions to a wider spectrum of EHC scenarios. The focal point of the integration idea is to yield a service to the final user that is not simply the sum of the services as provided now by the already existing pilots (e.g., HECTOR, MERMAID), but which contains instead a considerable added value in 1089–7771/98$10.00  1998 IEEE