No C 356/8 Official Journal of the European Communities 31. 12. 87 
Opinion on the proposal for a Council Regulation (EEC) amending Regulation (EEC) 
No. 2727/75 on the common organization of the market in cereals 
(87/C 356/04) 
On 22 October 1987 the Council decided to consult the Economic and Social Committee, 
under Articles 43 and 198 of the Treaty establishing the European Economic Community, 
on the abovementioned proposal. 
The Section for Agriculture and Fisheries, which was responsible for preparing the Commit­
tee's work on the subject, adopted its Opinion on 5 November 1987. The rapporteur was 
Mr Luchetti. 
At its 250th plenary session (meeting of 18 November 1987), the Economic and Social 
Committee adopted the following Opinion unanimously: 
The Committe approves the Commission proposal. 
However, as the Commission's new powers will in 
some cases assume significant economic importance, the 
Done at Brussels, 18 November 1987. 
1. Introduction 
1.1. Information technology and telecommuni­
cations have hitherto played a relatively insignificant 
part in health care, in contrast to other important areas 
of life. 
Initiatives taken in this field so far by the individual 
Member States have been uncoordinated, usually 
restricted to specific areas of health care, and incompat­
ible with each other. Committee urges that care be taken to ensure balanced 
management of the sector, respecting the interests of 
the various Member States. 
The Chairman 
of the Economic and Social Committee 
Alfons MARGOT 
Outside Europe, on the other hand, there is already a 
very wide variety of initiatives and projects in the field 
of medical informatics and bio-informatics involving a 
large number of supplier firms. 
1.2. Health care deals with one of the most basic 
human needs. 
The demand for health care services will increase in the 
future, mainly as a result of changing attitudes to health, 
demographic trends and the emergence of new forms Opinion on the proposal for a Council Regulation on a Community action in the field of 
information technology and telecommunications applied to health care, AIM (Advanced 
informatics in medicine in Europe) — Pilot phase 
(87/C 356/05) 
On 7 September 1987 the Council decided to consult the Economic and Social Committee, 
under Article 130 Q of the Treaty establishing the European Economic Community, on the 
abovementioned proposal. 
The Section for Protection of the Environment, Public Health and Consumer Affairs, which 
was responsible for preparing the Committee's work on the subject, adopted its Opinion on 
3 November 1987. The rapporteur was Mrs Tiemann. 
At its 250th plenary session (meeting of 18 November 1987) the Economic and Social 
Committee adopted the following Opinion unanimously with one abstention: 
31. 12. 87 Official Journal of the European Communities No C 356/9 
of disease. This will mean higher costs for the national 
health care systems. 
Health care cannot therefore evade technological pro­
gress. It is thus both desirable and necessary to accept 
the challenge and to take initiatives to ensure from 
the outset proper management of the application of 
technology to health care. 
Within this framework use can be made of all the 
possibilities offered by information technology and tele­
communications insofar as they help to improve health 
care and thus contribute to the individual's personal 
development. 
1.3. The objective of AIM is to create the basic 
conditions that will enable medical resources and ser­
vices to be adapted to the growing and changing indi­
vidual needs of patients. 
AIM seeks to achieve this by means of a new technology 
which makes possible common minimum standards 
for information and presentation. Thus comparable 
medical data will be expressible in a way which is 
comprehensible to all those involved in health care in 
Europe. 
AIM also reflects the justified desire to create, in line 
with the Single Act, a homogeneous Community market 
in this field and to make it competitive in the light of 
the developments that have taken place, particularly in 
Japan and the USA. The very heterogeneity of European 
health systems makes it possible to develop at Com­
munity level technological projects which are suited to 
the world market. 
1.4. The Commission's proposed pilot project is wel­
comed and supported in principle. It is expected, how­
ever, that the reservations outlined below will be taken 
into account during the trial phase. 
The 20 million ECU earmarked for the pilot phase must 
be secured to AIM as a matter of priority. It must also 
be ensured that, after completion of the pilot phase, 
sufficient funds are available for the continuation of 
AIM. 
2. General comments 
2.1. Scope of AIM 
2.1.1. The importance of support for 
biomedical research at infrastruc­
ture level 
2.1.1.1. AIM will be particularly relevant to the dis­
semination of research findings. 
Medical research, more than almost any other activity, 
opens up new dimensions in diagnosis and therapy. 
In the past, however, the flow of information to and 
from doctors and pharmacists and other medical per­sonnel has in some cases been inadequate so that there 
have been considerable delays in the utilization of 
research findings for the benefit of patients. 
Medical progress in all areas of health care can be made 
available for the patient more effectively and quickly if 
there is coordinated transmission of research findings 
to doctors, pharmacists and other medical personnel, 
and corresponding feedback, so that the information 
situation is improved. 
2.1.1.2. AIM could be particularly useful for the 
development and dissemination of new possibilities in 
preventive medicine. The development and the more 
intensive and effective use of preventive measures, early 
diagnosis and therapy form one of the most effective 
ways of making long-term savings in health care by 
preventing disease. 
AIM should thus be used in particular for the compara­
tive analysis of the effects of environmental damage 
and specific working conditions. In this way the import­
ance of the toxicological centres which already exist in 
some countries could be considerably enhanced. 
2.1.1.3. In the pharmaceuticals sphere, information 
on side-effects, market changes, price comparisons, 
reimbursement under social insurance schemes, etc. 
could play an important role. 
2.1.2. Contribution to health care plan­
ning 
2.1.2.1. AIM can also make an important contri­
bution to the provision of information for health care 
planning through the collation of depersonalized data. 
It is generally recognized that the national health care 
systems have hitherto not had sufficient concrete data 
for planning purposes. 
2.1.2.2. Health care planning can, however, initially 
only be expected to provide general means of control 
which can contribute to the even distribution of medical 
services. Quality can be assured not so much through 
health planning as through the shaping of national 
health care systems in such a way as to provide doctors 
and other medical personnel with the right conditions 
for effective treatment of patients. 
It would therefore be wrong to expect too much of 
AIM in this connection. 
2.1.3. Improving the quality and effi­
ciency of medical care 
2.1.3.1. The application of AIM is also to be wel­
comed insofar as it can help facilitate, speed up and 
intensify treatment so as to render it as effective and 
palatable as possible for the individual patient. 
No C 356/10 Official Journal of the European Communities 31. 12. 87 
2.1.3.2. The efficiency and the quality of health care 
are, however, difficult to measure, being dependent 
on a wide range of parameters which vary from one 
individual case to another. 
If therefore AIM is expected to improve the quality and 
efficiency of health care, such an improvement can only 
be visualized in terms of general targets rather than 
precisely quantifiable objectives. 
2.1.3.3. Health care itself does not generally lend 
itself to standardization. The 'standards' which the 
Commission repeatedly refers to can therefore only be 
of a technical nature e.g. those used in the drawing-up 
of programmes. 
At best it is possible to arrive at uniform definitions 
regarding the conditions governing entitlement to social 
security benefits such as pensions or the conferral of 
severely disabled status. And here AIM can help ensure 
that applicants as far as possible receive equal treat­
ment. 
2.1.3.4. AIM, being a Community-financed system, 
may permit reductions in the cost of health care systems, 
but it is too early to make any assessment. 
Experience suggests, however, that when the use of 
technology is stepped up, health care costs rise. This is 
due not only to the high cost of the equipment and its 
maintenance but also to related factors such as the need 
for technically qualified staff and the snowball effect 
of the ever more intensive use of equipment and technol­
ogies. 
It is usually possible to tell whether a given innovation 
has reduced costs only after a trial period of several 
years. The 18-month period which the Commission 
proposes for the pilot project seems too short. What is 
needed is a longer trial period, or a second trial period 
in which account is taken of preliminary experience 
accumulated during the first period. 
Even given the financing problems of the national health 
care systems, the primary objective of AIM cannot be 
to reduce costs. AIM must first and foremost provide 
another basis for the more effective organization of 
health care for the benefit of the patient. Cost 
reductions cannot be achieved in isolation by the use 
of technology but are tied up with overall social and 
health policy. 
The Commission draft leaves many questions un­
answered as regards the cost of the project. It is not 
possible to judge at present whether the cost of devel­
oping, acquiring and operating the new technology will 
be counterbalanced by savings on health care. It is also 
not clear who will bear the acquisition and operating 
costs. 2.1.3.5. 'Maximum care' cannot always be promoted 
by data and technology. Human caring must always 
come first. 
We should not lose sight of the fact that AIM can also 
lay the foundation for more effective application of this 
human caring. 
2.2. Implementation of AIM 
2.2.1. Preserving the human face of 
medicine 
2.2.1.1. Health is one of the most precious of human 
possessions and is inseparably bound up with the 
patient's human dignity and freedom of action. Efforts 
to improve the efficiency and flexibility of health care 
must therefore never be at the expense of humanity and 
respect for the individual. 
2.2.1.2. The use of information technology and tele­
communications must never damage the relationship of 
trust between patient and doctor. 
It is generally recognized that this relationship of trust 
and the doctor-patient interaction is a major factor 
contributing to the alleviation and healing of disease 
and the preservation of health. The patient's trust can­
not be transferred to technology nor can the doctor 
abdicate his personal responsibility for his patient to 
technology. 
The contribution of auxiliary medical staff must not be 
standardized in the search for perfection. This would 
lead to the 'robotization' of medicine. In this respect 
'telemedicine' can be used only when it meets health 
care needs. 
2.2.1.3. The striving for information and trans­
parency in health care must not lead to the 'transparent 
patient'. 
The confidentiality of case data must remain one of the 
fundamentals of health care. 
In this context data protection is of enormous import­
ance to the patient. It is gratifying to note that the 
Commission draft deals with this in several places. The 
obligation to observe secrecy applies vis-a-vis insurers, 
employers, sickness funds and other third parties. 
The principle of professional secrecy must remain 
intact. Thus the keeping of patient records can be a 
legitimate subject for AIM only insofar as this means 
that the doctor records the essential data of a patient's 
medical history in accordance with standardized prin­
ciples so as to make the data intelligible to any other 
doctors consulted by the patient. AIM must not be 
31. 12. 87 Official Journal of the European Communities No C 356/11 
used to make medical histories more accessible to third 
parties, particularly administrations, insurers and 
employers, without regard for the patient's wishes. On 
the contrary, AIM should be expected to contribute to 
the improvement of data protection. 
2.2.1.4. There are therefore reservations about any 
use of AIM for monitoring purposes in the adminis­
tration of health care systems. This would give rise to 
the danger of total surveillance of the patient and his 
or her medical history. 
Furthermore, such a system of monitoring, necessarily 
based on standardized programmes, would force doc­
tors to move in the direction of standardized treatment 
and prescribing procedures. 
The needs to be met and the possibilities to be offered 
by services that administer medical and accounting data 
depend to a large extent on the individual national 
social security systems; they cannot therefore be 
reduced to a common formula. 
2.2.1.5. It should also be borne in mind that in many 
areas of medicine the use of apparatus has already 
gained the upper hand over the human factor. AIM 
should not encourage this trend. AIM should, rather, 
be expected to increase the scope for human caring in 
medicine through the carefully targetted use of diagnos­
tic and therapeutic techniques. 
2.2.1.6. In implementing AIM a balance has to be 
struck between information needs and transparency 
through data on the one hand, and humanity and data 
protection on the other. 
The way in which new technologies are applied is 
therefore of decisive importance. Any application of 
new technology carries with it the risk that the human 
personality will become a matter of only secondary 
importance in the search for perfection. This would 
have a particularly disastrous effect on health care. 
Therefore from the very beginning measures must be 
evolved for preventing such abuses and misuse of the 
new technology. These necessary safeguards, particu­
larly as regards data protection, must already be incor­
porated in the work programme for the pilot phase. 
The Commission proposal in its present form, however, 
has nothing specific on this point. 
Nor does the description of the project reveal precisely 
what information is to be covered by AIM. Like the 
specific data protection measures, this needs to be clari­
fied before the pilot phase is launched. 
2.3. Acceptance of the application of AIM 
2.3.1. AIM as a basis for action 
2.3.1.1. AIM can provide programmes which serve 
as a basis for further action by those involved in health care in the Member States. Uncoordinated, individual 
measures, which are generally inappropriate, must be 
replaced by a coordinated programme which (a) meets 
the technological requirements and (b) also ensures the 
necessary protection for patients by exercising self-
restraint as regards the technological possibilities. 
2.3.1.2. On the other hand, AIM cannot itself seek 
to reshape the national health systems. For this the 
existing differences are too great, in the decision-mak­
ing machinery of the national systems, in the orientation 
of national health and social policies, and in the 
national legal systems, with their highly diverging 
requirements for the protection of the patient's privacy. 
Involvement of the national health systems in manda­
tory application of the uniform AIM programme would 
bring about alignment of the health systems, but the 
situation is not yet ripe for this. Further detailed exam­
ination and consideration is therefore needed before a 
uniform regulatory framework is created. 
2.3.2. Information on AIM 
2.3.2.1. AIM can only be implemented effectively if 
it is accepted by those involved in health care, especially 
the patients and the medical staff. 
So far considerable reservations about new information 
technologies have been expressed by doctors, depending 
on specialization, age and social environment. A major 
factor here are the aforementioned risks to the individ­
ual nature of the treatment, to the doctor-patient 
relationship and to the protection of the patient's 
privacy. 
The health professions' national organizations need to 
be involved and persuaded of the project's importance. 
In addition, doctors should be given detailed infor­
mation on the possibilities, the objectives and the 
existing safeguards so as to win acceptance. 
2.3.2.2. The same applies to patients, who look for 
a highly personal service from their doctor and a 
relationship of trust with him. The introduction of 
technology into medicine is basically unlikely to 
strengthen this trust and to give patients the feeling that 
their individual needs are being taken into account. 
Here too, detailed information is needed which should 
be provided in large measure also by medical auxiliaries. 
2.3.2.3. Furthermore, it will only be possible to apply 
AIM on a wide scale if the necessary equipment is easy 
to operate and entails little or no cost to the user. 
In this connection one solution would be a scheme 
comparable to the French Minitel which could offer the 
possibility of a personal code accessible only to the 
No C 356/12 Official Journal of the European Communities 31. 12. 87 
patient and thereby meet the confidentiality require­
ments. 
3. Specific comments 
3.1. Article 1 (1) 
In view of the complexity of the problems a pilot phase 
of 18 months seems too short. Neither the acceptance 
of the project nor its possible effects on health care 
could be assessed during such a period. This phase 
can only be the preliminary to a continuing integrated 
action. 
It is therefore recommended that provision be made 
from the outset for an extension of the pilot phase. 
Depending on the results expected from the pilot phase, 
a period of at least two years should be provided for. 
3.2. Article 1 (2) 
3.2.1. Findings from existing projects should be util­
ized in the pilot phase only if they meet the conditions 
set out above and are appropriate for the European 
market. 
It remains unclear how the concertation with public 
and private actions is to be effected and how a selection 
is to be made from existing projects. 
3.2.2. Nor is it appropriate in the German version 
to speak of the' Anbieter' (offerers, suppliers) of medical 
services as the usual terminology of the marketplace 
does not apply to health care. It is recommended that 
the terminology be adapted accordingly. 
3.3. Article 3(1) 
3.3.1. If the work plan provides for the participation 
of experts it will be necessary to draw in particular on 
medical expertise and the knowledge accumulated in 
medical practice, pharmacy and hospital adminis­
tration. 
3.3.2. It is noted with approval that great importance 
is attached in the work plan to data protection. But 
precise details should be given from the outset regarding 
the data protection requirements and the provision of 
information on the project. 
3.4. Article 3 (3) 
Consideration should also be given to, in particular, 
organizations of health professionals and small and 
Done at Brussels, 18 November 1987. medium-sized enterprises (SME) when shared-costs 
contracts are awarded. 
However, expecting contractors to bear 50% of the 
cost of the project does not seem realistic, especially if 
the expertise of medical service providers and univer­
sities is to be used. At all events, expertise contributed 
should count towards the proportion of the costs to be 
borne by contractors. 
3.5. Article 3 (4) 
Here it is necessary to avoid giving preference to multi­
nationals. The requirement that the application must 
be made by parties from two countries is seen as an 
unnecessary restriction. The 'Committee' provided for 
should be given greater freedom in the selection of 
suitable applicants. 
3.6. Article 5 
There are doubts as to whether the proposed amount 
of 20 million ECU is realistic for such a complex and 
expensive project. This can surely only be an initial 
sum. 
3.7. Article 6 (2) 
The 'Committee' should be made up of people with the 
necessary expertise in the areas covered by AIM. Well-
balanced representation of the health professions and 
other interested groups (e.g. consumers, scientists, 
industry) should be ensured, possibly through the 
experts and/or advisors provided for. 
The views of the economic and social interest groups 
on all relevant questions must be given a fair hearing. 
It is not clear to what extent the work of the 'Com­
mittee' is to be confidential. Publication of the interim 
results of the work in the pilot phase could be conducive 
to public discussion and hence also to acceptance of 
the project. At least the Council should be able to keep 
abreast of the progress of work. 
3.8. Article 8 
As well as the Council and the European Parliament, 
the Economic and Social Committee must be informed 
about the results of the work. 
The Chairman 
of the Economic and Social Committee 
Alfons MARGOT