The European Federation for Medical Informatics is a regional coordinat ing body. The Congress in Dublin. MIE 82. from 21st to 25th March 1982. is the fourth in the series following MIE 78 in Cambridge. MIE 79 in Berlin. There was a break in 1980 for the World Congress - MEDINFO 8- in Tokyo. This was followed by MIE 81 in Toulouse. The rationale behind these congresses is the scientific need to share results and ideas. and the educational need to train a wide variety of professional staff in the potential of Medical Informatics in health care delivery. All the caring professions are involved. doctors. scientists. nurses. pharma cists. paramedical staff. administrators. health care planners. commu nity physicj-US'I,!Dedical educationalists. epidemiologists. statisti cians. o. pe-~atio'ns 'analysts. together with specialists from the comput ing profession dealin~ with systems analysis. hardware. software. lan guages. data ba, s~s and marketing of systems. The pre-publi~~tion of'conference proceedings from a multi-stream con ference is partic~l~t~y valuable in a rapidly expanding multidisciplin ary field su~h as'M~dical Informatics. It enables participants to fol low work presented at sessions that they are unable to attend. More im portantly. is also provides a permanent record with relevant bibliogra phy for other workers to assess which groups are active and in which areas. All the papers have been refereed and the referees' suggestions incorporated in the final texts. Rapid publication. using camera-ready copy. reduces the time available for editing and indexing.

This volume contains the proceedings of the Tenth International Congress on Medical Informatics, MIE 91, that will be held in Vienna, Austria, August 19-22, 1991. The MIE 91 Congress was organized by the European Federation for Medical Informatics (EFMI) in cooperation with the Austrian Computer Society (OCG) and the Austrian Society for Biomedi cal Engineering (OGBMT). It follows the previous congresses in Cambridge (1978), Berlin (1979), Toulouse (1981), Dublin (1982), Brussels (1984), Helsinki (1985), Rome (1987), Oslo (1988), and the Congress 1990 in Glasgow. The proceedings contain 199 contributions to the MIE 91 Congress. They cover all presentations which are part of the scientific programme of MIE 91, among them 157 paper presentations with an average of five pages, 28 poster presentations again with an average of five pages, and 14 abstracts of demonstrations with an average of one page. The papers included were selected by an International Programme Committee out of over 300 submissions after careful review by at least two international reviewers (for whose estimable efforts we are especially thankful). The recommendations of the re viewers were incorporated in the final texts. Some papers were reworked by a professional translator to obtain a high quality of presentation. Several submissions could not be considered for presenta tion at MIE 91 because of shortage of congress time and limitations in the number of pages of the proceedings.

The European Federation for Medical Informatics (EFMI) is a regional coordinating body for the National Informatics Societies of Europe. EFMI has organized a number of congresses. The Congresses in Cambridge 1978, Berlin 1979, Toulouse 1981, Dublin 1982 and Brussels 1984 were all successful in providing the wide variety of people in the caring and specialists in the computing profession with up-to-date inform ation from the expanding multidisciplinary field of medical inform atics. We hope that the sixth European Congress on Medical Informatics, MIE-85 in Helsinki will be equally successful. You have in your hand the pre-publication of papers to be presented at MIE-85 as well as the short abstracts of the posters. The proceed ings enable the participants to follow work presented at sessions that they are unable to attend. It also provides a permanent record with relevant bibliography for workers in the field of medical com puting. All the papers have been refereed and the referees' suggest ions incorporated in the final text. Rapid publication, using camera ready paper, reduces the time required for editing and indexing. The editorial board has worked hard to improve the standard of the communications and to reduce the number of errors. Very few papers did not arrive in time to be included in the proceedings: these are marked with * in the table of contents.

The software has been developed in Smalltalk80 [1] on SUN and Apple Macintosh computers. Smalltalk80 is an object-oriented programming system which permits rapid prototyping. The need for prototyping in the specification of general practitioner systems was highlighted as long ago as 1980 [4] and is essential to the user -centred philosophy of the project. The goal is a hardware independent system usable on any equipment capable of supporting an integrated environment for handling both textual and graphics and 'point and select' interaction. The architecture is extensible and provides a platform for future experimention with technical advances such as touch screens and voice technology. User Interface Management Systems (UIMS) technology is developing rapidly offering a number of techniques which allow the abstract design of the interface to be separated from the screen/display management on one hand and the internal workings of the application on the other. [2] The importance of this 'layered' approach is that such techniques enable the user to tailor the application to his/her individual preferences and the design team has included and developed many of these ideas into the design. 7. Conclusion: Value Added to Health.

The European Federation for Medical Informatics has established itself as a regional body coordinating activity in medical informatics. The Congress in Toulouse, MIE-81, from 9 - 13 March 1981, is the third congress in the ser ies following MIE-78 in Cambr idge, and MIB-79 in Berlin with a gap during 1980 for the world congress MEDINFO-80 in Tokyo. The rationale behind all these congresses is the scientific need to share results and ideas and the educational need to train a wide variety of professional staff in the potential of health care and medical informatics. All the caring professions are involved, doctors, scientists, nurses, para-medical staff, administrators, health care planners, community physicians, epidemiologists, statisticians, operations analysts together with specialists from the computing profession dealing with system analysis, hardware, software, languages, data-bases and the marketing of systems. Medical Informatics is a very wide subject with ramifications throughout the health care and preventive services; it offers a key to the monitoring and improvement of patient care and to the provision of a healthier environment. The collection and evaluation of relevant data improves our understanding of the ways in which health care is provided while the availability of cheaper computer hardware and more versatile software enables us to design and implement more revealing and intelligent medical systems. Even though typical systems take a substantial amount of time to design, implement and evaluate, there is the continuing need for informaticians to assess the current state of developmen.

Europe faces a challenge: how to apply information and communication technologies to health care. One problem is the widening gap between the expectations of citizens and the limited resources available to provide health services. It is here that advanced technology can serve as an important tool to find innovative and more efficient ways of delivering health services. This book reports the summary of a study performed under contract by a team of consultants for Directorate-General XIII of the Commission of the European Communities. It analyses the key factors governing the evolution of advanced information systems for health care and medicine in Europe and provides guidelines for placing current and future work within the framework of the Community research and development programmes.