The University of Rome has been the first to create a telemedicine committee in 1976. At the same time the Fondazione Marconi and the University of Bologna realized an electrocardiograph (Ecg)

remote sensing prototype without any physician concurring. In 1976 too the Cselt (Telecommunications Institute of Studies and Laboratories) starts a research about the transmission required by a first aid, putting into effect a series of experimental services together with Sip (see “Leadership Medica”, n. 1/85 and 7/86). In 1983, a national program concerning a telemedicine research joined to public and private costs reduction research is launched. But it is abandoned for lack of financing. Two years later an important project of hospital remote consultation, the Telecos, is accepted by the ministry of health and put into effect in collaboration with Sip and some hospitals allowing the connection of twenty centres (among which seven were specialized) of three Italian regions. The experimentation lasted from May 1987 to April 1989, first involving oncology, orthopaedics, radiology and nephrology. In 1990, a telemedicine committee is constituted by the Ministry of the University and Scientific Research (with 100 billions financing) introducing a new sector program. The purpose is to settle some priority interventions

and to foster scientific and productive competencies and furthermore to reorganise and make more efficient the health system. This aim three intervention areas are focalized: management, health and social. The first to deal with the problems related to the hospital structures running (administrative and logistic) and to foster the health acknowledgements among the medical and no-skilled personnel and population. The second intervention area regards diagnostics and therapy processes. Some sectors particularity fitted for the experimentation of telematics systems are individuated both to be employed inside hospitals and to monitor territory, and extra-hospital therapy. Concerning the first they are mainly oriented to cardiology wards and services requiring images. The second one was directed to high-risk patients that can be monitored at home (for example cardiopaths) and to control home therapies (dialysis, perinatal medicine and oncology). The last one, the social field, aims to realize telematics systems to foster the disabled person integration. Communication aids are strongly researched for sensorial and motor disabilities.

Besides the telemedicine national program, since the eighties the regions manage the computerization of the Usl and they have this way control instruments over the health system. In Lombardy, Friuli-Venezia Giulia and Piemonte, for example, solutions supplied by regional informatics companies are provided incentives for. Till 1993, anyhow, the computerization of Usl is limited to applications interesting a little the management field and they are not employed as real instruments of governing. The reform law 502/93 by turning the Usl into Asl (Local health enterprise) and hospital into Ao (Hospital enterprises), often a clustered structure in the same territory, allow bettering the computerization of the National Health System. But few hospitals have a

net service integrated system. Many firms are developing telemedicine technologies since the 503 law will compel Asl and Ao managers and boards of directors to adopt informatics solutions in order to contain costs and to optimize their own structure running. Even if the health telematic service lacks of homogeneity some teleaid applications have had wide diffusion in Italy. The most successful experiences and technologies concern telecardiology, teleradiology, diabetology, transtelephonic spirometry, telepathology, teledialysis, home oxygen therapy monitoring, emergency, risk pregnancy home monitoring of and those related to multifunction equipment (Ecg, spirometry, oxymetry). In the next five years it's foreseeable the development of further

applications in remote histopathology, teledermatology, territory and home telemonitoring, permanent medical instruction. Computerized case sheet, administrative networks and integrate radiology nets will be created with devices in radiology, dermatology and pathology wards. Till now the sector where telemedicine is most employed is surely telecardiology based on the distance transmission of the electrocardiograph input by the means of a telephone line. The Aiim (Medical Informatics Italian Association) is one of the first medical-university structures to outline some guidelines for telemedicine by the means of a pool of physicians, technicians and engineers. By analysing some data coming from one of telecardiology centres it emerges some interesting elements (see table). The analysis have been carried out on a sample of 2.000 family doctors referring to 28117 patients (14.340 males e 13.377 females) with a 61 years old average in a period from April 3rd 1995 to March 30th 1999. On 30.300 reported Ecg, 60% (18.180) was normal; the 38% (11.514) showed electrocardiograph alteration and in 606 cases (2%), 190 of which were infarctions in course, it was necessary admission to hospital. Among more frequent pathologies alteration of morphology (4.050), tachyarrhythmia (2.929) and conduction disturbs (2.055). [See graph]

A cura di TIMED

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