key: cord-0699122-29pt7tiw authors: Masic, Izet title: European Federation for Medical Informatics – the Most Influential Promoter of Medical Informatics Development for the Past 45 Years date: 2021-06-03 journal: Acta Inform Med DOI: 10.5455/aim.2021.29.80-93 sha: 05a9a7475216227cfbcaac19b1907440e23ebbd6 doc_id: 699122 cord_uid: 29pt7tiw Medical informatics, as much as it is a result of evolution as planned philosophy, have its roots in the history of information technology and medicine. Development of medical informatics started in the fifties of the 20th century. In the period after Second World War USA was the leading country in the field of Computer science and the leader in using the first computers in medicine and healthcare services. The development of information and communication technologies (ICT) during the last two decades of 20th century was particularly important for development of medical informatics, with great influence of Internet by medical professionals at every level of health care system. Comprehensive and essential contents on medical informatics, but also the aspects nurtured by the main „schools of Medical informatics“ - Anglo-Saxon (Abbot, Anderson, etc.), French (Gremy, Remond, etc.), German (Reichhertz). et al.), American (Collen, Green, et al.), Middle and East Europe (Dezelic, Masic, Zvarova, Naszlady, Mihalas, etc.), whose terms „Health Informatics“ (Abbot) and „Medical Informatics“ (Gremy and Reichertz) have entered the European and world medical literature. For those studying the subject or working in the field, the experiences of others who use Information and Communication Technologies (ICTs) for the better of health care can provide a necessary perspective. In promotion and spreading the knowledge and experiences of the medical informatics as scientific and academic discipline in the world, great impact was given by IMIA and its „branch associations“ at every continent. But, most influential association became European Federation for Medical Informatics (EFMI), established on September 11th 1976 in Copenhagen with members of 10 national representatives (Barry Barber (UK), Antonio Perens de Talens (Italy), Francois Grémy (France), Rolf Hansen (Norway), Mogens Jorgensen (Denmark), Hans Peterson (Sweden), Peter Leo Reichertz (Germany), Jan Roukens (Netherlands), Jan van Egmond (Belgium) and Ilkka Vaananen (Finland) who adopted Statute of EFMI and other documents and prepared the first MIE Conference in Cambridge (UK) in 1978. Today EFMI represent leading European medical informatics professional organization representing 28 European countries and institutional members. EFMI is organized as a non-profit organization concerned with the theory and practice of Information Science and Technology within the Health and Health Sciences sector, in a European context. The goals set of EFMI are: a) To advance international co-operation and dissemination of information in Medical Informatics on a European basis; b) To promote high standards in the application of medical informatics; c) To promote research and development in medical informatics; d) To encourage high standards in education in medical informatics; and e) To function as the autonomous European Regional Council of IMIA. Author of this article described the facts about important events which EFMI, with contribution of national societies, members of EFMI, organized during 45 years of existence, including important facts about the influential medical informatics experts. Finally, author shortly described important facts about history of development of Health informatics in Bosnia and Herzegovina and South-Eastern Europe, including facts about his activities during long period of his participation in IMIA General Assembly and EFMI Council. There he was very actively involved in a lot of activities, including organization of 22nd MIE Conference in Sarajevo in 2009. The European Federation for Medical Informatics (EFMI) (1) (2) (3) (4) (5) is the leading organisation in medical informatics in Europe and represents 28 countries. EFMI is organized as a nonprofit organisation concerned with the theory and practice of Information Science and Technology within Health and Health Science in a European context. All European countries are entitled to be represented in EFMI by a suitable Medical Informatics Society. The term Medical informatics is used to include the whole spectrum of Health/Public health Informatics and all disciplines concerned with Health/Socialcare and Informatics (1) (2) (3) (4) (5) . Development of Medical informatics started in the fifties of the 20th century. In the period after Second World War USA was the leading country in the field of Computer science and the leader of using the first computers in medicine and healthcare services. The development of information and communication technologies (ICTs) during the last two decades of 20th century was particularly important for developmnt of Medical informatics, with great influence of Internet by medical professionals at every level of health care systems. Internet caused a new information revolution since medical information became available to the public and ceased to be in exclusive control of health professionals. The development and global spreading of ICT brought also new medical fields, interdisciplinary connected to medical informatics: telematics, telemedicine, teleducation, and cybermedicine. Auerbach L, USA, on behalf of the American Federation of Information Processing Societies sent in the year 1957 proposal to UNESCO to sponsor one international conference on information processing. The conference on Information processing was held in 1959 in Paris with 1800 participants from 37 countries. Representatives of some national societies had submitted statutes and sent them out to the national societies and had them approved. A provisional executive with Mr. Auerbach and Academician Anatol A. Doron-icyn, Union of Socialist Republics was elected. (1-3. The first council meeting was held in Rome in June 1960 and that is the beginning of the International Federation for Information Processing (IFIP). Already at that meeting 15 countries were members: Belgium, Canada, Czechoslovakia, Denmark, Finland, Germany, Japan, The Netherlands, Spain, Sweden, Switzerland, the Union of Soviet Socialist Republics, United Kingdom and United States of America. Mr. Auerbach (USA) was elected as President, Professor Alwin Walter (Germany) was elected as Vice-president and Dr. Ambrose Speiser (Swit- Germany) was Chair of Publication Committee. One year after the MEDINFO Congress in Stockholm (1974) (Chair of SPC was Professor John Anderson, UK), several European Medical informatics societies started with establishing of European Federation for Medical Informatics (EFMI). There were three persons that in 1975 had the first discussions and they were Jan Roukens (Holland), Jan van Egmond (Belgium) and Mogens Jorgensen (Denmark). They started to write Statute and discuss these with a few other interested representatives from other European countries. These persons were called the Preliminary Executive Group (PEG) and they held a meeting in Paris in June, 1976, where they decided to invite all known European societies to be represented at a constituent meeting of the Federation of the European Medical Informatics Societies. It was proposed that one delegate with voting right from each Society be present in Copenhagen on September 10 and 11, 1976. On September [10] [11] 1976 in Copenhagen at the Office for Europe of the World Health Organization, hosted by M. Sedeuilh and Albert Weber, representatives of ten national Medical informatics societies (Barry Barber (UK), Antonio Perens de Talens (Italy), Francois Grémy (France), Rolf Hansen (Norway), Mogens Jorgensen (Denmark), Hans Peterson (Sweden), Peter Leo Reichertz (Germany), Jan Roukens (Holland), Jan van Egmond (Belgium) and Ilkka Vaananen (Finland) adopted the Statute of the European Federation for Medical Informatics (EFMI) ( Figure 1 ). As the first Presidency of EFMI (Executive board) were elected: Antoine Remond (France), as a chairman, Barry Barber (UK), as secretary and Peter Leo Reichertz (FR Germany), as treasurer (1, 2) . The objectives of EFMI are (1-3): a) advance international co-operation and dissemination of information; b) promote research and development; c) promote high standards in the application; d) encourage high standards in education in this field; e) EFMI publishes scientific papers from its conferences in EFMI official journals. Today EFMI is the leading nonprofit organization in biomedical and health informatics in Europe. EFMI comprises 28 national societies and includes an exceptional network of experts and stakeholders in health, care, IT and its societal dimensions; supported by 14 topic working groups ranging from human factors, to security and translational health informatics (5) . EFMI has two governing bodies: FMI Executive Board (President, Vice-President WGs, Vice-President IMIA, Secretary, Treasurer, Executive officer, Publication officer, Institutional members officer) and the EFMI Council. Council members represent national societies and WGs. Former Presidents of EFMI during past 45 years are presented in Figure 2 . EFMI has a long tradition in working groups (WG) which are organising and supporting events and projects on a European basis but also worldwide in close co-operation with national and international WGs and institutions. EFMI Working Groups are: EDU -Education, EHR -Electronic Health Records, EVAL -Assessment of Health Information Systems, HIIC -Health Informatics for Interregional Cooperation, HIME -Health Information Management Europe, HOFMI -Human and Organisational Factors of Medical Informatics, IDeS -Information and Decision Support in Biomedicine and Health Care, LIFOSS -Libre/Free and Open Source Software, NI -Nursing Informatics, PCI -Primary Health Care Informatics, PPD -Personal Portable Devices, SSE -Security, Safety and Ethics, MIP -Medical Image Processing, THI -Translational Health Informatics, CHD -Citizen and Health Data, and yEFMI -Young EFMI. To advance its mission, EFMI started organizing the Med- EFMI Special Topic Conferences (STC) are typically 2-day events organized by member societies with 100+ participants in conjunction with their annual meeting, on a topic pertise to the multidisciplinary, health IT community and to policy makers, enables the transformation of healthcare in accord with the world-wide vision of improving the health of the world population. EFMI is constantly striving to further the services it provides to its members and the informatics community in general by promoting free interaction among and between its member network and the bio-medical and health informatics community at large. During past period EFMI Council has been elected 31 Fellows as most influential Medical informatics experts for their contribution in development of this academic and scientific field (3). In alphabetical order EFMI Honorary Fellows are: Abbott "Bud" William In the year 2015, during MIE conference in Madrid, the EFMI Council approved the establishment of a Medical Informatics Award of Excellence named "Leo Peter Reichertz Young Scientist's Award" and "Rolf Hansen Memorial Award" to be given to an individual, whose personal commitment and dedication to medical informatics has made a lasting contribution to medicine and healthcare through her or his achievements in research, education, development or applications in the field of medical informatics. Also, during MIE conferences Mantas' Prize for Best Paper on Education in Biomedical and Health Informatics is giving to presenter for "Outstanding paper about Education in Biomedical and Health Informatic" (37). In considering a 'history' of Medical/Health Informatics it is important to be aware that the discipline encompasses a wide array of activities, products, research and theories. Medical nformatics is as much a result of evolution as planned philosophy, having its roots in the histories of information technology and medicine. The process of its growth continues so that today's work is tomorrow's history. A 'historical' discussion of the area is its history to date, a report rather than a summation. As well as its successes, the history of Health Informatics is populated with visionary promises that have failed to materialise despite the best intentions. For those studying the subject or working in the field, the experiences of others' use of Information Technologies for the betterment of health care can provide a necessary perspective. In promotion and spreading out of knowledge and experiences of the Medical informatics as scientific and academic discipline in the world great impact was given by IMIA and EFMI associations and its members. The most important EFMI publication, indexed in Medline is Studies in Health Technology and Informatics, which publishes papers presented at MIE Conferences. EFMI also publishes several sub-specialty official journals covering the spectrum of medical informatics subdisciplines. Currently, EFMI has three officially endorsed general journals (Figure 4) , Methods of Information in Medicine, International Journal of Medical Informatics and Acta Informatica Medica. Until the year 2020 official journal of EFMI was also International Journal of Biomedical Informatics (EJBI), but excluded this year. From the year 2020 EFMI started to pubish EFMI Inside magazine. Through its work, EFMI provides leadership and expertise to the multidisciplinary, health IT community and to policy makers, enables the transformation of healthcare in accord with the world-wide vision of improving the health of the world population (9) (10) (11) (12) . EFMI is constantly striving to further the services it provides to its members and the informatics community in general by promoting free interaction among and between its member network and the bio-medical and health informatics community at large. During past period EFMI Council has been elected 31 Fellows as most influential Medical informatics experts for their contribution in development of this academic and scientific field (3). In alphabetical order EFMI Honorary Fellows are ( In the year 2015, during MIE conference in Madrid, the EFMI Council approved the establishment of a Medical Informatics Award of Excellence named "Leo Peter Reichertz Young Scientist's Award" and "Rolf Hansen Memorial Award" to be given to an individual, whose personal commitment and dedication to medical informatics has made a lasting contribution to medicine and healthcare through her or his achievements in research, education, development or applications in the field of medical informatics. Also, during MIE conferences Mantas' Prize for Best Paper on Education in Biomedical and Health Informatics is giving to presenter for "Outstanding paper about Education in Biomedical and Health Informatics". From the 1974 automatic analysis of health data in health care institutions in Bosnia and Herzegovina was introduced gradually thanks to the engagement of Fuad Sacirbegovic director of Department for Statistics of the Federal Public Health Institute, Serstnev, whose heritage is on the same position. From 1977 Institute has published annual reviews and summary health statistics reports in BiH and utilization of health capacities under the title "Network, capacities and services of health institutions in BiH". Initiation, development and implementation of some in- Second level, informatics education of this level is in regard to med-• ical staff which was directly involved in collection, manipulation, analysis and interpretation of health data. This kind of education was expanded with skills, knowledge and practical applications which are necessary for personnel on this level. The Third level is basically a very wide and highly specialized education for experts in the health sector who would like to be professionally involved in this kind of work. In B&H there has never been an accepted proposal for introducing sub-specialization from medical informatics in spite of the fact that authors of this paper put a lot of effort and energy into making it official. It is a fact that at some universities in European countries there are separate faculties or universities for graduates withthe title of engineers of health informatics. There are five medical faculties in Bosnia and Herzegovina (Sarajevo, established in 1946; Tuzla, established in 1976; Banja Luka, established formatics activities, such as automatic manipulation of health data and intensive use of information technologies for the need of diagnostics, therapy and patient rehabilitation on the all levels of healthcare in BiH health system started to be solved systematically in the end of seventies and in beginning of eighties. Crucial decision at state level was in 1981, when BiH government brought decision to start with work on the project "Development of BiH Health Information System -HISBiH". Before the project, the study/analysis "Social-economical position of the health system in BiH" was conducted. Based on that BiH Parliament approved preparation of appropriate project which should have made possible modernization of the information system of health care. Basically, this project should modernize and create automatic, well developed and functional health statistics system in Bosnia and Herzegovina which was part of also well organized (centralized) Yugoslavian health statistics system lead by the State Public Health Institute in Belgrade. Project "Development of information system of health care in BiH within circumstances of electronic data manipulation" was approved by Executive Board of Association of healthcare communities BiH (National Committee with multidisciplinary members: MDs, statisticians, electro and mechanical engineers, economists and was chaired by myself). In 1985, after positive assessments, the revisions of the project were adopted and its implementation began after financial funds were ensured. Implementation started in 1986 and it was planned to be Concept of centralization of data manipulation in the architecture proposed in HIS BiH project (central host and analysis in Sarajevo, regional analysis in eight centers in BiH and local in 109 municipalities) but it has never been finalized and failed. The true is that some of designed activities were started on institutional level, but never reached finish as Clinical information system of the University Clinical Center in Sarajevo, which was one of the biggest projects in area of development and construction of Health Information Systems. Unfortunately, during wartime 1992-1995 in BiH in regard to the procurement of hardware and production of software applications has never been completed and implemented in practice. As young physician, who was graduated at Faculty of med-icine at University of Sarajevo in the same year when EFMI was established (1976) I have been involved in project for revision of official system of medical documentation of current Health Statistical System in BiH, as a part of Federal Health Statistical System regulated on national level by Federal Government in Belgrade. The system was recognizable in Europe with its structure, content, organization and utility with very well designed "information flow" of medical data at every level of health care service (collecting, processing, evaluation, storage, using for decision making, etc.) in family practice, out-patients' clinics, general and special hospitals and university clinics. The time from primary collected data at every working place in health care system until final storage at in Department for statistics of WHO in Geneva was less than one year, it means it was very prompt and useful method and way for decision makers. But it was very huge and "paper based oriented" and health professionals were very occupied with data collecting and processing. We need to mention that one of founders of WHO and the first President of General Assembly of WHO in 1948 was Academician Andrija Stampar from our country and several directors of Department for Statistics and Informatics of WHO were professors from former Yugoslavia (most of them Pubic health experts). The need for additional education of health professionals was realised after the first application of electronic data manipulation. For physicians in primary health care and in clinics, in order to perform their duties in a high quality manner, must have been up to date with the latest accomplishments in medicine and health. Since the 60's the development of information technologies has had a quantitative and qualitative growth especially in diagnostics and therapy, and health workers had to follow that. The International Federation for Information Processing (IFIP) in the early 60's organized expert teams whose task was to develop strategy, concepts and content of under and postgraduate medical education. At a These are already mentioned facts which I published in interview with Professor Dezelic and explained important events regarding establishing and implementation of Health Informatics in Former Yugoslavia, but also in South-East Europe. I must describe some important points about development of Medical informatics and influence of our influential persons, not only from former Yugoslavia, because in the past very few experts in this field were mentioned as important persons who created strategy, tactic and operational activities in all kinds of Health and Medical informatics, not only in the Europe, even worldwide. Unfortunately, not so many of them became engaged in managing structure of EFMI and IMIA in the past (as presidents of IMIA or EFMI) besides very hard and effective influences od development of those associations. But, readers need to know that our students of Biomedical faculties have possibilities to learn the same subjects and contents of Heath informatics at Universities in former Yugoslavia as in US, UK, Germany, France, etc. because in that time we have had one of the best educational system in the world, also one of the best organized health care system in the world, which produced very qualitative products in all kind of industry, economy, education, etc. especially in Africa and Middle East, educated students from undeveloped countries, because president of former Yugoslavia, Tito chaired more than 100 countries ("The Nonaligned Movement /The Block of Independent Countries"). Interesting fact is that in 1984, Energoinvest Company in Sarajevo produced computers (IRIS 16 and IRIS 32), led by Academician Bozo Matic and his team (he was Director of "Energoinvest" company, also, President of Academy of Sciences and Arts of BiH, and Rector of Sarajevo University) where his team of experts in 1977 worked on projects on biological robotics and produced "biological prosthesis", etc. One of my projects was creating "Family Registration Card" as "Medical Record Linkage" in Primary healthcare system for collection and depositing "minimal data sets" on electronic cards, as optimum of data processing and storage medical data for quality assessment outcomes of MDs work in Primary Healthcare System protection ("all data about one patient stored at one place" and the stored data must be kept by family practitioner). It was my project to establish the first Local Information System in BiH for Family medicine practice. Unfortunately, war in our country (1992-1995) stopped all those projects. For education of Medical informatics subject, academician professor Dezelic (1931-), as pioneer of Medical informatics in former South-East Europe, established almost all Cathedras at universities in former Yugoslavia, From such formulations it clearly follows that the terms "Medical informatics" and "Health informatics" were considered synonymous, but in the former Yugoslavia areas (with a socialist society organization, in which there was no private medical practice) the adjective "health" was preferred. With the appearance of the international associations, IMIA and EFMI, the name Medical Informatics finally prevailed in our country (recommendations by IMIA experts of WG for education). Gjuro Dezelic and three other professors: Stefan Adamic in Slovenia, Rajko Vukasinovic in Serbia and Izet Masic in Bosnia and Herzegovina in the late '80s of the last century formed Yugoslav Association of Medical informatics (YAMI) in 1989 in Osijek (Croatia) by the Republic Societies for Medical Informatics in Bosnia and Herzegovina, Croatia and Slovenia, and the Section for Medical Informatics within the Serbian Medical Society (1, (5) (6) (7) (8) . It was decided that the headquarters of YAMI would be in Zagreb, and Professor Dezelic was elected as president. Association for Medical Informatics -YAMI. YAMI organized the First MI Congress in Belgrade in 1990 (Figures 7 and 9) with an impressive participation of over 500 participants. This scientific meeting of MI left positive effects on the later development of MI in Europe and the World (11) . At the time of the 1990 MIE Congress in Glasgow at a meeting of the EFMI Council and the IMIA Annual Assembly, YAMI was admitted to the membership of both international medical informatics organizations, but this did not last long. Already at that time, Yugoslavia entered a period of political unrest that led to its disintegration. It should be noted here that after the wars against Slovenia and Croatia in September 1991, both MI associations -Slovenian and Croatian -withdraw from YAMI, followed by the MI association of Bosnia and Herzegovina a few months later. After the Republic of Croatia and other republics of the former Socialist Federative Republic of Yugoslavia (SFRJ) were internationally recognized in January 1992 and became members of the UN in May of the same year, the conditions were met for medical informatics associations of the former three Yugoslav republics -Bosnia and Herzegovina, Croatia and Slovenia -to become members of IMIA and EFMI. This happened during the 1992 MEDINFO Congress in Geneva (7), but oficially accepted Izet Masic as national representative of Bosnia and Herzegovina at EFMI Council in Lisbon, Portugal, during MIE '94 Conference ( Figure 10 ) . The worst time was for the Medical Informatics Society of Contributions to the History of Medical informatics. Avicena, Sarajevo Honorary Fellows of the European Federation for Medical Informatics Honorary Fellows of the International Association of Historical Backgrounf of EFMI in Development of The History of Medical Informatics Development -an Overview Former President of Yugoslav Medical Informatics Association of Medical Informatics, Former President of Croatian Society of Medical Informatics, EFMI Council member 1990-1992 After three decades of Medical Informatics Europe congresses. Stud Health Technol Inform History of Medical informatics in Europe-a short review by different approach Medical informatics-an interdisciplinary approach Medical Informatics in a United and Healthy Europe The History and New Trends of Medical Informatics Five Periods in Development of Medical Informatics History of Medical Informatics in Bosnia and Herzegovina. Avicena. Sarajevo Bosnia and Herzegovina (BHSMI) was, because the armed conflict lasted between March 1992 and November 1995, with the siege of the capital Sarajevo. But even in such a terrible situation, BHSMI, which I led, had a fruitful activity, amazing in such circumstances, managing to organize professional gatherings, produce numerous publications and launch the journal "Acta Informatica Medica" (www.actainformmed. org) (Figure 4 ). Cooperation with EFMI Medical informatics helped me in organization of these events in Sarajevo: in 1999 the First Congress of Medical Informatics, opened by Attila Naszlady, EFMI President, who helped me during wartime in BiH that BSMI became official member of EFMI ( Figure 11 In the post-war period, BHSMI organized national symposia and applied for the MIE Congress, which was held in 2009, and signed from a lot of participants of former MIE Conferences as "the best ever MIE". Much more about these facts described in this part of article could be read in my other articles and several books in the field of Medical Informatics (mentioned in the list of references at the end of the text). A few articles are published in two official EFMI journals: Acta Informatica Medica (indexed in PubMed) and EFMI Inside, both deposited on www.efmi.org) (7) .I will finish this small review about history of MI in BiH with words said by Gjuro Dezelic during opening of the MIE 2009 in Sarajevo in his keynote lecture: "We should consider the mandate to organize the MIE 2009 Congress in Sarajevo as the crown of all efforts of professor Masic efforts to get it for a long time… ". I added that the credit should be given to EFMI, which, by choosing Sarajevo, supported the construction of new medical, biomedical and health-information bridges between the western and eastern parts of the European world" and images which illustrates very important activities which helped to improve and use all achievements of Health/Medical/Biomedical informatics as scientific and academic disciplines and also in functioning of all segments of health protection at every level of healthcare systems. Health (medical) informatics as separate scientific discipline began to be effective in academic institutions in the end of seventies by presentation of actual accomplishments in this area in under and postgraduate education at biomedical faculties. During past forty five years of existing EFMI, as leader in the field of Medical informatics in Europe and worldwide, have had great influence on the development of Biomedicine as a science and as a academic discipline, especially to improve quality of the healtcare protection of population on every level of health care systems and and in every country in the world.• Acknowledgments: Author would like to thank to all colleagues from EFMI Council who helped to make this article more informative and ilustrative, especially to Gjuro Dezelic, Jacob Hofdijk, George Mihalas, • Author's contribution; Author was involved in all steps of preparation this article, including final proofreading:• Conflict of interest: None declared.• Financial support and sponsorship: Nil.