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.

Vol. for 2000 contains proceedings of the Medical Informatics Europe Congress and of the annual congress of the German Association for Medical Informatics, Biometry and Epidemiology (GMDS).

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.

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.

These proceedings reflect the major scientific contribution by the First International Congress of the European Federation for Medical Informatics. The European Federation for Medical Informatics is a co-operative venture between the National Informatics Societies of Europe. It is sponsoring this first inter national meeting organised by the Medical Specialist Groups of the British Society under the guidance of a European Scientific Programme Committee. The challenge of medical informatics has been well taken and the scientific papers by its members cover a wide range of topics dealing with medical records, laboratory investigation, indexing and administrative systems, nursing records, planning and administration modelling, data bases, text processing, transferability, user education, privacy, etc. Not published in this volume are presentations by industry about hardware and software. Also at the meeting there will-be teaching sessions for doctors, nurses, scientists and administrators who are just entering this field which are also not published. Medical informatics has established itself as an important area of medical activity and its growing application, as this conference illustrates, suggests a very rich potential for the future. Aids to medical decision making and modelling are newer areas of activity, where significant progress has been made. Sociological changes have taken place to meet this challenge and developments in the issues of privacy and confidentiality are important, as also are user education, and the teaching of medical informatics to medical students and to doctors.

This volume seeks to reflect the state of the art on medical informatics. It presents ideas that will guide the process of medical informatics. Topics in the book include: information systems in health care and medicine; telemedicine and telematics; security; biomedical processing, data mining and knowledge discovery; training and education; Internet/intranet; resources management; intelligent medical systems; health guidelines and protocols; electronic patient encounter, card technology, electronic data interchange; terminology; nursing informatics.

The 33rd Annual Meeting of the German Association for Medical Documentation, Informatics and Statistics was combined with a Special Topic Conference of the European Federation for Medical Informatics and takes place at Hannover, F. R. of Germany, from September 26 to 29, 1988. It was planned and initililly prepared by the late Prof. P. L Reichertz, who headed the Hannover institute from 1969 to 1987. To commemorate his contribution to the development of medicine the conference was devoted to him "Peter Reichertz Memorial Conference on Expert Systems and Decision Support in Medicine" Since computers in the early Fifties were first applied to support medical reasoning, various phases of euphoria and resi~ation have . followed. Every new methodology which became technically possible was and will be applied to the old questlon of how to diagnose diseases more reliably. Artificial Intelligence is just one new approach to the old challenge. Over the years some· authors have been very optimistic and put forward opinions which motivated the common press to coin the phrase 'Dr. med. computer'. Papers printed under this heading rebuffed the majority of physiCians for many years. Today we know that medical decision making is a most complex buman performance. And 30 years of research on decision support have given us only limited insight into the underlying processes. Most of the principal methodological questions were already asked very early on.

First multi-year cumulation covers six years: 1965-70.