Delivery of healthcare services over mobile phones: e-Vital and CHS paradigms.

Health delivery practices are shifting towards home care, since there are better possibilities for managing chronic care, controlling health delivery costs, increasing quality of life and quality of health services and the distinct possibility of predicting and thus avoiding serious complications. Mobility brings a totally new dimension to the healthcare domain and to the whole interdisciplinary provision of regional healthcare. Healthcare services can be provided in virtually any location, where access to a mobile communications system is available. Mobile tele-health systems apply mobility as a potential means in order to bring significant improvements to emergency, treatment, routine check-ups and medical consultation, e-Vital project (eTen) and CHS project (IST) worked towards m-health applications.

Continuous home care monitoring services through INTERLIFE.

INTERLIFE is a revolutionary product that can radically change the way healthcare services are offered by introducing new means for quality health care management by the healthcare providers, and by improving the patients', health providers' and citizens' quality of life. INTERLIFE is a technological and medical knowledge management and processing infrastructure able to support an early discharge and a continuous home monitoring service thus leading to reduction hospitalisation rates and to the increased efficacy of healthcare service delivery of patients suffering from chronic diseases such as CHF, COPD and Diabetes as well as a special category of acute health care related patients. Six test sites are participating in the validation trials, more specifically EAP Sardenya and MUTUAM in Spain, Hippokrateion Hospital and AHEPA Hospital in Greece, RAMIT in Belgium and University of Regensburg Medical Centre in Germany.

SENSATION remote monitoring system for enabling the "anytime, anywhere" monitoring of patients with selected sleep disorders.

The SENSATION Integrated Project aims at promoting the health, safety and quality of life of people and protect the environment by reducing relevant accidents and thus the impact on environment through the application of novel micro and nano sensors and related technologies, of low-cost and high-efficiency, for physiological state monitoring. The focus of the work will be the brain activity, including the sleep and wakefulness states and their boundaries, stress, inattention and hypovigilance states, for hypovigilance detection, prediction and management as well as diagnosis, treatment and remote monitoring of sleep disorders. In this paper, a presentation of the application scenarios of the integrated medical system will be made.

Healthcare services towards individualised wellness (i-wellness).

Information technology applications in medicine are rapidly expanding, and new methods and solutions are evolving since they are considered pivotal in the success of preventive medicine. In this paper two different concepts will be presented, the PANACEIA-iTV and the e-Vital concept. PANACEIA-iTV is a home care service provision system based on interactive TV technology and supported by the IST programme of the European Commission. The e-Vital service, supported by the eTEN programme of the European Commission, regards an integrated homecare and telemonitoring service chain aimed at large sensitive parts of the European population, the "at-risk" citizens. Both concepts developed a generic, flexible and adaptable framework for the combination of heterogeneous information sources and the creation of the individualised wellness (i-wellness) profile for prognostic purposes and early intervention.

Citizen centered health and lifestyle management via interactive TV: The PANACEIA-ITV health system.

In the context of an IST European project with acronym PANACEIA-ITV, a home care service provisioning system is described, based on interactive TV technology. The purpose of PANACEIA-ITV is to facilitate essential lifestyle changes and to promote compliance with scientifically sound self-care recommendations, through the application of interactive digital television for family health maintenance. The means to achieve these goals are based on technological, health services and business models. PANACEIA-ITV is looking for communication of monitoring micro-devices with I-TV set-top-boxes using infrared technology, and embodiment of analogous H/W and S/W in the I-TV set-top-boxes. Intelligent agents are used to regulate data flow, user queries as well as service provisions from and to the household through the satellite digital platform, the portal and the back-end decision support mechanisms, using predominantly the Active Service Provision (ASP) model. Moreover, interactive digital TV services are developed for the delivery of health care in the home care environment.

Medical support system for continuation of care based on XML web technology.

In this paper, the implementation of an Internet-based telematic service for medical support is presented, which was developed and operated in pilot form within the INTRANET HEALTH CLINIC project--a 2-year project supported by the European Commission under the Health Telematics Programme. The aim of the application is to offer high quality care to users of health services over inexpensive communication pathways, using Internet-based, interactive communication tools, like remote access to medical records and transmission of multimedia information. The XML technology was employed to achieve customised views on patient data, according to the access rights of different user profiles. Strict security and access control policy were implemented to ensure secure transmission of medical data through the Internet. The system was designed to collaborate with existing clinical patient record systems and to be adjustable to different medical applications. Current implementations include the fields of Oncology, Lupus Erythrematosis, Obstetrics and Chronic Obstructive Pulmonary disease. The results of the pilot operation with oncological patients in Greece were encouraging, so that the refining of the system and its expansion to a large number of patients is already in progress.

Utilising multimedia for training merchant mariners as paramedics.

MERMAID is a telemedicine project with global reach and a 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model is not limited to medical diagnostics but it encompasses all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications are considered while the full range of network choices is explored in terms of the cost/performance tradeoffs inherent to them and the developmental stage each of these options occupies in its life cycle. MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialty care best suited to each particular case. Finally, the development of programme modules for training and education of the seafarers in the use of the MERMAID medical communications system is given top priority as such modules constitute the firmest basis for the promotion of proper practice of telemedicine at sea.

Intranet health clinic: Web-based medical support services employing XML.

In this paper, the implementation of an Internet-based telematic service for medical support is presented, which operates in pilot form within the INTRANET HEALTH CLINIC project--a two-year project supported by the European Commission under the Health Telematics Programme. The aim of the application is to offer high quality care to users of health services over inexpensive communication pathways, using Internet-based, interactive communication tools, like remote access to medical records and transmission of multimedia information. The XML technology was employed to achieve customised views on patient data, according to the access rights of different users. Strict security and access control policy were implemented to ensure secure transmission of medical data through the Internet. The system is designed to collaborate with existing clinical patient record systems and to be adjustable to different medical applications. Current pilot implementations are under clinical evaluation and include oncological patients (Greece), Lupus Erythrematosis (Canada), Obstetrics (Belgium) and Chronic Obstructive Pulmonary disease (Spain).

Medical emergency aid through telematics: design, implementation guidelines and analysis of user requirements for the MERMAID project.

MERMAID is an EU financed telemedicine project with global reach and 24-h, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) are considered while the full range of network choices (digital land lines, cellular/wireless, satellite and broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

A convincing case for the provision of telemedicine services to ocean going vessels: the MERMAID paradigm.

MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) are considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental state each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Relief for maritime medical emergencies through telematics.

MERMAID is a European Union (EU)-financed maritime telemedicine project with global reach and 24-h multilingual capability, so as to serve multinational crews working in the isolation of the world's oceans. It provides a model for the provision of healthcare services based on the electronic transmission of medical information via ISDN-based video conferencing. This model is not limited to medical diagnostics, but it encompasses all cases in which the actual delivery of healthcare services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an extensive telecommunications infrastructure that includes both satellite transmission for ship to shore communication and an extensive ground-based network for summoning expert medical help from around the world so as to meet the project's multilinguality requirements and, therefore, the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low-, medium-, and high-bandwidth data requirements) are considered, while the full range of network choices (digital land lines, cellular/wireless, satellite, and broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their lifecycle. Finally, out of that, MERMAID utilizes advanced land-based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

ATTRACT--applications in telemedicine taking rapid advantage of cable television network evolution.

ATTRACT is a project that intends to provide telemedicine services over Cable Television Networks. ATTRACT is an European Commission funded project (Healthcare Telematics). The main objective of ATTRACT is to take advantage of emerging European Cable Television network infrastructures and offer cost-effective care to patients at home. This will be achieved through a set of broadband network applications that competitively provide low cost interactive health-care services at home. The applications will be based on existing or developing European Cable Television network infrastructures in order to provide all kind of users with affordable homecare services. It is ATTRACT's intention that citizens and users benefit from high quality access to home telemedical services which also implies cost savings for patients, their families and the already over burdened health institutions. In addition, the European industries will have extensive opportunities to develop, evaluate and validate broadband network infrastructures providing multimedia and interactive telemedical services at home. ATTRACT contributes to the EU telecommunications and telematics policy objectives that promote the development and validation of "applications and services" which "provide an intelligent telematic environment for the patient in institutions and other points of care that helps the patient to continue, as far as possible, normal activities and external communication".

Medical liability, safety and confidentiality in maritime telemedicine--the MERMAID position on issues of importance.

Telemedicine dates to the days of "wireless telegraphy". As an "extraordinary" arrangement for medical services delivered at time of need, telemedicine has thus far escaped the developments that have taken place over the last 50 years in the areas of medical liability, safety and confidentiality. Today, however, telemedicine is also used to increase quality and cost effectiveness of healthcare provision. This trend is set by the U.S. where the U.S. federal government funds telemedicine at an annual rate of more than $100 million i.e., at a rate 30 times or more than what the EU does while state and local agency support and private business investment in telemedicine is 3 to 4 times larger than that of the U.S. federal government. In this respect it must be stressed that technology tends to satisfy the relevant demand for telecommunications. Telemedicine is used in diverse areas such as pathology, surgery, physical therapy, and psychiatry. It is expected to revolutionise health care in the coming decade and, therefore, it will certainly take into account requirements for medical liability, safety and confidentiality in the same way as traditional "establishment" medicine does.

Medical emergency aid through telematics: design, implementation guidelines and analysis of user requirements for the MERMAID project.

MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) will be considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) will be tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

MERMAID 1996--report on the implementation of a European Project on "medical emergency aid through telematics".

MERMAID is a project that intends to provide multilingual medical emergency services to seaborne vessels around the world. MERMAID uses two-way transmission of live images in marine medical teleconsultation, greatly improving services that up to now depended on short-wave and VHF radio alone. Transmission of high resolution still pictures is also possible, so that the teleconsulting physician may closely (visually) examine his patient, along with transmission of biological signals and patient anamnesis details. Telemedical interventions are critically dependent on local paramedics. Merchant marine officers are trained in first-aid procedures and basic medical transactions. In practice, however, this training is often inadequate. For this reason MERMAID uses a multimedia medical guide that covers the absolutely necessary basics to handle medical emergencies and common medical problems on board. This application is based on the WHO "Medical guide for ships" and EU Council Directive 92/29. The delivery of medical and mental health care to distant populations has never been easy. In addition, the progress of technology has widened the disparity between the quality of care available to the urban citizen and that available to the rural or remote location resident. The only viable solution to the problem seems to come from telecommunications technologies. Indeed, ISDN is the first widely available public network that supports integrated services and can serve as a reliable backbone for telemedical services. Communications satellites provide a means of expanding ISDN network to geographically remote locations. Against this background, MERMAID combines mobile satellite technologies, VSAT technologies and ISDN protocols in order to realise a Global Telemedicine System that is reliable, exhibits, continuity, is seamlessly connected, has low cost and is downward compatible.

Transeuropean network for the provision of added-VAlue Services in Telemedicine--(VAST-Net).

Populations most likely to use telemedicine are usually located far away from ISDN networks in contrast to providers of telemedical services who normally dwell in urban centers. VAST-Net is a consortium that aspires to reach such populations by introducing added-value ISDN-based telemedical services across Europe, through networking a small number of selected, strategically distributed, points-of-care and by focusing on a series of well defined health care provision scenaria. This will be achieved by relying on: (1) the Euro-ISDN infrastructure, (2) satellite based ISDN medical networks (e.g. the INMARSAT/VSAT based MERMAID network), (3) private ISDN networks. The VAST-Net telemedical network will be initially operated on a small but transnational scale in order to assess: (1) the acceptance of telemedical services by end users, (2) the economic viability of the telemedical sector, especially in an international context (3) the legal implications of telemedical practice (4) the regulatory framework within which telemedicine will be developed in the E.U. Based on this assessment the VAST-Net Consortium will proceed to develop appropriate business plans that will allow PTTs and other Telecom operators, medical groups, insurance companies and public health authorities to offer transnationally ISDN-based telemedical services. Potential forms of cooperation may include: (1) "Framework agreements" between PTTs, telemedical service providers (e.g. doctors, hospitals etc.) and "bulk users" (insurance companies, public health authorities), (2) PTT provision of "telecommunications backbones" over which competing telemedical networks can be organised, (3) organisation of a European Economic Interest Group (EEIG), modeled upon international companies such as INMARSAT, that will undertake the operation of VAST-Net.