Hindawi Publishing Corporation International Journal of Telemedicine and Applications Volume 2010, Article ID 357156, 7 pages doi:10.1155/2010/357156 Research Article Tile-Ippokratis: The Experience of an Ehealth Platform for the Provision of Health Care Services in the Island of Chios and Cyprus Homer Papadopoulos Department of Applied Technologies, National Center for Scientific Research “Demokritos”, 15310 Attiki, Greece Correspondence should be addressed to Homer Papadopoulos, [email protected] Received 2 November 2009; Revised 2 May 2010; Accepted 19 July 2010 Academic Editor: Tasos Dagiuklas Copyright © 2010 Homer Papadopoulos. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tile-Ippokratis proposed an integrated platform for the provision of low-cost ehealth services to citizens in southeast Mediterranean area (Island of Chios and Cyprus). The aim of the paper is to present the architecture, the design, and the evaluation results of this platform. The platform based on already evaluated state-of-the-art mobile ehealth systems and using wireless and terrestrial telecommunication networks is able to provide the following health care services: (i) telecollaboration and teleconsultation services between health care personnel and between health care personnel and patients and (ii) ehealth services for “at risk” citizens such as elderly and patients with chronic diseases (Island of Chios) and postsurgery patients (Cyprus). The ehealth systems supported capabilities for vital signal measurements (ECG 1 lead, SPO2, HR, BP, weight, and temperature), an Electronic Patient Record (EPR) infrastructure, and video conference, along with communication gateways for data transmission over ADSL, GPRS, and WLAN networks. 1. Introduction gave a great promise to help people in isolated and remote regions to gain access in health care services [3]. Ehealth is an umbrella term which refers to the use of The evolution on ehealth systems supported by advanced information and communication technologies (ICTs) for algorithms, high performance computers, sensors, moni- the provision of health services from distance. Ehealth, toring devices, and telecommunication networks permits distinguished into eCare, eLearning, eSurveillance, and the provision of good quality of medical care even to eGoverment/eAdministration [1], is one of the most rapidly remote/isolated regions, the information exchange, and growing areas of health. According to a global survey of the the distribution of medical knowledge among health care World Health Organization (WHO) there is a significant professionals [3]. demand for the provision of generic tools to support the Ehealth applications have been successfully used for the clinical (elearning tools, access to digital libraries, databases provision of emergency ehealth in understaffed areas like, to support evidence-based medicine, telemedical systems, among others, rural health centers [4, 5]aswellasfor remote diagnostic systems, electronic patient records, deci- home monitoring and home care [6, 7], whenever is needed. sion support systems, etc.) and administrative (e.g., financial Recent studies have shown that the home monitoring of support systems, patient referral systems, etc.) functions elderly patients, as well as patients with chronic diseases, of health care services in WHO member states [2]. The increases the individual’s comfort, enhances quality of life, above is in line with the latest attempts, which have shown and encourages the patient empowerment while it reduces that the use of ICT for the provision of healthcare services the number of needless transfers at hospitals and the cost of across geographic, temporal, social, and cultural barriers provided health care services [7–9]. 2 International Journal of Telemedicine and Applications Furthermore several projects deal with elderly chronic NCSR disease management as CONFIDENCE [10], ATTENTIANE “Demokritos” [11], ENABLE [12], and K4Care [13]. 2.5 G bps This paper presents the architecture of the Tile-Ippok- “Skylitsio” ratis ehealth platform. The platform covers a wide range of general services: Athens hospital 15 (i) support the collaboration and consultation between 5M Chios island bps remote located health care personnel, Nicosia (ii) enable the electronic monitoring of “at risk” citizens, general elderly, and patients with chronic diseases, in the area hospital of Island of Chios, (iii) home telemonitoring of post-surgery patients who Cyprus had been provided intensive care medicine in the Intensive Care Unit of the Nicosia General Hospital; these patients were having Home Ventilation Care Figure 1: Tile-Ippokratis pilot sites. within their residents. The main objectives of the project are considering: Limassol. The patients were receiving support in their own (i) the collaboration between doctors and citizens homes. locatedinGreeceandCypruswithdifferent health A summary of the various services provided per pilot site care systems, different technology infrastructure, and and transmitted data is presented in Table 1. different needs, in order to enhance the quality of The paper describes the Tile-Ippokratis architecture, the health care services in the region South Mediter- design of the entire platform, the provided services, the used ranean, systems, and the platform infrastructure (Section 2)and presents the protocol of the trials (Section 3). In Section 4, (ii) the improvement of the self-management skills of the evaluation results of the validation phase are discussed those patients with minimum ICT skills (the ehealth while the conclusions are presented in Section 5. platform and their electronic personal record could be accessed by them through a web browser), (iii) the efficient monitoring and health management of 2. Platform Description chronic and post-surgery patients by their doctors The description of the platform is divided into three parts. and the early response to emergency incidents using The first part describes the teleconsultation systems and low-cost state-of-the-art web-based technology, the patients’ peripheral systems that entail the acquisition (iv) the evaluation of the usability and acceptability of the of the patients’ biosignals and their transmission to the proposed ehealth services in the pilot areas. central database server, the second part describes the remote centralized database itself, and the third part describes the The platform, which had been developed during the network technology selected for the uploading of the data to Interreg IIIA “Tile-Ippokratis” project: An INTEgrated pilot the database. ehealth-platform for enhancing health care provision between Greece and Cyprus, has been tested and validated in the pilot sites in Greece and Cyprus (Figure 1). The platform 2.1. Teleconsultation Systems and Patients’ Peripheral Systems. and the provided services have been assessed by patients and The Tile-Ippokratis platform provides a series of services, which have been supplied through the combined use of physicians in the aforesaid sites. ff The platform (Server Software, EPR, Web Viewer-en- already evaluated systems (o the self-systems as well as abling Internet access to patient measurements) has been systems coming out of EU-funded projects) as presented in installed within the premises of the National Center for the following paragraphs. Scientific Research, “Demokritos”. In the Island of Chios the platform has been used (1) Teleconsultation Systems. The teleconsultation services by the Skylitsio General Hospital of Chios and the rural have been mainly provided by the Wavelet-based INteractive medical peripheral health centers residing in Chios Prefec- Video Communication System (WinVicos). WinVicos is a ture Municipalities of Volysos, Kardamyla, Oinouses and high-end, interactive video conference system providing real- Pyrgi supporting elderly citizens and patients with chronic time video, still images, and audio transmission [14]. The diseases. The patients were receiving support in the rural system has been designed mainly for medical applications, health centres. like intraoperative teleconsultation, in various EU-funded In Cyprus the platform has been used by the Intensive projects. WinVicos supports communications via satellite, Care Unit of the Nicosia General Hospital supporting post- Local Area Network (LAN), Internet, ATM, xDSL, and so surgery patients in the municipalities of Nicosia, Larnaca and forth. International Journal of Telemedicine and Applications 3 Table 1: Services provided per pilot site. Connected end-points Services Data transferred between end-points Incident data: personal info, contacts, medical EPR, NCSR (server) info (diseases, medication), medical data (vital Web services signs) Skylitsio General Hospital (monitoring Teleconsultation, Medical data (vital signs), images station) ehealth Rural medical peripheral health centers Incident data: personal info, contacts, medical residing in Chios Prefecture Municipalities Teleconsultation, info (diseases, medication), medical data (vital of Volysos, Kardamyla, Oinousses, and Pyrgi ehealth signs), real-time video conference “at risk” citizen (client) Intensive Care Unit of the Nicosia General Incident data: personal info, contacts, medical Hospital (monitoring station) postsurgery Teleconsultation, info (diseases, medication), medical data (vital patients in the municipalities