An open eHealth platform for health management using adaptable service profiles for different medical specialties is currently being validated in the regional health information network (RHIN) of South Aegean in Greece. The core of the installation is an electronic health record (EHR), customized for primary care, that has been extended with advanced eHealth services. Users of the EHR can create an active episode folder by selecting an eHealth service profile. Relevant clinical data can be added to the folder and users will be aware or be notified of updates. Once in a folder, a connected user perceives the actions of other users in the same folder and may use medical devices in a collaborative manner. The underlying service engineering framework allows maintenance of service profiles without disrupting the operation of the system. Preliminary results show that end-users have recognized the efficiency of the system and are eager to use it in managing the health of their patients both in their office and at the patients' home.

HYGEIAnet [1], the health telematics network of Crete, has been in operation since the second half of the 90s. Its main purpose is the creation of a communication infrastructure aimed to constitute the basic layer for the establishment of the citizen’s electronic health record ( R) and the creation of information systems able to cover all the different levels of care and all levels of hierarchy [2]. Crete has a population of about 600000 inhabitants, but this number is more than doubled during the summer period. A rough estimation of the tourist flow is around 2500000 people per year. The health care structure must be arranged to be able to effectively serve this people flow. In the whole island there are 16 primary health care centres and 7 hospitals and a large number of isolated communities in remote locations due to the particular morphology of the island very rich of mountains. According to the statistics, accidents are more than tripled during the summer period and 42% of accidents involve tourists. Thus, all the aspects related to emergency and pre-hospital care are of primary importance in the regional health service. EKAB (Hellenic National Centre for Emergency Care) is the sole public provider of Emergency Pre-Hospital Care in Greece. EKAB in Crete is composed by 6 mobile intensive care units, 8 medical doctors, 120 paramedics, 38 ambulances and 16 centre coordinators. It manages about 25000 emergency episodes per year, of which 40% are due to trauma and 20% are due to cardiac problems, and 200 air medical evacuations per year. An integrated Pre-Hospital Emergency Information System has been operational in the EKAB Coordination Centre of Crete (HECC) since 1998[3-4]. All emergency calls are registered online resulting in a volume of 25000 episodes per year. The integrated system includes modules for ambulance tracking, resource management, and medical device communication. The ambulance-tracking module uses a geographic information system to track in real-time available resources on an area map (see figure 1) [5]:

For the last five years, a system for the management and coordination of pre-hospital health emergency has been in regular use at the Emergency Coordination Centre of Heraklion, as part of HYGEIAnet, the Regional Health Information Network of Crete. Approximately 20,000 emergency episodes per year are currently being logged in the system. The need for better support of cardiac cases (about 20% of the total) prompted the extension of the system to include the continuous acquisition of 12-lead ECGs and their real-time transmission to the coordination centre for evaluation by an expert. The 12-lead ECG module has been developed and integrated in the existing system with special attention to the provision of an easy user interface so that the extra work required to the ambulance personnel is negligible. The overall system has been carefully tested and is now in daily use.

In an age where medical collaboration is the key to effective healthcare delivery and continuity of care, the location of experts and the management of their time are affecting the wide deployment of eHealth services. In this setting, the use of instant messaging and presence technologies provides a possible solution. A collaboration platform based on instant messaging and presence technology has been employed to implement flexible and adaptable eHealth services. The platform is characterized by the use of medical device components that currently support real-time and/ or store-and-forward access to spirometry examinations, medical imaging, vital signs, ECG, and auscultation data. Other important features of the platform are eHealth service profiles that entail electronic document templates conforming to HL7's clinical document architecture (CDA), the electronic signing of clinical objects using smart cards, and the use of Object Management Group's (OMG) person identification service (PIDS) to interoperate with clinical information systems.So far, eHealth services profiles have been designed for cardiology and respiratory problems. The storage of clinical data in actively shared episode folders and the flexible messaging services that provide users with feedback, feedthrough, awareness, and notification irrespective of their location, have been immediately embraced by the healthcare community. In the immediate future, eHealth service profiles are expected to be further refined based on user feedback and usage data to support service evolution and thus, lead to even more effective service provision in healthcare.

Describes the architectural considerations of HYGEIAnet (the Regional Health Telematics Network of Crete), the R&D issues involved in the design, development and implementation of a modular and configurable Home Care Platform that supports different health and social care domains, and the results of the clinical pilots to evaluate the platform and the service. In addition, the R&D issues that must be addressed in order to transform and extend the aforementioned platform for the support of personal health management services are presented.