Updated: Aug 26, 1998
This is the most recent structured information on this project. Complementary data can be found on previous documents
HERMES Telematic healthcare remoteness and mobility factors in common Europeanscenarios

Overview

Taking into account the recommendations of the auditors at the phase one review, these services will be focused in phase two to fulfil the requirements of the airline and tourist industries. The range of HERMES services that are envisaged are seen however as reflecting the content of all healthcare - which is ‘delivered to the point of need’. They fulfil the user need for ‘immediate access to care’ (whenever this is required and no matter where the location of user and provider); for ‘immediate review of patient-related information’ (including test results, diagnostic monitoring and care-planning); and for ‘immediate expert advice’ (for patients and carers of all types). This range of activities involves all users and providers in the healthcare enterprise.

The HERMES major validation sites will be on Airline flights and on the islands of Madeira (Portugal) and the Aegean (Greece). In addition, the phase one HERMES sites, for ‘Local Community-Based Services’ (High Risk Pregnant Mothers and Newborns), and for ‘Ambulatory-Care Services’ (High Risk Respiratory and Cardiology Patients) will also be used to validate the HERMES Technical Platform. The consortium will also produce ‘a portable vital-signs monitoring system’ based on previous EU Health Care telematic work and constructed to meet the requirements for the HERMES Airline and Tourist Services. This equipment is expected to have a major impact on the uptake of services and the market potential includes carers of all types as well as patients and the relatives of patients.

The initial HERMES technologies which were developed in phase one, will be integrated with the model of the SITA network for ‘global service provision’ and the resulting platform will be made interoperable in both technical and clinical service aspects.

Purpose and objectives

In HERMES, the initial definition, development and construction of the proto-platform began with the early implementation of a technical proto-platform that was based on previously known requirements. The client- and participant--user requirements that determined the future HERMES applications were defined in parallel utilising agreed descriptive methods. This was possible because of the in-depth experience of partners. It was also an appropriate approach in order to provide an early opportunity for participant-users to provide their input to specification through the 'hands-on' proto-cycling of technical products and components. A purely theoretical approach to defining user needs would not provide a good functional specification. Instead the practical approach of proto-cycling with reiteration of user requirements was chosen as the method to underpin the platform development process.

This practical approach has now led to a proper appreciation and emphasis on the medical service organisation and on the medical guidelines and service quality standards that are required to be met in the application of telematic technologies in the healthcare environment. Participant-users and platform-developers are now working together toward the common goal of implementing quality assured services.

The initial proto-platform was concerned with Urgent Response Telemedicine Services, which are available on a 24hr basis at the point of need. There has been good progress towards determining the quality components of these services and a start has been made to documenting the standards to be met for the HERMES Services Handbook. This is an essential step for future commercialisation of products and services and it is likely to continue beyond year three.

In order to meet ISO service standards the methodology - Total Quality Management (TQM) as defined in PRINCE (Projects in Controlled Environments) has been applied within the HERMES work. Members of the Consortium have been provided with training to use PRINCE. This training, together with implementation, oversighting and control reports is the responsibility of the external QA agency Healthskills. PRINCE was adapted to the Project and the initial FEST Framework provided a quality assurance tool. A description of the methodology is contained in the Quality Assurance Strategy.

Internally all deliverables have passed through a formal quality procedure. During the first phase (year one) of the project work, strategies for medical, technical and service quality standards were also completed and this is reported on in Deliverable 2.2.

Currently the national regulations within the EU member states are at different stages of maturity with respect to quality management in healthcare. It is expected that, driven by European efforts, some standardisation will be achieved within the next few years. However, delays in this process might also have an impact on the Quality Certification procedures for the HERMES services. Before the Consortium can achieve the ISO 9000 standard in all its work it may therefore be necessary to enter an interim phase of 'labelling' for HERMES products and services. The same is true for commercialisation with the formation of business entities. It may be more appropriate for this process to enter an interim phase of establishing the legal entities required through the formation of European Economic Interest Groups (EEIG’s). The consortium is currently evaluating these approaches.

This objective of establishing a coherent platform development process and applying TQM was met in month 3. Work to ensure implementation across all sites is a continuing process. It is anticipated that the current drive to commercialisation in years two and three will provide a further impetus to this objective being met.

Project Objective 2 - The development and use of ‘User Tools’

A set of user tools has therefore been developed by the HERMES consortium, each one of which is responsible for assisting the user in addressing the platform development process. They have already been used to describe the components of the overall existing services in the local sites of HERMES partners and are contributing to the development of the HERMES standardised telemedicine Platform for global applications. These tools have been made freely available on the HERMES network for others to use. They are the following:

The HERMES User Tools

• The HERMES Question Set (URL: http://pc47.cee.hw.ac.uk/neil/html_fly.htm)
• The HERMES Medical Event Categorisation Methodology
• The HERMES Medical Event Analysis Methodology
• The HERMES Telemedicine Services Guideline Methodology
• The HERMES Evaluation Methodology
• The HERMES Quality Assurance and Quality Certification Procedures

In order to achieve ‘fit for purpose’ telemedicine services, HERMES has also utilised a descriptive framework approach to specifying its ‘European Platform’. The HERMES ‘seven-step’ methodology for deriving all Quality Components and Standards is an example of this approach. Members of the Consortium used an initial paper collection procedure to obtain inputs from all users and providers of the services envisaged. These initial inputs were built into the specification of the Initial HERMES Proto-Platform. Work to provide medical guidelines has also been pursued in all sites (deliverable 2.2) Site specific telemedicine services are to be fully integrated vertically by type of service.

Initially the FEST Question Set was used in an iterative proto-cycling way by all pilot sites. With the revision of the Question Set to form the HERMES Question Set information is now being collected electronically. This electronic QS forms part of the user-tools developed by HERMES which now include the medical standards/guidelines and the quality standards which were highlighted as the initial process was completed. The electronic tools are made available on WWW and have been improved to make easier completion by participant users. It is anticipated that the revised user tools will be a marketable product as part of the HERMES Education and Training Programme (see deliverable 4.3)

This objective of providing common methods and tools to support users, will therefore be met and further developed with reiteration in user group activities. It will lead to valuable material for establishing the HERMES education and training requirements and the agreed ‘medical guidelines’ for service provision. It will also provide a basis for achieving wider input and could be useful to other telematics in healthcare projects (see Deliverables 2.2; 4.3; 9.2).

Project Objective 3 - Use and Integration of Available Technologies and Conformity to Standards

HERMES is a customer to network providers but has considered establishing a corporate network for its services with a single European number, automatic routing and security/access control. With re-focusing on the airline and tourist scenario the network requirements and technical integration tasks are being pursued with SITA.

The added value of being able to interconnect local, national, regional and global networks to form an integrated communication network, was recognised at the G-7 sponsored meeting on “Global Healthcare Applications” held in Brussels in April 1995. This served as a forum for identifying health care needs that could be met in the context of the development of global telecommunication networks. A priority domain identified as part of this global infrastructure was the development of a 24 hour multi-lingual telemedicine surveillance and emergency service (Sub-project 4) which had the ability to deliver medical services to people who are injured or become ill far from their usual systems of care.

However, the success of such an exercise and the provision of a seamless service are inevitably highly dependent on the existence of well-formed, integrated information pathways with a high level of systems interoperability. These essential requirements in turn depend on the resolution of many issues including governmental policy on the transfer of healthcare information, the reciprocity of information, the protection and maintenance of privacy, confidentiality and security of information, intellectual property rights as well as conformity to technical, medical and service standards. Poor awareness of these issues and poor compliance to such standards will lead to a lack of interoperability between telemedicine service systems that are being developed.

The HERMES project is an appropriate paradigm to address these issues with a structure planned to provide a link between the users and providers of telemedicine services while ensuring a high quality of medical and technical service by the incorporation of recognised and evaluated medical and technical standards.

The approach of ‘not re-inventing’ the technology required for telemedicine services and at the same time achieving compliance with standards has provided the consortium with an early realisation of an initial proto-platform which can be utilised for proto-cycling purposes. The ‘Initial HERMES Proto-Platform’ provides Services for Passenger Airline Transportation, European Holiday Resorts and Isolated Communities, Home Care for ‘high-risk’ Pregnant Mothers and Newborns, and Ambulatory Care for ‘high-risk’ Respiratory and Cardiology Patients.

The approach has also led to the development of user-driven specifications for future hardware and software requirements. Continued proto-cycling work with the final specification of a European Platform will be completed by months 34-36. The project is now focused on the airline and tourist scenario and a commercial drive to service provision is under way - see below.

Project Objective 4 - Adaptation to Identified Requirements (Proto-cycling)

Some multimedia S/W was adapted to meet the GEHR structure and an initial vital signs monitor was specified and constructed to meet the initial Proto-Platform requirements. The network has been investigated but not completed at this stage since negotiations with SITA have only just been concluded. SITA will now be an associate partner in HERMES and the consortium will be an affiliate partner in SITA.

Options for the network requirements and integration of the HERMES technologies with the SITA network are now proceeding. An initial trial for the airline scenario has taken place and other trials for the remaining scenarios are nearing completion.

The objective of considering user needs for capture, processing and exchange of patient related information was met for the initial proto-platform and this was demonstrated at the year one audit in October 1996 (see below). Work is now focused to provide reiterations and adaptations for the airline and tourist scenarios. This includes the gateways to all HERMES related external databases as well as to provide different ‘fit for purpose’ PVSM’s.

The second half of year one of HERMES and the beginning of year two of HERMES saw the early proto-cycling activities using the new platform components. Technical work this year has been focused on pilot site adaptations and integration issues (see Deliverables 6.3; 6.4 and 2.3). The identification through the proto-cycling process of those components of the Proto-platform required to sustain the two leading applications in HERMES – Tourism and the Airline Scenarios is proceeding rapidly and demonstrations will be available for Barcelona in February 1998. Parallel to these activities has been the ongoing work to continue to refine the overall Telemedicine platform architecture, incorporating new security technologies and new developing WEB technologies. This adaptation aspect of the platform development process will continue throughout the lifetime of the project and beyond but a final project specification will be available for month 36.

Deliverable 3.2 describes the User requirements based on the initial work performed with the new platform components, together with knowledge from previous experiences. The current specification for the technologies to be implemented to achieve real-world service provision is also described in that deliverable.

Project Objective 5 - Co-operative Endeavours (Interoperability and Harmonisation)

In year one, considerable effort was put into the ‘Harmony Initiative’ to bring together the members of the currently funded EU HCT consortia clustered in group 5 Emergency Telemedicine Services. Unfortunately these endeavours have not as yet been fruitful but the development of electronic user tools and the current drive to commercialisation is expected to produce a movement toward more realistic co-operation.

The HERMES consortium believes that no one group can provide all the solutions and that a harmonisation process is essential to reduce the risks and to maximise the benefits. In particular the widest possible user base will be required to achieve the goals of ‘approval’ and ‘widespread uptake’ of telemedicine services. All would benefit from such harmonisation because it would increase structured input to user requirements from all pilot sites. This in turn would allow common implementations for assessment and would open up a telemedicine marketplace. Each local HERMES site has made efforts to expand their own services based on the services that are locally and nationally required and these efforts are now beginning to bear fruit with the prospects of local and national agreements and inward investment.

Although considerable work has been done, this objective will require further efforts in the future, with the gaining of approval and acceptance of telemedicine services both locally as well as within Europe. The HERMES Business Group are setting out a framework for the commercialisation process and the relationship with SITA is beginning to open doors for future harmonisation of applications in the real world.

Co-operative efforts outside Europe are also continuing to be investigated. The aim is to work with other projects at national and international levels with similar interests - in providing both common telemedicine service applications and in providing a common International Platform for these services. Considerable effort has been expended in making contacts in Canada and Australia as well as in Eastern Europe, USA, South Africa, and Thailand. These efforts will continue and in this regard HERMES services are in line with the G7 initiative of the Global Healthcare Application Project and The Information Society, Sub-Project 4. HERMES partners are also involved in the TENS Telecom initiatives and would welcome co-operative endeavours in the area of 24hr telemedicine surveillance services with other groups. An open invitation has been made to the EU countries currently participating in the G7 initiative as well as to other countries with EU R&D agreements and groups in Eastern Europe as well as in USA, Canada and Australia. This objective will require further work in years 2&3 and beyond and will gain an impetus from a commercial drive to service provision.

Project Objective 6 - Commercialisation of services

Since the year one audit the project has focused on the airline and tourist scenarios and several adaptations have been made. In its widest sense, these adaptations address the totality of what is required in the specific circumstances met on-board aircraft and in tourist resorts. In this context adaptations are dependent on, which telematic technologies are felt to be applicable and what healthcare is regarded as appropriate to be delivered in these environments. There are also specific features that need to be addressed by adaptation, in order to meet the requirements of healthcare purchasers and providers as well as those of the commercial/business entities involved in the intended services.

The range of activities to be considered is large. The importance of each activity will have a different weight depending on a series of factors, such as the environment of care, the expectations of service users (clients as well as participants) and the existing service infrastructures that have to be adapted to. In a commercial environment these factors will include the definition of the agreed service procedures and guidelines which set the standards for the service quality. In general terms this is not a well-advanced concept in the world of healthcare delivery.

There will be a need for intensive work both within the HERMES Consortium and at the pilot sites to satisfy these aspects of service provision. The HERMES sites in Greece and on the island of Madeira will be the initial focus for proving the applications to be implemented. The other HERMES partners and pilot sites will support them in order to establish the required service infrastructures.

The main part of the work to be accomplished is concerned with adaptations to meet both local and global standards. This involves regulatory requirements in both technologies and services and includes software validation and the provision of quality assured services that take account of ‘the environment of care’. Of particular importance is the adaptation of HERMES medical procedures and guidelines for the delivery of care and for the overall service organisation.

Another major issue is the conformity to good manufacturing and design practice as outlined within the Medical Device Directive and other documents emanating from regulatory bodies such as the FDA. Within a global context these aspects cannot be ignored but must form part of the demonstration and commercialisation processes.

The different sections of Deliverable 6.4 give an account of the significant steps that are to be taken to demonstrate the shift from the technical development issues, which represented a considerable part of the effort in the previous 18 months, to the commercial and services aspects of the HERMES Platform. This shift from technical development to service application issues is in line with the content of the Technical Annex and with the recommendations of the 1996 Auditors to ‘focus’ on services for the tourist and the airline industries (see below). Both of these now require the HERMES consortium to consider the implications of a commercial drive to service provision.

Commercialisation is an important topic. The consortiums industrial and commercial partners as well as the European Commission are being asked to provide guidance on this matter. In future activities it may not be possible for all partners and all pilot sites to co-operate as 'a single business unit' in the context of some services. A sub-set of partners with or without other interested parties may be a more appropriate combination.

The current view of the consortium is that the formation of European Economic Interest Groups (EEIG's) may provide the intermediate structure necessary for future activities. It is expected that these EEIG's will provide the necessary legal framework for members who have the shared interest and the synergy to pursue the commercialisation of specific HERMES telemedicine products and services (see Deliverable 4.3).

For the Airline and Tourist Services, there are current adaptations that have future commercial implications. These include the utilisation of the SITA network and the interfacing of HERMES services to the private and public purchasers and providers of healthcare. HERMES has already taken a first step by including SITA as an associate partner in the consortium and by becoming an affiliate member of SITA. There are also adaptations that are designed to meet client/customer expectations and choices in this environment. In this regard there may be a future commercial activity in the provision of electronic educational/advisory material that is specifically designed for 'the well-traveller'.

HERMES is developing through its Education and Training Programme and the HERMES Quality Management System, all the necessary tools and the Consultancy/Assistance skills that are required for the delivery of quality assured telemedicine services. This has a definite commercial implication for the future and is currently being adapted for services related specifically to tourists and to airline travellers. The formation of an EEIG for the airline and tourist services is currently being considered.

Results

List of deliverables

Phase 1

Phase 2

List of participants

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