The current application has been elaborated under a strong cooperation and coordination mechanism between the participating Member States. Putting in place the solid technical and interoperable organisational infrastructure required for the trans-European exchange of healthcare related data aimed for by the present CEF telecom call requires that different milestones be reached in a coordinated way. Hence, a series of common activities and tasks have been jointly agreed and an operating modus “Wave for operation” introducing some synchronization for the start of the operation.

The existence of such cooperation and coordinated mechanism resulted from Member States self organisation, supported by the eHealth Network, with the purpose of assure the right alignment between the several Member State applications, i.e. application criteria and structure, as well as joint efforts to maximize the impact of work activities and services deployed.

The established cooperation and coordinated mechanism is composed by the following Member States: Austria, Finland, Cyprus, France, Sweden, Greece, Portugal, Luxemburg, Germany, Latvia, Slovakia, Italy, Malta, Croatia, Hungary, UK, Estonia, Spain, Poland and Switzerland.

Establishing such a communication infrastructure implies reaching different milestones in a coordinated way. Indeed, one country cannot go live without any coordination with the other partners. In order to enforce this coordination, a series of activities and task have been jointly agreed, making thus a skeleton driving each country’s own process and work. Of course specific tasks will vary from one country to another, but a certain number of tasks have been identified as required in each country and thus included in the skeleton. Five activities have been identified:

 

A1: Preparation work

Regroups all preparation tasks required before a service can be offered (go live);

 

A2: Service testing, approval, and deployment

Regroups all tasks related to the implementation of the service, its validation and deployment. Indeed strong coordination for the validation is required as conformance has to be validated with and against the other countries – possibly through a Project-a-thon.

A3: Operation

This activity supports the exploitation and surveillance of the service. It includes security audit, which need to be based on the same criteria for all countries as security is a global concern, not only of each country independently.

 

A4: Dissemination, Training and Support

While the dissemination and training are mainly national concerns, material could be shared between countries. Moreover as each service implies two or more countries, having some coordination on these activities is of global interest. Support is not only intended for country’s users but may also be related to supporting the community itself.

 

A5: Governance and management

The eHealth Platform is about communication between countries – some global governance rules and management activities are there necessary for the success of the platform.

 

Four basic services are planned: Patient Summary country A resp. B, ePrescription and eDispensation. It is reasonable to expect that not all countries will implement all services at the same time. On the other side, coordination for the start of operation of each service is highly desirable.

 

In order to take into account both these requirements, the notion of “Wave for Operation” has been agreed, introducing some synchronisation for the start of operation. Waves impact mainly activities 1 to 3, partly activity 4. Activity 5 being a global coordination mechanism, it has no dependency on which service is live when.

 

Three waves have been decided, implying that each country has 3 slots for starting operation of a new service. Countries can participate to one or more waves – depending on their own agenda.

The table below illustrates the activities skeleton and tasks.

• WAVE 1: Entrance in Operation – Feb-2018, after approval by the eHN on the Nov-2017;
• WAVE 2: Entrance in Operation – Feb-2019, after approval by the eHN on the Nov-2018;
• WAVE 3: Entrance in Operation – Feb-2020, after approval by the eHN on the Nov-2019;

 

The Cyprus Consortium

The eHealth Lab of the Department of Computer Science of the University of Cyprus and the Ministry of Health of the Republic of Cyprus have a long standing collaboration on eHealth projects, consulting and services spanning in the last 20 years.  Selected activities are highlighted simply to demonstrate the strength of collaboration in support of the CEF proposal.  The eHealth Lab team in collaboration with the Accident & Emergency Department of the Nicosia General Hospital participated in one of the first EU eHealth projects carried out in Cyprus (when Cyprus was eligible for inclusion in EU projects).  The AMBULANCE project was funded by FP4 in 1996-1998 and targeted in the development of a mobile unit for health care provision via telematics support.  This project was followed by Emergency-112 (1998-2000).  Both projects were a great success and the mobile units developed that facilitated the collection of vital signs (ECG, blood pressure, SPO2, and other) and the wireless transmission from the mobile unit to the base station in Nicosia were installed in 2 ambulance units and 1 remote medical centre.  The systems developed in emergency telematics were further advanced via the funding of 2 Interreg IIIB projects (2004-2008) that enabled the connection of 2 more remote medical centres to the Pafos General Hospital.  Moreover, several projects were awarded by the 2 collaborators related to higher and continuing medical education and the establishment of a Mediterranean network (Leonardo Da Vinci Programmes (1997-2001) and Interreg IIIB & IIIC projects (2004-2008).  More recently, as it has been mentioned above, the 2 organisations collaborated in developing the epSOS content creator open source code enabler that passed also related IHE profiles with the finding of the FI-STAR EU FP7 Future Internet ICT project.  The two organisations participated jointly in the Lisbon 2015 Expandathon and will also do so in the Bochum 2016 Connectathon.  Furthermore, it should be highlighted that one of the Co-Directors of the eHealth Lab,  Prof. Christos N. Schizas, participated in the eHealth Week, Ministerial meeting – Dublin 2013 as National Representative and invited speaker at the eHealth Forum, Ministerial meetings – Athens 2014 and Riga 2015. He is also special advisor the President of the Republic of Cyprus and Ministerial Consultant on eHealth.

 

The University of Cyprus (UCY) is the largest University and main research organisation in Cyprus. UCY has a student population of 7000 (2000 graduate). The Dep. of Computer Science has 21 faculty members, and 100 postdoctoral researchers and PhD students. Its research activities cover Intelligent and Distributed Systems, Software Engineering, Internet and Mobile Technologies, e-Health, and e-Government. The Dep. publishes more than 100 journal papers per year and attracted a total funding of more than 30 MEuro in the last decade.

 

eHealth Lab (www.medinfo.cs.ucy.ac.cy) – Department of Computer Science – The lab has more than 20 years’ experience with funded eHealth research projects.  It hosts a multidisciplinary team of experts with a strong background on eHealth, mHealth, intelligent diagnostic systems, medical imaging, and life sciences informatics and has a long list of completed and on-going projects in the above areas in Europe and internationally with a total funding managed in excess of 7 MEuro.  The Lab has a long standing experience in eHealth projects and is strongly collaborating with the Ministry of Health of Cyprus (including the Nicosia and Pafos General Hospitals, and numerous rural centres), major private hospitals (Areteion, Ippokratio), “Paedi” Center for Specialized Pediatrics and the Cyprus Institute of Neurology and Genetics.  Moreover, the lab is collaborating with numerous eHealth informatics and sensor informatics SMEs (Unilogic, Infotex, Signal Generix, Stremble, Istognosis, and other).

 

The eHealth lab based on previous project experience is working towards deploying in real operation in the clinical setting the following three platforms: (i) EHR, (ii) Patient, and (iii) Multi-centre data analytics and knowledge extraction.  To cover the needs of the first two platforms the eHealth lab exploits the knowhow and open source software tools of the electronic health record and PACS that were developed under the fi-star project by our team (see P.1 below – fi-star is an EU FP7 Future Internet ICT project, www.fi-star.eu).  Moreover, the needs of the EHR and PACS were clearly identified and shaped in the EHR national project carried out by our team in collaboration with the Ministry of Health of Cyprus, the eHealth unit (see P.3). Additionally, for the patient platform, the group capitalizes on its expertise and tools in the development of serious games and home monitoring for the elderly via the partnership with the Long Lasting Memories – project (see P.5, www.longlastingmemories.eu).

 

Selected projects include:

P.1 Future Internet Social and Technological Alignment Research (FI-STAR): EHR Application Support Service Enablers (EHR-EN), FP7 Fut. Internet ICT, 2014-15, Fund: 121KEuro;

P.2 A Next-Generation, Secure Linked Data Medical Information Space for Semantically-Interconnecting EHRs (Linked2Safety), FP7-ICT-2011-7, 2011-14, Fund: 560KEuro;

P.3 Electronic Health Record at National Level, Research Promotion Foundation, Cyprus, 2012-14, Fund: 179KEuro;

P.4 A Social Collaborative Working Space Interlinking Biomedical Knowledge and Data for the Design and Execution of in-silico Models (GRANATUM), EU FP7 ICT, 2011-2013, Fund: 330KEuro;

P.5 Long Lasting Memories (LLM), EU FP7 ICT PSP, 2010-11, Fund: 349KEuro.

 

Key Personnel

Prof. Constantinos S. Pattichis (male) is Professor with the Dep. of Computer Science and Director of the eHealth Lab. He has 25 years of experience in eHealth systems, medical imaging, biosignal analysis, intelligent systems, and more recently in life sciences informatics. He has been involved in numerous projects in these areas funded by EU and other bodies, with a total funding managed close to 7 million Euro. He has published 93 journal publications, 210 conference papers, and 27 chapters in books in these areas (no. of citations more than 5000, h-score 36).  He is Co-Editor of the books M-Health: Emerging Mobile Health Systems, and Ultrasound and Carotid Bifurcation Atherosclerosis, published in 2006 and 2012 by Springer, and was Guest Co-Editor of the Special Issues of the IEEE Trans. on Information Technology in Biomedicine on Emerging Technologies in Biomedicine (2009), Computational Intelligence in Medical Systems (2009), Citizen Centered eHealth Systems in a Global Health-care Environment (2011), and Atherosclerotic Cardiovascular Health Informatics (2012), and of the IEEE Journal of Biomedical and Health Informatics (J-BHI) on Computational Solutions to Large-Scale Data Management and Analysis in Translational and Personalized Medicine (2014).  Moreover, he serves as Distinguished Lecturer and member of the Technical Committee on Biomedical and Health Informatics of the IEEE EMBS, and an Associate Editor of the IEEE J-BHI.  He was general chair of IEEE International Conferences on Information Technology Applications in Biomedicine (ITAB 2009), and Bioinformatics and Bioengineering (BIBE 2012), and he is the general chair of the 13^th Medical and Biological Engineering and Computing (Medicon 2016). He is a Fellow of IET, and Senior Member of IEEE.

 

Prof. Christos N. Schizas (male) is Professor with the Dep. of Computer Science and Co-Director of the eHealth Lab, and Director of the Computational Intelligence Lab (CIL). He has 35 years of experience in information systems development with more emphasis on eHealth, computational intelligence, medical diagnosis, medical informatics, biosignal analysis, intelligent, and more recently in brain activity modelling with emphasis on attention. Received the B.Sc. degree in electronic engineering from the University of London, UK, in 1978, the M.B.A degree from the University of Indianapolis, Indiana, in1988, and the Ph.D. degree in systems theory from the University of London in 1981. He received the 1979 William Lincoln Shelley award from the University of London for excellence in research, and a Fulbright fellowship for collaborative research in the USA in 1993. He was a Fellow of the IEE, Fellow of the British Computer Society and Senior Member of the IEEE. He edited conference proceedings and served as associate editor of the journal Technology and Health Care, area editor of the journal IEEE Trans. on Information Technology in Biomedicine, and member of the editorial board of the journal of Intelligent Systems. He was Postdoctoral Fellow at the University of London, and Professor of Computer Information Systems at the University of Indianapolis. Since 1991 he has been with the Dep. of Computer Science, University of Cyprus, where he served as Interim Chair, Member of the Senate, and Vice Rector. He has taken part in European Commission initiatives for promoting the Information Society, especially the Euro-Mediterranean partnership. He has been a member of the Committee, formed by the Minister of Communications and Works in 1996 for establishing the Information Society in Cyprus, and member of the advisory committee of the Ministry of Commerce and Industry for promoting High Technology in Cyprus. Advisor to the Cyprus Ministry of Health; coordinator of a team of experts that prepared the tender document and evaluated the proposals for the Health Information System in Cyprus. Participated in the eHealth Week, Ministerial meeting – Dublin 2013 as National Representative and invited speaker at the eHealth Forum, Ministerial meeting – Athens 2014, and Ministry meeting – Riga 2015. He lectures the course on eHealth at a master’s level, and at the Schools of Medicine (UCY).

 

 

Ministry of Health

eHealth is one of the priority initiatives of the Ministry of Health for achieving high-quality and sustainable health care and long-term care services.  In this context it is foreseen that the CEFeHealth services will greatly help the Republic of Cyprus in achieving its health care priority initiatives in the offering a better health care service to the citizen.

 

Key Personnel

1. Yiapatou IT Unit Officer A, Project Manager of the Integrated Healthcare Information System, and eHealth Unit Coordinator of the Ministry of Health. Her duties include the following: 1. Provide technical support of the software, hardware, and network communications provided to Hospitals and Health Centers of the Ministry of Health. 2. Develop new systems and projects for the advancement of productivity and efficiency. 3. Prepare the user requirements/specifications in order to promote rational utilization of human resources. 4. Provide operational support systems for the continuous upgrading of the quality of service offered by the Ministry. 5. Prepare tender documents relating to computer systems. 6. Prepare progress reports on projects.

 

Elli Yiapatou – IT Officer A’ – Project Manager of the Integrated Healthcare Information System  and Responsible for the Ministry of Health IT Unit  (with the retirement of Ms. Kalakouti) – duties include the following: project management, contracts management, preparation of proposals, technical specifications and tender documents,  budget preparation.

 

Dr Minas I. Kyriakides, ICT Coordinator. Graduated from Athens University in 1988. Master in Public Sector Management (2000). M.A in Health management (2013). Registered as Dental Surgeon in the Cyprus Dental Association (1988). Appointed in the public service as a Dental Officer (1991-2001). ICT coordinator of the ministry 2001- today with active involvement in various co-funded projects, participation in EU committees , working groups and steering groups and current involvement as expert in eHealth.

 

Subcontracting Rationale

In order to achieve technical excellence the Applicant will subcontract the following technical tasks to a competent provider that has pre-existing knowledge and experience in the following domains:

1. Proven knowledge of interoperability standards, especially those used in the epSOS project, namely IHE XCA, IHE XCPD, IHE XUA, IHE BPCC, IHE XDR.
2. Participation in IHE testing events for cross border healthcare such as epSOS projectathons, Expand-athon or similar
3. Knowledge of the technologies and components used in the openNCP community
4. Provision of open source software implementation and support services.

This subcontracting is necessary to acquire promptly and accurately the necessary technical expertise to establish an operational national contact point in the shortest time, releasing NCP-B services in the first wave in Q1-2018. The applicant expects that this subcontracting is both necessary and in the best interest of the proposal since it will allow:

1. Fast and efficient transfer of knowledge to the applicant’s team concerning the technical complexity on both the eHealth DSI technologies and specifications
2. Reduce of cost of implementation and cost of operation of the NCPeH that will be created since competent resources will be immediately integrated into the Applicant’s teams
3. Provision of an expert helpdesk during the operation period, ensuring immediate resolution to technical and operational issues via a structured Service Level Agreement.

List of subcontracted tasks

Activity and Task	Description of expected services	Reason of subcontracting	Minimum technical capacities of the subcontractor foreseen
A1. Preparation  / T1.2 – Design National architecture	•         Architecture design and integration with national infrastructure  •         Cross border requirements finalisation •         Web services & Connectors design •         Specifications documentation and management	•         Need for expert knowledge in cross border healthcare specification for epSOS, EXPAND and IHE profiles  •         Technical ability to comply promptly and thoroughly with EU guidelines and recommendations on patient summary and ePrescription	•         Proven Knowledge of epSOS specification and European Interoperability specification
A1. Preparation  / T1.6 – OpenNCP localisation implementation, integration and testing	•         Provide support concerning openNCP new version  •         Participate in openNCP community development community •         Provide transfer of knowledge concerning openNCP developments •         Install the Applicants eHealthDSI infrastructure via the openNCP components •         Provide localization services •         Create needed connectors and extensions to establish the service •         Establish security and VPN connections	•         Knowledge transfer and expertise on establishing an eHealth DSI via the openNCP system  •         Cope with the complexity of interoperability specifications •         Manage the NCPeH specifications	•         Participation in openNCP  •         Knowledge of software programming in openNCP components •         Knowledge of cross border interoperability specifications and integration profiles. •         Be aware of agile programming techniques
A1. Preparation  / T1.7 – Perform unit, integration and pre-PPT testing	•         Perform unit and integration testing as described in epSOS/EXPAND interoperability shops and future eHOMB quality checklists  •         Perform pre-PPT testing based on approved testing tools	•         Manage the implementation, quality and testing cycle	•         Have a structured software implementation strategy  •         Provide quality procedures on software implementation and integration
A2. Service Deployment  and testing” / T2.2 Undergo Pre-Production Testing and Project-a-thon	•         Participate in pre-production testing events  •         Complete successfully the needed test plans •         Manage the needed enhancements after testing	•         Secure effective IHE based testing (profile based)  •         Secure quality of exchanged documents	•         Proven Experience in epSOS/EXPAND/other projectathons and connectathons
A2. Service Deployment and testing /T2.3 Perform Security audit	•         Perform internal security audits  •         Perform security and vulnerability analysis	•         Ensuring security specifications for the proper operation of the eHealth DSI are met	•         Knowledge of ehealth security issues  •         Knowledge of critical infrastructure protection guidelines
A2. Service Deployment and testing /T2.5 Service deployment	•         Create and implement a service launch strategy	•         Need for a high quality service deployment process	•         Experience in deploying interoperability infrastructure into production
A2. Service Deployment and testing /T2.6 Non regression testing	•         Continuous integration of new specifications when version of openNCP or other components occur	•         Need for extensive knowledge in non-regression testing especially for the openNCP components	•         Experience in technical support procedures  •         Maintain a 3rd level support
A3. Operation /  T3.2 Service Maintenance and Change Management	•         Provide all needed upgrades and debugging services to the eHealth DSI installation	•         Outsource to a competent entity the technical helpdesk and support to obtain value added and quality services to end users.	•         Have 1st, 2nd and third level procedures  •         Be aware of agile programming techniques
A4. Dissemination and Training	•         Participate in tasks “T4.1 Health professional Dissemination, Education and Training , concerning eHealth DSI and portal B training material and sessions	•         Need for expert training services for cross border healthcare, integration profiles and NCP utilization by end Users	•         Have experience in developing train the trainer programs in the eHealth domain.

Estimated effort in subcontracting is estimated between 35 and 40 person months. Cost estimates have been done by assessing similar subcontracting during the epSOS project for similar tasks.

Subcontracting will be done in accordance with EU procurement regulations and of the grant agreement. The Applicant has already allocated at least one legal entity that covers all the above-mentioned technical capacity and has the intention in requesting Gnomon Informatics to perform the above-mentioned technical tasks. Gnomon is well known European eHealth interoperability solution facilitator which participated actively in the epSOS Industry team, being a steering committee member from the beginning. Gnomon also participated in the first reference implementation of the NCP components (NCP in a BOX). Gnomon is an active member of the epsos openNCP Community and development team with participation in many components development (configuration manager, audit manager, cda display tools, NCP B Portal layer, etc). Gnomon has also participated in the integration of the non-repudiation components to the openNCP framework as well as supporting STORK beneficiaries in integrating openNCP software with STORK toolkits on eID, successfully demonstrated in conference and review meetings. Gnomon has actively participated in many epSOS projectathons and connectathons supporting many member states in their process to establish cross border healthcare infrastructures (Malta, Luxembourg, etc).

Subcontracting will be carried out in two phases.  Phase 1 that will cover activities in A1 Preparation (as documented in the above table) will be granted to Gnomon (GNOMON INFORMATICS SA, ANTONI TRITSI 21, PO Box 22461, Post code 551 02 Thessaloniki, GREECE, VAT No 082964412, D.Ο.Υ FΑΕ Thessaloniki, Μ.Α.Ε. 47783/06/Β/00/0325) thus facilitating a key start of the project with a very experienced subcontractor.  Phase 2 that will cover activities in A2 Service Deployment and testing, A3 Operation, and A4 Dissemination and Training (as documented in the above table) will be subcontracted via an open call for subcontracting.