**1. Introduction**

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A considerable amount of R&D&I has been carried out in recent years in the area of teleme‐ dicine and e-Health directed at supporting innovative health care models for people with chronic health conditions such as hypertension, cardiac insufficiency, chronic pulmonary obstruction, asthma, diabetes, cancer, dementia and other ailments [1]. The objective is to implement more appropriate and effective health care models in order to maintain health under everyday conditions, avoiding serious complications and without the need to resort to emergency services and hospital admittances. One priority is to avoid or delay for as long as possible the situation of dependence on the health care system for pluripathological conditions.

The development of telehealth applications is guided by its potential to confront the challenges brought about by the aging of the population and financial restrictions together with the need to satisfy the population for better services and access to them.

In this context, a convergence can be observed between the transformation movement of health care systems, the development of new information and communication technologies (Internet, Web 2.0, 3G and 4G mobile communications, touch-screen terminals, etc.) which have a high support potential for new ideas in the field of health care implying the active support of the patients and facilitating collaboration environments between all of the actors involved.

It must be borne in mind that telehealth systems and services are in the definition and positioning phase in traditional health care systems and coexist with other systems such as Telecare, Personal Health Systems (PHS), mobile Health (mHealth) and Personal Health Applications (PHAs) with which often overlap [2,3].

© 2013 Monteagudo et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 Monteagudo et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

It is important to consider that innovation in telehealth does not only rest in technological advances. The system of innovation in this domain is very complex and interdependent. A fusion of technology with health care knowledge and the organization of health care systems is necessary together with measures to empower the users and a redefinition of the contact of the professionals with the patients.

by presenting the current context of the evaluation in e-services (section 2.1.1) and methodological basis which has shown to be more suitable for the obtaining of evidence (section 2.1.2). The challenges that persist are highlighted, brought about by the intrinsic complexity of the environments in which the evaluations have to be carried out. The need for implementation in the organizations stands out as the factor that most compromises the viability and validity of the process (section 2.1.3). The methodology designed and proposed in PITES is then described in order to tackle the complexity of the search for evidence on the e-services process (section 2.1.4). As regards interoperability, the fundamen‐ tal aspects of interoperability in clinical information (section 2.2.1) and the interoperabili‐

PITES: Telemedicine and e-Health Innovation Platform

http://dx.doi.org/10.5772/57021

165

The PITES platform is presented in section 3. Firstly, a conceptual model of the organizational and functional framework is described as a proposal for the reduction in users, resources and its interactions to which the interventions must be adapted to be able to be evaluated with the support of the platform (section 3.1). After that, the architecture of the PITES platform is presented as an open system of distributed services and its advantages in collaborative research and innovation in this field (section 3.2). Finally, some of the services that currently support the platform and which already act as permanent components supporting the projects

In section 4, as a result of the platform, a description of some of the already finished projects is included together with very brief descriptions of some of the current projects that our unit

One of the permanent challenges facing e-health, and therefore telemedicine and its effects is the obtaining of scientific, generalized and reliable evidence (transferable between different contexts) on it. There are numerous reasons for evaluation: promotional, pragmatic, ethical, medical-legal, even academic. The objective is to promote and legitimize practices of excel‐ lence, evaluate the policies, regulations and national legislations on e-health and value its impact in terms of efficiency and technical and clinical effectiveness, impact on the organiza‐ tion, health staff, costs, patient satisfaction and personal ethical health aspects, confidentiality

The recommendation for evaluation has been endorsed from multiple authorities and inter‐ national organizations such as the World Health Organization in its "eHealth Program for Health-Care Delivery" (eHCD) [5] and the "Global Observatory for eHealth" [6], which established that services based on e-health will be essential when they demonstrate that they are based on evidence, requiring well-defined agreed specifications and criteria for it, and

is working on plus a list of current projects of other research groups.

**2. Context of innovation within the PITES scenario**

**2.1. Evaluation of services based on telemedicine**

*2.1.1. Current context of the evaluation of e-services*

ty framework of the platform (section 2.2.2)

are described (section 3.3).

and safety.

In this chapter, an experience is described in the conception, design, implementation and evaluation of a Platform of Innovation in Telehealth Systems (PITES) oriented at improving the health care of chronic, fragile and dependent patients.

The PITES platform is a stable and public innovation infrastructure. It is made up of a technological platform, services and tools, with its use directed at research groups, public or private entities and organizations, with the objective of offering support for the obtaining of evidence on new models for health care provision based on ICT (Telehealth) in scenarios related to chronic illness and dependency.

PITES is directed at broaching two main objectives: a) facilitating and accelerating the development of telehealth applications by making available technological infrastructures which in another way would not be tackled or would have to be designed and constructed from scratch by each project, and b) promote interoperability through the adoption of open standards for the communication of medical data and information (semantic interoperability).

PITES stems from experience and lessons learned over 15 years in the design, implementation and use of telehealth applications in different environments and contexts of real application, supported by a large number of pilot projects and trials. PITES currently serves as an infra‐ structure for diverse projects in different locations in Spain. PITES also forms part of the Accion B3 of the European Innovation Partnership for Active and Healthy Ageing [4].

The PITES platform supports research or innovation projects, not health care activities nor commercial services. The platform permits different telehealth projects to be implemented in a flexible and transparent manner using different local approximations and contexts of use for both professionals and patients. PITES incorporates the philosophy of separating the applica‐ tions of the infrastructures that support them.

As an R&D&I platform it has been conceived to be flexible, functionally transparent, secure and with the capacity to evolve and coexist with other platforms (for research or clinical use) by means of technical and semantic operability mechanisms based on standards. Technolog‐ ically, it is aligned with the current convergence framework for the provision of digital services on IP networks using Web technologies and SOA.

PITES follows an open innovation model promoted from the knowledge of the professional health users for the application of secure, accessible and interoperable telehealth environments using open standards. The PITES digital ecosystem gives each Project the freedom to design and implement its protocols.

The structure of the chapter is as follows: The two goals of the PITES innovation activi‐ ties are described in section 2. The obtaining of evidence (section 2.1) and the interoperabil‐ ity of the clinical information (section 2.2). As regards the obtaining of evidence, we begin by presenting the current context of the evaluation in e-services (section 2.1.1) and methodological basis which has shown to be more suitable for the obtaining of evidence (section 2.1.2). The challenges that persist are highlighted, brought about by the intrinsic complexity of the environments in which the evaluations have to be carried out. The need for implementation in the organizations stands out as the factor that most compromises the viability and validity of the process (section 2.1.3). The methodology designed and proposed in PITES is then described in order to tackle the complexity of the search for evidence on the e-services process (section 2.1.4). As regards interoperability, the fundamen‐ tal aspects of interoperability in clinical information (section 2.2.1) and the interoperabili‐ ty framework of the platform (section 2.2.2)

The PITES platform is presented in section 3. Firstly, a conceptual model of the organizational and functional framework is described as a proposal for the reduction in users, resources and its interactions to which the interventions must be adapted to be able to be evaluated with the support of the platform (section 3.1). After that, the architecture of the PITES platform is presented as an open system of distributed services and its advantages in collaborative research and innovation in this field (section 3.2). Finally, some of the services that currently support the platform and which already act as permanent components supporting the projects are described (section 3.3).

In section 4, as a result of the platform, a description of some of the already finished projects is included together with very brief descriptions of some of the current projects that our unit is working on plus a list of current projects of other research groups.
