4 Monitoring device Wireless USB PC gateway Ethernet Internet Data server -EPR Figure 2: The system operation process. transmission and bidirectional communication by means of audio-visual content transmission. Through the platform clinical data have been exchanged which were collected by distributed nodes (e.g., regions supported by low-bandwidth earth network, such as rural areas in Chios Island). The uploading of the measurements data from the patients’ premises to the database have been achieved either by wireless technologies—General Packet Radio Service (GPRS) data cards for PC have been used or wired technologies—Asymmetric Digital Subscriber Line (ADSL) depending on the availability of ADSL connection. ADSL was selected to be the primary technology for use in the patients’ premises as well as in the Peripheral Health Centres due to the low overall cost of usage compared to the other technologies available and the provision of high speeds which can support the teleconferencing scenario as required in the project. Depending on the availability of ADSL lines, the patients’ Peripheral Health Centres were connected with speeds of 1.024 Mbps download and 512 kbps upload which were suﬃcient for monitoring and teleconferencing. In the case of the patient’s premises, these were connected with speeds of at least 512 kbps download and 128 kbps upload which were suﬃcient for monitoring. Security issues in health care information systems are of great importance. Our major objective was to allow doctors quickly access patient data when and where they needed it without compromising security. In the proposed integrated ehealth platform security, mechanisms are incorporated in order to protect the information during the transmission and storage as well as at the system level (logical access control, legitimate, and availability). For each network type an eﬃcient security policy has been deployed, in order to protect data from unauthorized use or alteration/damage and legal issues that concern the exchange of medical data between the two countries. The platform maintained the security of the data throughout all the communication stages, data storage, and user access to the data. More speciﬁcally the following security actions have been adopted: (i) access control/single sign-on, (ii) authentication, (iii) authorization—user Access rights, International Journal of Telemedicine and Applications (iv) session control, (v) activity log—audit, (vi) data protection, (vii) encryption—HTTPS SSL, (viii) network ﬁrewalls, (ix) application security—application Firewall. 3. Protocol for the Trials During the six-month trial phase, general practitioners and specialized doctors supported the chronic and postsurgery patients from distance, minimizing routine transportation of patients from and to hospitals. The recruitment process was based on willingness, ability, and commitment of the patients referenced by medical personnel in charge. A training process was conducted concerning the use of devices and the proto- col of the monitoring program. Regular followup with users by the project partners involved scheduled reassessment, reassurance of the case management program compliance, corrective actions, reinforcement of the pilot patients and medical personnel. Particular attention has been paid to ethical issues. (i) The respect of their privacy: an internal Consortium Agreement regulated all the operations involving them with basic rules imposing the respect of their habits, their environment, and their times. (ii) The respect of an ethic code, ensuring a correct behavior and the respect of the patients’ rhythms and attitudes. Signs of discomfort or uneasiness on the user’s part during the evaluation activities have been taken into consideration. (iii) The collaboration with their family members: people surrounding the end users have been involved in the evaluation process. The patients have been provided with information about the purpose of the research activities, duration of their participation, and which procedures are followed. Sixteen patients suﬀering from chronic diseases partici- pated in the trials in Chios Island: (i) four hypertensive patients were monitoring their HR and BP, (ii) four individuals with chronic pulmonary disease (chronic asthma or chronic obstructive pulmonary disease) were monitoring their SpO2 and ECG daily, (iii) eight individuals with chronic cardiovascular disease were monitoring their ECG, BP, and weight. According to the rural health center scenario (Island of Chios) and the protocols that have been applied by the four General practitioners of the rural health centers together with two specialized doctors in Skylitsio General Hospital, the selected patients were measuring their vital signs frequently (2-3 times per week) in the rural health centers. Although the sixteen patients were using only