Inpatient rehabilitation following cardiosurgical intervention is a proven and effective method. However, this form of rehabilitation is cost-intensive and often lacks the means to establish a sound basis for sustained long-term success of the intervention. If a patient doesn't happen to live in the vicinity of a rehabilitation clinic, conventional outpatient rehabilitation is often deemed too impractical. Also, a clinic's resources for ambulatory rehabilitation can be limited, resulting in waiting lists for patients who want to continue their rehabilitation in such a manner. With (wireless) biomedical sensors becoming more available and affordable, and with an increasing percentage of homes having access to broadband telecommunications, tele-rehabilitation as a new option for rehabilitation is within reach. Tele-rehabilitation can take place at a patient's home and offers several advantages: It allows for a shorter inpatient phase of the rehabilitation, reducing the costs without diminishing the quality of care. An earlier discharge from the inpatient rehabilitation means an earlier return of the patient to their home, which is generally considered to add to the quality of life. The active involvement of the patient and thorough supervision both aid the process of secondary prevention. Feasibility and cost-effectiveness have been demonstrated for patients with cardiovascular diseases.

The objectives of the SAPHIRE project include the development of an intelligent healthcare monitoring system and a decision support system for therapy. For this purpose, a platform is being developed that collects data from wireless medical sensors and integrates them into the hospital information system (HIS). This patient monitoring is based on agent technology, whereby the "behaviour" of the agents is an intelligent clinical decision support system. This assistance system is based on computer-readable guidelines/guidelines derived from clinical treatment practice. Through semantically enriched web services, the guidelines are given access to the entire medical history of a patient stored in the HIS and the interoperability of the system is ensured. Thus, not only the data from the sensors can be used for the assistance system, but also the data already stored for a patient. A graphical tool supports the physicians in recording clinical procedures and ensures that a large number of procedures and guidelines can be recorded and are available in a computer-readable format. This intelligent healthcare monitoring system is being tested in two pilot applications. In the first application, which is being carried out in Romania, cardiac patients in hospital are being monitored 48 hours after surgery. The second application, in Germany, looks at rehabilitation in the home environment. In both applications, the medical practitioner has several options to be informed. At a web frontend, the physicians can decide about which patients they want to receive information, in which way (SMS/e-mail/web/pager) and set the thresholds at which alarm levels for a patient individually. OFFIS is implementing the interoperability platform in this project. This is provided on the basis of OSGi, which has created a comfortable and simple way for remote maintainability (home area) and high availability. The modular structure guarantees a high degree of reusability. Extensions or adjustments can be made at runtime. The wireless medical sensor data collected with this platform is then made available by OFFIS to the clinical decision support system (agent) through semantically enriched web services and also integrated into the HIS.

This project was carried out at OFFIS Health between 01/2006 and 06/2008. SAPHIRE was funded by the European Union under priority 2.4.13: Strengthening the integration of the ICT research effort in an enlarged Europe focus: eHealth.

Koslowski, O.; Lipprandt, M.; Busch, C.; Eichelberg, M.; Müller, F.; Willemsen, D.; Hein, A. (2011): The SAPHIRE Project: A Retrospective View on the Homecare Scenario. In Digital Homecare - Successes and Failures (Eds. L. Bos, A. Dumay, L. Goldschmidt, B. Manning, G. Verhenneman, K. Yogesan), Communications in Medical and Care Compunetics, Volume 3, Springer-Verlag Berlin Heidelberg 2011, pp. 181-196.

Nee, O.; Hein, A. (2010): Clinical Decision Support with Guidelines and Bayesian Networks. In Advances in Decision Support Systems (Edited by: Ger Devlin). ISBN 978-953-307-069-8, IN-TECH, 2010, pp. 117-136.

Busch, C.; Baumbach, C.; Willemsen, D.; Nee, O.; Gorath, T.; Hein, A.; Scheffold, T. (2009): Supervised training with wireless monitoring of ECG, blood pressure and oxygen-saturation in cardiac patients. Journal of Telemedicine and Telecare 2009; 15: 112-114.

Nee, O.; Gorath, T.; Hein, A.; Willemsen, D.; Busch, C. (2009): Cardiac tele-rehabilitation with SAPHIRE. 2nd German AAL Congress, Berlin, Germany, 27-28.01.2009, pp. 177-180.

Nee, O.; Hein, A.; Gorath, T.; Hülsmann, N.; Laleci, G.B.; Yuksel, M.; Olduz, M.; Tasyurt, I.; Orhan, U.; Dogac, A.; Fruntela, A.; Ghiorghe, S.; Ludwig, R. (2008): SAPHIRE: Intelligent Healthcare Monitoring based on Semantic Interoperability Platform - Pilot Applications. IET Communications, Volume 2, Issue 2, February 2008 pp. 192 - 201.

Nee, O.; Ludwig, R.; Hein, A.; Gorath, T.; Willemsen, D.; Stahl, K. (2008): Cardiological tele-rehabilitation with SAPHIRE. mdi - Forum der Medizin-Dokumentation und Medizin-Informatik. Special issue: Tele- and homecare in chronic diseases. Heft 1 / März 2008 (Jahrgang 10), Vereinigte Verlagsanstalten, Düsseldorf (ISSN 1438-0900), pp 24-29.

Nee, O.; Hein, A.; Ludwig, L.; Willlemsen, D.; Busch, C.; Scheffold, T. (2008): Cardiac tele-rehabilitation with the SAPHIRE system. Med-e-Tel, Luxenbourg, April, 16-18, 2008.

Nee, O.; Gorath, T., Hein, A., Ludwig, R., Willemsen, D., Baumbach, C., Scheffold, T., Stahl, K. (2007): SAPHIRE: A system for cardiac tele-rehabilitation. Telemedicine Guide 2008, pp 146-150.

Hein, A.; Thoben, W.; Appelrath, H.-J.; Jensch, P. (Eds.): European Conference on eHealth 2007. GI series "Lecture Notes in Informatics - Proceedings", Köllen Druck+Verlag GmbH, Bonn.

Hein, A.; Nee, O.; Willemsen, D.; Scheffold, T.; Dogac, A.; Laleci, G.B.: SAPHIRE - Intelligent Healthcare Monitoring based on Semantic Interoperability Platform - The Homecare Scenario -. 1st European Conference on eHealth (ECEH'06), Fribourg, Switzerland, October 12 - 13, 2006, pp. 191-202.