In the early part of the 2010-decade, a number of Danish research projects were experimenting with the collection of patient monitoring data in the home of the patient. Some projects were using existing proprietary systems, while others chose to develop new software prototypes, and release the source code of these prototypes as open source for the benefit of future projects. Soon, these prototypes were used in large-scale experiments, and the need arose to ensure the continued life of these maturing software platforms after the research projects ended (and funding expired).
At this time – during the spring and summer of 2013 – the 4S foundation was created to govern this pool of open source software created by all these research projects, and to lead the software maturing process into the future. The following time-line presents an overview of the history of these projects up to the time, 4S was founded.
These research projects can roughly be divided into two categories: A group focused on software infrastructure and national architecture, and a group focused on (large scale) pilot testing of concrete use cases:
The first group (Connect2Care, Net4Care, End2End Demonstrator, and Telemed.nu) explored ways to standardise the collection of patient monitoring data, in particular the new (at the time) guidelines from the Continua Health Alliance. These research projects participated in the creation of Danish profiles of key standards (PHMR, QFDD, and QRD) and created the Net4Care toolbox as an open source demonstration. The End2End Demonstrator project finally made a full system demonstration aligned with many of the recommendations from the Continua Design Guidelines, demonstrating how data collected in the home of a citizen could automatically be handed over to one of the Electronic Health Record systems used in one of the Danish regions. Another key outcome from these research projects were the participation in formulating the Danish national Reference Architecture for Collecting Health Data from Citizens published in mid 2013 as indicated on the time line.
The second group (TELEKAT, Tele Skejby, Telecare Nord, and KIH) focused on real-life testing the use of remote patient monitoring with citizens/patients and clinicians. TELEKAT and the Telecare Nord (North) would focus on COPD patients in the North Denmark Region, Tele Skejby on pregnant women in the Central Denmark Region, and the KIH (Clinically Integrated Home Monitoring) project would continue the Tele Skejby project in both the Central Denmark and Capital Region, extending the scope with more use cases (e.g. how to share the collected data between systems) and medical diagnoses according to the Danish national Action Plan for Dissemination of Telemedicine which was authored at this time. In the early part of the Tele Skejby project, the project group decided that the business case for developing their own telemedicine platform was better than using a proprietary system, so they began developing what we now know as the OpenTele platform in early 2012. The Telecare Nord project would soon come to the same conclusion and adopted OpenTele as well. Later, in the KIH project, the KIH Database was developed – partly using Net4Care software – as an adaptation between the OpenTele platform and other regional and national systems, such as Electronic Health Record systems and the Danish e-Health Portal.
The primary funding of 4S for the first couple of years came from the Telemed.nu project (which was in turn funded by The Danish Agency for Science, Technology and Innovation).
Information about the projects mentioned above:
Research journal papers describing the birth of 4S and the vision behind it: