The Healthware project has designed, manufactured, integrated, tested and validated a telemedicine and telecommunications platform to be used for interactive tele-consultation, remote interactive training, second opinion and homecare. The most important achievement was the actual architecture and the results from the pilot medical networks. Indeed, the pilot medical networks operation has validated the architecture and helped to propose how the platform or part of it could be used in the future. The Healthware telemedicine network The Healthware telemedicine network is composed of about 40 sites over 7 European countries. Sites are equipped with DVB-RCS satellite terminals and with telemedicine workstation to connect to the Healthware telemedicine platform and access to the services. The Healthware telemedicine platform The Healthware telemedicine platform provided end-users with access to the services, allowed progress of the validation phase and to generate feedback from the users. As soon as platform integration has been completed and sites acceptance tests done, the pilot network leaders have been proceeding with the usage phase. Thales Alenia Space was collecting and updating a weekly usage planning in order to provide the whole consortium with an up to date view of the planed usage. Each pilot network leader was in charge of managing sessions, inviting participants and make sure of the good achievement of the session, providing regular feedback to the technical staff about problem or malfunctioning. Concerning software application, and in order to avoid installation of various solutions on the Healthware pilot network sites, a trade-off was conducted after a few months trial period. Finally, Thales Alenia Space multimedia communication software was approved by the whole Healthware end-users community and installed on each telemedicine workstation. The proposed multimedia communication software is a collaborative working software based on a client/server architecture, which allows remote users to join a virtual room to work with and get real time and interactive feedback from the other participants as if it really was physically in the meeting room. Main features of the software, both at client and server sides are as follow: - The chat is a handy tool used for text based conversations. The chat module is useful when you do not want to use audio, during a presentation or lecture for instance. It is also useful for getting people's attention. A message sent through the chat area is seen by all the participants. On the other hand, the leader has got also a powerful one-to-one function that can be used to send audio and text messages to a single recipient. - The whiteboard is ideal for sharing and commenting documents and drawings, taking meeting minutes, scribbling and sketching, etc. It supports multiple pages which in turn can be used simultaneously by several users. Pages can be saved to disk and later on reopened. It is possible to import images, text and MS Office documents (it can also share/present any other window open on the computer). It can also capture and import picture from the webcam in real time. - Synchronised web surfing: the application supports collaborative web surfing, i.e. one participant can lead others on the world wide web (WWW) and browse pages to provide participants with particular contents. It uses default computer web browser like IE, Firefox, Safari, … and is compliant with Flash or Dynamic Web technologies. - File transfer. - Application sharing: Microsoft Office, Professional, possible sharing using computers with different operating system (Linux / Windows). - Videoconference : video codec H.264, H.263, H.261, audio codec Speex, GSM, transport stream RTP/RTSP, UDP. - Videostreaming: streaming of video/audio data flows from IP camera (MJPEG / MPEG-4 or H.264), streaming of video files (AVI, OGG, DIVX, MPEG, VM ...), processing of webcam images (contrast, alpha, zoom), video sizing (QCIF, CIF, 4CIF, Full Screen). - Connection in unicast or multicast mode. - Multiplatform (Windows, Linux, and Mac OSX). - UDP and/or RTP streaming. - NAT traversal with the STUN technology. Helathware pilots were running meanwhile at hospitals and universities in Cyprus, Czech Republic, Greece, France, Poland and the United Kingdom. The selected scenarios and practical examples demonstrate the way the Healthware pilots contribute to a better delivery of health care by employing satellite telecommunications. Following are some examples of telemedicine realisation done in the frame of the Healthware project's experimentations. Based on the significant Healthware network usages, an acceptable level of sustainability of the end-to-end solutions has been achieved. It is a sign that the delivered solutions are close to 'operational' conditions and have reached an acceptable level of performance to go on the market. Regarding delivery of 'turn-key' end-to-end service, the pilot operations have evidenced the difficulty to efficiently integrate the whole set of operation components (applications, automatic processes, quality of service, satellite system and network, satellite terminals, operations) supplied by different providers to ensure an efficient support and troubleshooting to the users and / or to anticipate problems at the user site: the fact that difficulty in setting up properly the end user local network is not of the responsibility of the service provider, however it may considerably impact the felt added value of the delivered service. Multiple competences are needed (software, networking, satellite communications, video and audio) and trouble-shooting procedures must be thoroughly studied and established, on site interventions well ruled (otherwise resulting in high operational costs) and the terminal hardware well selected and adapted to the kind of users (for instance, noisy satellite modems are designed to be hosted in professional computer rooms, not at home). This just further evidences that the integration work is not obvious, requires high efforts and shall not be considered on a case by case, but from a specialised service operator provided that the market creates the conditions for sustainability. Regarding usages (duration, frequency, etc…), the Healthware project has demonstrated that the proposed telemedicine solutions well suit to remote interactive training, interactive teleconsultation, second opinion as different kind of usages can now rely on the same software and system.