T4MOD - Remote Assistance for Medical Teams Deployed Abroad

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T4MOD LogoT4MOD project aims at defining, developing, realising, qualifying and validating a user friendly Telemedicine system, through an interoperable IP overlay satellite network associated with an intelligent end-to-end communication platform, capable of supporting different medical specialities. This solution, to be validated in a military environment, could also be extended for future exploitations in civilian field for organisations (for example national health systems) operating in underserved and/or geographically isolated areas (such as in the case of natural disasters or humanitarian crises) and to develop new medical protocols for a cooperative medical work of diagnosis and therapies. T4MOD involves as users the health Department of four Ministries of Defence: France, Germany, Italy and Spain.

Study/ Project Objectives

  • Developing a system capable to fulfil different needs in terms of applications and services for the provision of healthcare in the frame of military peace keeping missions, with the possibility of evolving towards civilian utilisation (for disaster relief and humanitarian missions);
  • Leveraging collaboration among public institutions within their national contexts and among the four representative member states;
  • Enabling the medical experts on the reference site to assist the remote site in case of a medical emergency or during a planned consult;
  • Provide an easy to use solution able to be operated by medical and non-medical (but trained) personnel;
  • Procuring technical elements (satellite capacity, IT elements, critical breakthrough medical technology, etc.) to implement the designed system;
  • Ensuring inter-operability (with other systems used by the same Medical Service) and intra-operability (among different Medical Services of the four MoDs) via the overlay provided by the T4MOD system;
  • Providing an intelligent and cost effective solution requiring minimal training, installation, maintenance and running costs;
  • Developing and enabling an optimised shared approach for the satellite capacity to minimise the communications costs;
  • Providing a comprehensive framework for evaluating the applications and the project overall outcomes.
  • Deploying the system both in peaceful and mission environments, performing field trials to validate the capabilities and usefulness of the system.

Target Users

The system is addressed at end users belonging to Military Health Services in France, Germany, Italy and Spain. The hospitals involved in the pilot will be in Europe and in some remote areas of operations.


The main need refers to Medical Services deployed for peace keeping and humanitarian missions in geographically isolated and underserved areas, with the most difficult environmental and operational conditions due to the lack of local medical specialists. The T4MOD project will use two space assets (i.e. satellite communications and use of a technology initially developed for manned spaceflights: robotised tele-echography).


T4MOD aims at offering an innovative architectural solution in terms of a system and associated operational Telemedicine services; strong points will be the provision of broadband communications over very wide coverage in mesh topology, the ability to manage dynamic on demand access using a simple and user friendly interface for the end users and the ability to handle different resources booking according to the four reference Medical Services needs. The proposed solution presents some characteristics:

  • A satellite capacity will be shared between the users and made available via a suitable scheduling or on priority basis;
  • A distribute deployment: hospitals have to create an ad-hoc structure in terms of logistics, inventory stocks, skilled personnel devoted to maintenance, help desk and management of satellite infrastructure distributed on single sites;
  • An on-demand solution, based on assignment of satellite resources according to the needs, consequent to the non-continuous nature of the T4MOD service;
  • An integrated algorithm also able to manage and assign medical resources and specialists;
  • The T4MOD Network Control Centre (TCC), main core of system and located at the Fucino Space Centre (FSC, Central Italy).
  • Security: authentication and confidentiality thanks to the security  framework implemented at the MoD sites.

In the following figure the high level T4MOD architecture is depicted:
T4MOD Architecture


Key Issues

In this project a number of critical elements will be addressed. The most important of them are those concerning the characterisation of medical services in a military environment, those related to interoperability issues (analysing the technical aspect and implementing a common application layer) and finally those involving the security considerations (aiming at dealing with the aspects of IP acceleration, compression and security that will guarantee the compliance of the architectural proposed solution with the security norms and regulations that are applicable for telemedicine service).

Expected Main Benefits:
The implementation of telemedicine services on a large scale is inherently affected by a number of barriers that the T4MOD project tries to overcome with the support of institutional entities such as MoDs, National Space Agencies and ESA.

This common effort should mitigate the hurdles of barriers, helping the project to develop an effective solution and address all the necessary issues with adequate answers.

The T4MoD project is expected to deliver costs reduction due to the utilisation of medical information for better decision (e.g. avoiding non necessary medical evacuations), cooperative use of shared technical resources, decrease of medication errors, improved labour productivity and additional health care.

Service Concept

The following telemedicine services will be the primary focus of the project:

  • Radiology
  • Microbiology
  • Cardiology
  • Dermatology
  • Trauma surgery
  • Neurosurgery
  • Intensive care
  • Emergency medicine (casualty care and management)

A high layer application will be developed with the purpose of managing the services within and inter- and ita-operable environment. This layer will simplify the system operations and integrate elements that could simplify the standard medical workflow while keeping the compliance with the working procedure of the end users. Finally it will help to extract, in the friendliest and automatic way, those parameters that could contribute to measuring the clinical performance gain. These important advantages will be enhanced by means of an efficient satellite architecture.

Space added value

T4MOD relies on two main assets coming from space technologies: on the one side satellite communications, and on the other side a robotized tele-echography solution initially developed to support crews onboard the International Space Station.

Current Status

Following the CDR and AC board discussions some actions have been envisaged and completed so far. The most important decision agreed by the Consortium concerned a new approach in terms of profiling and management of the offered telemedicine services. This new approach results in the utilisation of ANTARI software libraries that provokes a centralised architecture structure and guarantees better performances for the offered services. The ANTARI introduction also causes baseline requirements retailoring, consequent documentation updating and some security issues concerning Data Management and Privacy that the Industrial Team is investigating.

The activities concerning the procurement of the COTS items and the development of some application elements have been almost completed. Activities concerning subsystems integration are on-going with the purpose of preparing the system test bed to be used during the system acceptance test (DQR Milestone, June, 24th 2013) to be held in Telespazio Fucino Space Centre (T4MOD Network Control Centre).

In the meantime, an accurate site survey is currently taking place to properly prepare the system deployment and start after the DQR milestone, the European demo campaign and the Field Trials planned between the second half of 2013 and mid 2014.

A first iteration concerning the project sustainability analysis has been performed comparing ASSIST tool outcomes and costs breakdown belonging to the project initial business plan.

Leading Partner

Leader Company Name: 
Telespazio S.p.A
Leader Company Country: 


Company Name: 
GMV Soluciones Globales Internet S.A.U.
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NDSatCom GmbH
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Company Name: 
Dialcom Networks S.L.
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DLR e.V.
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Project Managers

ESA Project Manager

Francesco Feliciani
Keplerlaan 1
2201 AZ
United Kingdom

Partner Project Manager

Aldo Vincenzi
Via Tiburtina 965
United Kingdom

Related Links

Status Date

16 April 2013