European Space Agency



SKYMED is an initiative launched in 2000 dedicated to develop and operate on a pilot service phase an advanced satellite based e-Learning system to support Continuing Medical Education (CME) services. The final objective of the project was the set-up and validation of satellite services with performances not comparable to those available at present on Internet terrestrial systems and the definition of CME services as part of Telbios' spin-off company portfolio.

The Project dealt with several aspects: technical, organizational, educational and strategic, all of which made the project very challenging. From a technical point of view, the system is based on a multi-terminal service centre derived from the integration of the Euromednet Telemedicine Operation Centre (TOC) based on DESNET platform and SkyplexNet for multicasting/broadcasting. SKYMED has its major competitive advantages on exploiting Skyplex technology which, granting the distributed access to the satellite transponder, turns out to be the best tool to provide multimedia services in accordance with DVB-S standard directly from the content provider premises.

Part of the SKYMED project has been addressed to define and develop a suitable multimedia interface for on-line and off-line training activities, providing textual chat interactions among the different client sites. Live lectures and presentations increase the immediacy of the content and enhance the users' feel of 'really being there'. So far SKYMED has distributed six courses (one on Medical Imaging, the others on Ambulatory Surgery) and CME, in general, to seven hospitals, to ten individual users in the Veneto Region in Italy, 2 individual sites outside Italy (UK and the Netherlands). The involvement of public healthcare institutions and private individuals implied the management, in the frame of the project, of organizational and logistic aspects peculiar to the implementation of e-learning services.

The SKYMED system has


Continuing Medical Education (CME), or the broader term Continuing Professional Development, (CPD) is considered a moral obligation in many countries, not only for physicians but for all health care professionals. Without the continual education of health professionals, progress is not possible. New developments, methods, techniques, etc., in medicine and health care are being put into practice daily and a patient rightfully expects that doctors and nurses be able to administer "state of the art" medical care. Therefore, CME/CPD is an important issue for national authorities.

In Italy, it has been established by law, (Decreto Legislativo 19 giugno 1999, n. 229 -  'Norme per la razionalizzazione del Servizio Sanitario nazionale, a norma dell'articolo 1 della legge 30 novembre 1998, n. 419'), that CME is mandatory for physicians. In other words, each physician, every 5 years, has to demonstrate the acquisition of a certain amount of 'credits'. The "Providers" are the entities entitled to certify and manage the CME credit assignment processes. After a preliminary experimental phase promoted by the Italian CME Commission aiming to provide feedback and indications for the definition of the e-learning guidelines, in April 2005 the "Government-Regions Conference" approved a document for the re-organization of the CME in Italy through the creation of new offices that should support the National CME Commission.
Based on this agreement (between Government and Regions), CME through e-learning should start within the end of 2005.

CME Contents are an issue. Many difficulties had to be overcome during the development of the teaching and communication models. Firstly, authors were not familiar with the new multimedia teaching tools. Authors had to construct lectures and teaching materials for a variety of media (audio-video lecture, slides and course content). They had to take into account the backgrounds of the different targets, specialists,


Aimed initially at physicians, but with eventual benefits for all medical workers, from hospital managers to nurses and surgeons, SKYMED's fundamental goal is to make Continuous Medical Education (CME) more readily available.

Currently, doctors are required to fulfil most of their educational needs by attending events such as seminars and congresses at both regional and international levels. The travel costs associated with these can not be sustained unless sponsored by the pharmaceutical industry.

Balancing these costs and legislation, such as the Italian law (Decreto Legislativo 19 giugno 1999, n. 229 - 'Norme per la razionalizzazione del Servizio Sanitario nazionale, a norma dell'articolo 1 della legge 30 novembre 1998, n. 419') which requires physicians to acquire a set number of educational credits every five years, is proving a dilemma for doctors.

Physicians are less likely to frequent CME events because it has been too costly for them to attend. The average physician in private practice not only sustains an unrecoverable income loss, but must also pay travel, registration, hotel and other expenses associated with such events, unless sponsored by the pharmaceutical industry.

The SKYMED challenge was to be an appropriate and cost-effective means of meeting life-long learning needs of healthcare professional, through a variety of independent formats and delivery media (satellite broadcast, content package delivery, etc.).

Technology- driven self-study CME sources based on distributed, or distance-learning multimedia broadband platforms thus look like the viable cost-efficient and user-friendly alternative to conventional methods.

SKYMED, as e-learning solution, becomes important in CME because it can avoid bridge gaps (both national and international, cultural and language gaps), it can bring education to the health professional and it empowers the learner for more effective and individualized learning by pr


The SKYMED System consists of the following major elements:

  • The SKYMED Service Centre also referred to as Tele-medicine Operation Centre (TOC)

  • Client receiving terminals

  • The SKYMED Content Provider
The architecture is the result of the analysis of different approaches considered to achieve the EuroMedNet-SkyplexNet integration, each requiring different client typologies and related costs while providing different quality levels on different services.

A key element in the selection of the integration strategy has been the re-use of the existing hardware and software components, as far as possible. Another criterion is to keep the system complexity low while testing new pilot applications.

Hence, the overall architecture reflects the following integration scenario:

  • The SKYMED Service Centre manages the overall bandwidth capacity (on Eutelsat SESAT and on Eutelsat HB6) and service scheduling on both satellites

  • Dynamic bandwidth capacity reservation is performed for Eutelsat SESAT only; static bandwidth capacity is allocated to SKYMED on HB6 due to the missing of software interfaces between the TOC and the SkyplexNet NOC (Network Operation Centre).

  • SKYMED content is directly transmitted towards the satellite and the related transport stream is then multiplexed on-board with the transport stream (TS) of other content contributions originated by other providers. The multiplexed TS is forwarded in downlink as a conventional DVB-S stream which can be received by Personal Computers equipped with a DVB reception board, or by DVB receivers/routers, able to distribute the multicast traffic within the Local Area Network of the remote attendants sites.

  • The SKYMED Service Centre hosts the off-line DVB content

  • The SKYMED Content Provider generates and transmits live courses only

  • SKYMED DVB users receive DVB content both from SESAT and HB6.


The Project has been developed in 3 phases:

Phase I
The purpose of phase I was to demonstrate the technical, operational and commercial feasibility of the project. The SKYMED service requirements, the Pilot System Architecture and the Utilisation Plan were frozen during this phase. The phase ended with the Baseline Design review (BDR).

Phase II
During this phase, the SKYMED system (SKYMED Operation Centre, client sites installation, Continuing Medical Education courses, evaluation policies, etc.) was set-up for the Pilot Operations. The Distance Learning Model was defined in this phase as well as the production of all course contents and their packaging in different multimedia formats. In addition, an assessment of the commercialisation strategy was performed. The phase ended with the Mid-Term Review (MTR).

Phase III
SKYMED Pilot Operations were performed in this phase. The phase ended with the Final Review (FR) where the pilot Operations evaluation results, recommendations gathered from the end user community, and the future strategy were provided.

Current status

Overall, the learning model and content were well accepted and most participants consider distance education as a viable form of CME. In some cases, telephone interviews were used to assess progress and better evaluate participants' satisfaction or dissatisfaction: nurse participants expressed enthusiasm about the course and felt that others would benefit from this course; physicians expressed interest in distance education (eLearning) and in SKYMED courses in general.

However, the main factor contributing to their motivation to participate to the Pilot (off-line courses sections) was the courses accreditation. During the Pilot Operations, SKYMED courses were not accredited due to the lack of any indication and rules for e-learning from the CME Commission. In July 2004, SKYMED courseware (5 courses on Day Surgery) was inserted in the catalogue of a national experimental program on testing eLearning in the Public Hospitals sponsored by the Ministry of health and coordinated by FIASO and Federsanità ANCI. This project gave wide visibility to the SKYMED off-line product and the opportunity to extend the pilot project to a wider group of participants. For this purpose, SKYMED courses were accredited for CME.

The use of satellite communications confirmed its value when both the video quality and the reaching of all users with guaranteed bandwidth are requirements. In the SKYMED context these requirements are mandatory when live surgical operations are transmitted. SKYMED, as it is, can play a role in the CME interactive multimedia satellite services and in particular to support:

  1. Special Events: conferences with a participation geographically distributed, surgical intervention, where the video quality is a requirements, etc. in support to educational programs and then with a direct link with the CME programs (e.g. live event in the context of a CME residential or on-line course), or as stand alone events.

  2. Special e-learning Project: international education project with a strong component of "live events" via satellite transmission and utilization of "virtual classroom" instruments.
According the initial strategic objectives, SKYMED platform's services are currently part of a more articulated Telbios e-learning offer based on two lines of products:

  •  "MedConference" for occasional events (congresses, lectures, etc.)

  •  "MedLearning" for education and information (courses)

What SKYMED team experienced during the project development is the need to have an integrated solution able to manage the whole learning and teaching process. The need is clear to have flexible e-learning systems which are designed for reuse and personalization, dynamically addressing the learning needs whenever and wherever they arise.

Based on this consideration there are some topics that SKYMED in the near future will take into account, as integration to the current provided functionalities, in order to be a competitive product on a commercial basis and these are:

  • WEB based Learning Platform

  • Hybrid WEBCD and WEBDVB Supports

  • Content for different devices, fixed, mobile or wireless, such as Web station, digital TV set-top boxes, e-books, mobile phone, etc.

  • Broadband Interactive Distance Learning Technologies and Architectures

  • Distributed Learning databases and Networks

  • Learning Objects metadata indexing, storage and retrieval.

SkyNurse, a project co-funded by the European Space Agency, developed by TelBios and Padova Ricerche for the distance education of nurses, takes into account part of these recommendations.


Status date

Thursday, June 19, 2008 - 17:49