Trust and Scalability in Remote Patient Monitoring: Tellu's Journey with ENTRUST

Healthcare systems across Europe are under increasing pressure. An aging population combined with a rising burden of chronic diseases like diabetes, is straining traditional in-person care models. At the same time, many countries face shortages of healthcare personnel, particularly in rural areas. 

Remote Patient Monitoring (RPM) offers a practical response to these challenges, enabling continuous care for citizens while living at home, reducing the need for hospital visits, and helping healthcare providers allocate their limited resources more effectively.  

Tellu, ENTRUST project partner, provide the TelluCare platform, a cloud-based eHealth solution offering a suite of services within the eHealth domain. In the TelluCare Remote Patient Monitoring module, they collect vital health measurements from medical devices deployed in patients' homes through our Personal Health Gateways (PHGs), to allow health personnel to follow up patients remotely in a secure and simple manner. 

As RPM services scale to potentially hundreds of thousands of patient homes, ensuring security, privacy, and regulatory compliance across this distributed infrastructure becomes significantly more complex. This is what Tellu's participation in ENTRUST is addressing. 

The Challenges We're Addressing With ENTRUST 

Tellu is one of several use case partners in ENTRUST, exploring how the solutions offered by the ENTRUST framework can solve challenges, an industry is facing in this domain, currently and in the near future. Partners identified three main challenges which they wanted to explore how ENTRUST could help us tackle: 

1. Efficient and trustworthy onboarding: Their previous process for onboarding new PHGs was manual, time-consuming, and lacked robust integrity verification. With a growing customer base, Tellu needed a scalable approach that could also verify device trustworthiness before deployment. 

2. Robust fleet management: Managing large numbers of distributed devices presents operational challenges. Devices may be stored for extended periods, and when they eventually come back online, remote health checks and timely software updates are critical. 

3. Compliance verification: Operating in the healthcare sector means adhering to strict regulations like GDPR, as well as various national frameworks. As a certified medical service provider, demonstrating compliance during audits requires substantial documentation. Tellu wanted to explore more automated approaches for generating and managing compliance evidence. 

What We've Accomplished 

Through both the components provided by the ENTRUST framework and the learnings from the discussions and workshops throughout the project, the team has explored solutions to these problems. Some main accomplishments from the project so far are: 

• A redesign of the PHG software stack and cloud architecture to incorporate several framework components. Further, the team explored a new two-phase onboarding process. The Manufacturing Onboarding phase handles device provisioning before shipping, including ENTRUST Zero-Touch Onboarding and initial trust assessment. The subsequent Domain Onboarding assigns devices to specific customer accounts with trust verification. 

• Tellu has developed an integration with the Kardinero  KardinBLU ECG device as a third-party connected medical device, demonstrating how ENTRUST enables secure onboarding of devices not directly controlled by the service provider. This integration now supports full lifecycle management through the TelluCare interface. 

• For fleet management, Tellu deployed the ENTRUST Secure Software Update component using the Digital Twin-based approach. The system monitors device metrics continuously and can detect when software versions need updating for both the PHG and the connected medical devices, triggering secure updates with verified delivery. This approach can significantly exceed our current level of control regarding device management at scale. 

Looking Ahead 

As the project moves forward, the team is evaluating the measurements captured during the latest experimentation period to understand how we can apply these learnings and potentially exploit some ENTRUST technologies in the TelluCare services. For Tellu, the ENTRUST project has already offered valuable hands-on learning and insights that will help guide our thinking as we continue refining our approach to security and trust for large-scale operations. 

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This blog post was written by ENTRUST partner Tellu

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