Real-Time Remote Patient Monitoring in Mountainous Regions: Architecture and Pilot Deployment of a Telemedicine Ecosystem

The rugged morphology and dispersed settlements of the Calabrian region pose long-standing barriers to timely and equitable access to healthcare, particularly for elderly and fragile populations living in mountainous areas. In this paper, we present a telemedicine ecosystem specifically designed for Calabria that integrates certified wearable wristbands, secure communication infrastructure, and intelligent back-end services to enable continuous home monitoring and rapid clinical intervention. Building on the SidlyCare platform, the system acquires real-time physiological signals (heart rate and oxygen saturation), streams them to a central server through encrypted channels, and applies machine learning and deep learning-based anomaly detection models to identify both acute and insidious deteriorations in patient status. Alerts are propagated via a multi-stakeholder workflow involving patients, family caregivers, general practitioners, non-profit organizations, and local health authorities, who interact with the platform through role-specific dashboards that support longitudinal visualization, risk stratification, and integration with existing electronic health record infrastructures. A pilot case study in a tele-home care programme for elderly patients in Calabria demonstrates the feasibility and potential of this architecture to improve safety, foster patient engagement, and strengthen continuity of care in geographically isolated communities, offering a scalable blueprint for territorial telemedicine in similar rural and mountainous contexts.