The Complexity of eHealth Architecture: Lessons Learned from Application Use Cases

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The proposed architecture is a generic architectural framework centred on data management issues, for up-to-date eHealth solutions. Its description provides the opportunity for an extended review of all relevant technologies, which is a valuable contribution that could be of interest to a large number of interested readers. Being generic, the proposed architecture is expected to accommodate architectural solutions for a large variety of particular systems. The two application use cases presented in Section 3 are relevant in this respect, considering their complementarity in implemented eHealth approaches. 

In Section 2, it is mentioned that, regarding the Legal Frameworks and Regulations, the focus is on the EU context. This approach may be considered justified for a State-of-the-Art analysis.  However, from an implementation perspective, the national context should be considered first, including an evaluation of its compliance with EU-level regulations. 

Considering the topics of the Special issue, I propose that the authors assess the opportunity of emphasising the AI-related issues in the description of the proposed architecture.

In the same section, Figure 1, the content of data management boxes for ”Fog-centralised Networking” and ” Centralised Processing” should be interchanged in my view.

In Section 3, it would be interesting to know what development stage, including the Technology Readiness Level, has been achieved in the presented use cases. Are the identified challenges the result of their demonstration or proof in an operational environment? 

At the end of Section 4, the need for extensive validation of the proposed eHealth architecture is emphasised for a larger number of eHealth systems covering a broader scope, to classify and compare them.  I am wondering whether developing an architectural toolkit of ready-to-use components compatible with the targeted regulatory framework and supported by available technologies could be a more effective evolutionary path for the proposed generic architecture.

Regarding self-citations, they are justified by the authors' contribution to the development of the analysed use cases. Nevertheless, one of the authors is a co-author of seven references, so I suggest he reconsider this level of self-citing.

Author Response

Dear Reviewer, please find the reply to your comments in the file attached

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

** Quantitative indicators of architecture efficiency are not presented (for example, data processing speed, error rate, scalability). This makes it difficult to objectively assess the advantages and disadvantages of the proposed solution. ** The German case notes the difficulty of data integration due to the heterogeneous sensor formats. Despite the mention of standards (HL7 FHIR, SNOMED CT), the details of their implementation and effectiveness are not sufficiently disclosed. ** Both cases revealed problems with the adoption of technology by users (elderly patients), but the proposed solutions (for example, simplification of interfaces) are described superficially. There is no analysis of long-term adaptation. ** On page 25, the text goes beyond the page boundary. ** It is recommended to check the design requirements. Should the "References" section be marked as an appendix ("Appendix A Appendix A.1")?

Author Response

Dear Reviewer, please find the reply to your comments in the file attached

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This paper is a case-based architecture analysis and proposal, which aligns well with the scope of Computers (an ESCI-indexed journal). While it lacks dataset-based experimental validation, it provides value by conducting an in-depth analysis of two real European projects and deriving architectural lessons and alternatives. Therefore, I believe it is publishable after minor revisions (clarification of research type, more concrete interoperability analysis, and strengthening of generalization discussion).

Minor Issues

1. This paper is not an experimental dataset analysis, but rather a case-based architecture analysis and proposal. The authors should make this explicit in the Introduction or Methodology so that readers do not mistakenly expect a clinical or data-driven validation study.
2. The Italian (heart failure management) and German (fall monitoring) cases are well-structured, but the generalizability beyond Europe is limited. The authors should clarify that the proposed framework is optimized for European regulations (GDPR, NIS-2, etc.) and explicitly note that additional considerations are required for applications in non-European contexts.
3. Although international standards such as HL7 FHIR, SNOMED CT, and LOINC are mentioned, the description of technical and organizational issues encountered in real implementation is somewhat abstract. The paper’s practical contribution would be stronger if at least one case presented a more detailed account of data flows, standard adoption, and specific interoperability challenges.
4. While the paper provides a clear account of the technical architecture and regulatory framework, real-world implementation challenges (e.g., limited technology adoption among elderly patients, network disparities, resistance from healthcare staff to workflow changes) are treated only briefly. Since the strength of a case-based study lies in highlighting such practical challenges, a more detailed discussion would enhance the contribution of the paper.

Author Response

Dear Reviewer, please find the responses to your comments in the file attached.

Author Response File: Author Response.pdf