Abstract
PURPOSE: The primary objective of this study was to develop and implement a Hybrid Cloud Environment for Telerehabilitation (HCET) to enhance patient care and research in the Physical Medicine and Rehabilitation (PM&R) domain. This environment aims to integrate advanced information and communication technologies to support both traditional in-person therapy and digital health solutions. BACKGROUND: Telerehabilitation is emerging as a core component of modern healthcare, especially within the PM&R field. By applying digital health technologies, telerehabilitation provides continuous, comprehensive support for patient rehabilitation, bridging the gap between traditional therapy, and remote healthcare delivery. This study focuses on the design, and implementation of a hybrid HCET system tailored for the PM&R domain. METHODS: The study involved the development of a comprehensive architectural and structural organization for the HCET, including a three-layer model (infrastructure, platform, service layers). Core components of the HCET were designed and implemented, such as the Hospital Information System (HIS) for PM&R, the MedRehabBot system, and the MedLocalGPT project. These components were integrated using advanced technologies like large language models (LLMs), word embeddings, and ontology-related approaches, along with APIs for enhanced functionality and interaction. FINDINGS: The HCET system was successfully implemented and is operational, providing a robust platform for telerehabilitation. Key features include the MVP of the HIS for PM&R, supporting patient profile management, and rehabilitation goal tracking; the MedRehabBot and WhiteBookBot systems; and the MedLocalGPT project, which offers sophisticated querying capabilities, and access to extensive domain-specific knowledge. The system supports both Ukrainian and English languages, ensuring broad accessibility and usability. INTERPRETATION: The practical implementation, and operation of the HCET system demonstrate its potential to transform telerehabilitation within the PM&R domain. By integrating advanced technologies, and providing comprehensive digital health solutions, the HCET enhances patient care, supports ongoing rehabilitation, and facilitates advanced research. Future work will focus on optimizing services and expanding language support to further improve the system's functionality and impact.