The latest computer and communication technologies in combination with an enhanced ECG analysis system can be used to improve cardiac patient's follow-up out-of-hospital. In this way, real-time transmission of the so-called ambulatory electrocardiogram (AECG) to a remote health application with awareness of the patient's context can support decision making as well as to allow efficient emergency attendance. However, the effectiveness of such a service requires tackling challenges of hardware and software beyond the common issues normally addressed in the literature. This paper proposes an ECG provisioning system that handles advanced issues such as flexibility and interoperability in pervasive scenarios as much as the well-known need for efficient transmission. This system architecture embraces an ECG analysis system based on hidden markov models and makes use of an original ECG markup language. Categories and Subject Descriptors J.3 [Computer Applications]: Life and Medical...