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July 18, 2017

How NASA uses telemedicine for astronauts in space—and what it can teach hospitals on earth

Daily Briefing

NASA's experience using telemedicine to treat astronauts on the International Space Station can help improve care in "resource-constrained environments" back on Earth, Anil Menon, a physician and Air Force and NASA flight surgeon, and colleagues write for the Harvard Business Review.

Why telehealth technology isn't enough

Four times per year, the world's space agencies send astronauts and cosmonauts to the International Space Station, where they stay for six to 12 months at a time. While they're there, "access to medical care is crucial," the authors write. These long-duration missions call for "a much wider-ranging mandate" for medical care "beyond minor illness and urgent care," the authors explain—and that's where telemedicine comes in.

"Telemedicine enables preventive, diagnostic, and therapeutic care during many months in space, and ideally allows for seamless continuity of care before and after missions," they write. However, deploying telemedicine successfully requires planning and training ahead of time, along with clear communication and "rapid learning" on the mission.

Three telehealth lessons that apply to life on the ground

The authors outline their experience with planning, training, and communication and rapid learning—all of which apply to other resource-constrained environments.

Planning: A medical team of doctors, nurses, biomedical engineers, and other specialists plan the medical care for each mission based on the "mission profile"—the factors that influence medical needs and risks, such as flight duration and medical evacuation capability. The experts determine the material assets, such as medicines and instruments, and intangible assets, such as medical expertise and protocol, that the crew will need.

Training: Ahead of the launch, the astronauts learn how to use onboard medical instruments. Because there isn't always a doctor on each mission, some astronauts receive paramedic-level training to qualify as a crew medical officer. A group of experts evaluates NASA's procedures and medical kits to ensure they meet current best practices.

Good communication and rapid learning: Astronauts, doctors, nurses, and Mission Control personnel develop strong operational skills through classes, practice, and simulations, the authors write. These trainings teach the team how to communicate about and respond to a "range of medical concerns." When emergencies arise in flight, crew members will act immediately in line with their training. Afterward—and for less-pressing medical issues—the crew will have a private conference with a doctor on the ground, conducted over a secure connection set up by a biomedical engineer.

A case study in the sky

In one instance, an International Space Station crew member with a history of knee injury started experiencing knee pain during exercise training while on a six-month mission. After two days of pain and occasional over-the-counter painkillers became ineffective for the crew member, the team arranged a private medical conference with the physician on the ground.

The physician requested an ultrasound of the affected joint. According the authors, ultrasound is the only medical visualization device currently available on a spacecraft: "The technology is radiation-free, versatile, cost-effective, and easily repeatable, and its results are more reliable and less operator-dependent than techniques such as computed tomography and magnetic resonance imaging."

In the case study, NASA ultrasound specialists on the ground led the crew through the procedure. An orthopedic radiologist viewed the image in real time and gave a preliminary impression. After the full imagery was downloaded from the space station, the radiologist was able to confirm the diagnosis.

The affected astronaut was directed to reduce exercise and take medication. He was later able to resume the normal exercise routine and "completed the mission without difficulty," according the authors.

The authors write, "The procedure would not be possible without telemedical remote guidance by an experienced ultrasound 'guider' on the ground, and could be incomplete without additional expertise from the remote radiologist." They add that the pre-mission training and engagement during the encounter were also key to its effectiveness.

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Applying the lessons on the ground

The authors contend that the approach "would hold true for other 'guidable' medical procedures as well, such as a dental procedure, minor surgery, or acupuncture." They continue, "The remote guidance paradigm works in remote care scenarios wherever imaging technology and internet connectivity are available but local expertise is lacking."

Further, the authors contend that NASA's lessons could be applied to a range of areas that are "currently underserved by medicine," including rural parts of the United States and in developing countries (Menon et al., Harvard Business Review, 7/6).

Why telehealth technology isn't enough


There are dozens of telehealth technologies to choose from. But planners who ask, "What technology should I invest in?" are focusing on the wrong question.

Technology is a tool that enables strategy, not a stand-alone solution. To build a successful strategy that effectively leverages telehealth technology, start by asking these three targeted questions.

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