Telehealth has allowed NASA to take care of astronauts in orbit, but the agency is eyeing the moon and beyond
Photo: Jeff Lagasse / Healthcare Finance News
LAS VEGAS – Space: This is the last frontier not only for humans, but also for telehealth.
The benefits of telehealth have become widely known here on Earth, and it is an increasingly accepted treatment modality for patients during the pandemic. Virtual remote care has been a lifeline for dozens of people with their feet on the ground.
But it has also become a lifeline for astronauts inside the International Space Station, and in some ways low Earth orbit has been the zero point for telehealth. NASA began treating astronauts remotely as early as 2002, a necessity given that astronauts are particularly isolated from the world. The lessons learned during this time will be a launching pad for the future as NASA plans to send humans beyond low Earth orbit and deeper into the depths of the solar system.
Michelle Frieling, program manager for the human health and performance contract at NASA, and Dr Shannan Moynihan, deputy chief medical officer at NASA Lyndon B. Johnson Space Center, were on hand at HIMSS21 in Las Vegas to talk about this future during their session. , “Caring for Astronauts in Space: NASA’s Experience with Telemedicine.”
Of course, the treatment of people in space is a little different than the terrestrial version, as astronauts suffer from illnesses unique to space travel. In addition to the usual illnesses and injuries that can occur on Earth, these astronaut-specific conditions are linked to the body’s adaptations in response to low-gravity environments.
“We are sending very healthy people,” Moynihan said. “That’s always the point. (But) normal physiology is put in an abnormal environment. It works fine while you’re up there, but when you come back, those adaptive changes aren’t always a positive thing.”
One of the big adaptive changes that can occur is SANS, or neuro-ocular syndrome associated with spaceflight, an optic disc anemia that can cause temporary vision problems in people with extended space missions.
“We don’t have a corollary here on Earth,” Moynihan said. “It teaches us a lot about the physiology going on here in space, and I hope it helps us understand the physiological issues here on Earth.”
Other problems include neurovestibular disorders, which can affect an astronaut’s balance and posture, causing them to sway while walking when they are back on solid ground. This is a condition that can last for up to two weeks after returning from a flight. Then there are fluid shifts, in which body fluids, usually drawn to the feet by gravity, settle around the chest and head instead. Not a problem for those in space, but certainly a problem for new terrestrials.
How do you deal with these conditions, or any other, when a human being is 250 nautical miles away?
Ultrasound devices are the primary imaging devices used on the ISS, according to Frieling. In the absence of CT or MRI scanners, ultrasound machines are used in innovative ways capable of giving clinically relevant examinations in space with the ability to send this information to people in the field.
These people on the ground – whom NASA calls “remote guides” – are the key. In many ways, telehealth in space resembles telehealth in the field: video or audio encounters in which a patient consults with a medical expert. What remote controllers do is lead astronauts through procedures, in layman’s terms, to ensure that solid clinical data is collected and that the relevant procedures are performed aboard the space station.
“We don’t always have a doctor on board the space station,” said Frieling. “So we ask someone who has maybe 45 minutes of training on the ultrasound device and ask them to get clinically relevant results while learning other things like ISS systems and experiments and activities. scientists they’re going to do. The remote control guides arrive. They walk the crew through various procedures. They’re out in the field talking to the crew in real time… in order to get the footage we need on the plane. field for clinical diagnostics or research studies as well. “
Ophthalmologists and other specialists review data as it arrives and provide guidance and techniques to remote controllers. An important thing for remote controllers to consider is their own layout. Since many of these interactions take place via video, the crew aboard the ISS may perceive smiles and frowns, and these cues of a person’s mood may have an effect on those who cross the void of space.
Essentially, what telehealth does is save astronauts from having to take hours of medical training. Instead, they can focus their time and attention on the mission.
Equipment considerations are unique, however, as there is a great deal of planning and logistics involved in certifying a medical device to be transported to the space station. Data requirements should be carefully considered, as well as compatibility with other devices and technologies on board the ISS. Since the space station is a closed environment, crews need to consider how something like an ultrasound machine will affect the atmosphere.
So far, the telehealth approach is working well as expected. But there are future challenges. Low Earth Orbit is one thing, but plans are already underway to land the first woman and the first person of color on the moon. Beyond that, humanity is eyeing Mars, a mission that could take an astronaut into space for up to three years.
This will not only bring about significant physiological changes for astronauts, but also an overhaul of the way telehealth communication will take place. The further away a crew is from the planet, the longer it takes to send and receive data, which means that communications will no longer be in real time.
They’ll be challenges, but NASA understands these issues and has a rough game plan to address them.
“We’re going to think about how we organize these medical conferences in a very different way,” said Frieling. “We need to develop things like software systems that help make diagnostic and treatment decisions for the crew. We need real-time training videos. We really need an integrated architecture that provides us with advanced analytics so that we can put the power in the hands of the crew. “