Gap ExMC 3.02: Lack of knowledge about the current state of the art in telementoring/telemedicine as a tool for assisting crewmembers to diagnose and treat medical conditions that occur in space flight (CLOSED)
Last Published:  07/30/21 01:05:31 PM (Central)
Responsible Element: Exploration Medical Capability (ExMC)
Status: Closed
Closure Rationale

Gap Closure Synopsis
There will be situations during exploration class space missions where a crew member will need medical attention to the point where the acting physician-astronaut Crew Medical Officer (CMO) will need to be remotely guided by a ground-based subject matter expert to assure that proper care (i.e. diagnosis and treatment) has been implemented. This type of guiding is called telementoring and is defined as the delivery of training and mentoring via telecommunication networks typically in the format of audio and video. As a subset modality of telemedicine, telementoring is focused on providing a means to train operators (e.g. CMO) with the instructor physically located in a remote location. Based on the type of training content, the presentation format may vary, including teleconference, video conference, or web exchange. Effective means to communicate and deliver techniques to convey information are constantly under development. This gap was established to focus the latest on telementoring technologies and techniques as well as media platforms on which the information could be presented for exploration class space missions.


To address this gap, ExMC conducted a data mining exercise to discern the latest developments in Telemedicine, including the area of Telementoring. In addition, ExMC also conducted a workshop to bring together leaders in remote medicine to outline the medical operational concept for a manned mission to a Near Earth Asteroid (NEA). Information from the data mining and the workshop were documented in “Exploring the Currents of Telemedicine” (Descartin KS, Watkins SD), a NASA internal white paper and a summary report (NASA/TM–2012-217364), respectively. These documents provide sufficient closure to this gap by identifying telementoring techniques and technology applicable to exploration class space missions.

 

NASA has already been a pioneer in telemedicine and continues to demonstrate the utility of telementoring applications in space. At the same time, rapidly advancing terrestrial technologies and techniques in the area of telementoring can also benefit space exploration. Even simple modifications can lead to positive results. For example, one study showed the simple remote use of a laser pointer can improve clinical outcome. A remote-controlled laser pointer was paired with a video camera streaming live video, allowing a telementor to reach out and point to specific anatomical locations on a training mannequin. In the simulation, inexperienced operators (e.g. non-physician CMOs) instructed on the technique of thoracentesis by the telementor with the aid of the pointer were found to be significantly more successful than those given instructions without the precise, instructional dimension provided by the pointer (Ohta et al. 2006). This is one of many examples how telementoring techniques and technologies can assist minimally trained caregivers. ExMC can apply such telementoring modalities to the astronaut physician CMO cohort to expand their level of care even further than those not formally trained. Of course, this expansion will require shifts in the current medical training of CMOs.

 

Physician CMOs would need to be practice-current and should be given specific additional training on the in-flight diagnosis and treatment of conditions that are most likely to occur during exploration class missions. In flight, the background of the CMO will dictate the skills that will need to be supplemented with virtual assistance. For example, if the CMO were a skilled surgeon, surgical procedures might not need to be telementored virtually, but primary care assistance would need to be provided in a virtual manner. On the other hand, if a primary care physician were selected as a CMO, then technical and procedural assistance would need to be telementored virtually.

 

In regards to training programs currently employed by remote medicine organizations, Objective Structured Clinical Exams (OSCE) have been addressed by ExMC. These exams are used to assess the clinical and technical skills of physicians and could be used to assess a CMO’s ability to diagnose and treat conditions on the medical condition list. Other organizations have made use of pre-deployment checklists of skills needed in the remote environment. Such checklists could be adapted for the training of both crew and telementors for exploration missions.

 

In regards to using technology that would foster telementoring operations, at least one camera would be needed and be located in a position to allow the telementor to see both the patient and CMO. It would be of benefit for the camera to be fixed, which would prevent the view from being lost if a camera was accidently bumped. If multiple cameras were used, it would be beneficial for the second camera to be hand-held or a hands-free camera thus allowing a possible close-up view of the patient. In addition, monitors that are moveable (e.g., tablet, heads-up display) rather than hard-wired would also help with the telementoring of CMOs. Such technology, hardware, and corresponding techniques would also be used by NASA Flight Medicine Clinic personnel to help practice time-delayed, ground based cases with an emphasis on understanding and using the proper telementoring terminology.

 

Rationale for Closure

In addition to already applying NASA’s pioneering capabilities for telementoring crew aboard the International Space Station (ISS) in the areas of medicine, ExMC has discerned the current terrestrial technologies, techniques, and strategies that may be applicable to exploration class space missions.  ExMC will continue to monitor the progress of this research, in particular, via ExMC Gap 3.03 such that the field of telementoring can be expanded and effectively used for exploration missions.

Tasks and Supporting Reports Completed
1. Karina S. Descartin; Richard P. Menger; Sharmila D. Watkins, Application of Advances in Telemedicine for Long-Duration Space Flight, 1/1/2015, pp. 62, NASA Johnson Space Center. 

2. Barsten, K., Watkins, S., and Otto, C., Telemedicine Workshop Summary Report,
8/1/2012, NASA Johnson Space Center. 


Description

1)  Initial State 

Telementoring is the delivery of training and mentoring services across telecommunication networks typically in the format of audio and video. As a subset modality of telemedicine, telementoring is focused on providing a means to train operators with the instructor physically located in a remote location. Based on the type of training content, the presentation format may vary. Various formats include teleconference, video conference, or web exchange. Due to the relative novelty of this form of communication, telementoring has only recently started to gain momentum as a means to guide and train remote operators. As such, effective means to communicate and techniques to convey information are constantly under development. This gap is focused on understanding the latest on telementoring technologies and techniques as well as media platforms on which the information is presented.

Target for Closure
No Target for Closure available.
Mappings
Risk Risk of Adverse Health Outcomes and Decrements in Performance Due to Medical Conditions that occur in Mission, as well as Long Term Health Outcomes Due to Mission Exposures
You are here! Gap ExMC 3.02: Lack of knowledge about the current state of the art in telementoring/telemedicine as a tool for assisting crewmembers to diagnose and treat medical conditions that occur in space flight (CLOSED)
Completed

Multi-Disciplinary Research Plans

Documentation:
No Documentation Available