Real-time satellite-based telemedicine service for professional clinical users in remote locations
This project is based on a previous ESA-backed project that resulted in the successful development of a telemedicine system for commercial aviation applications (TEMPUS). Since its launch the system has achieved strong interest in other markets – predominantly in pre-hospital care applications where the potential for satellite-based communications and other new features enable users to do more with less equipment. The project will seek to leverage the existing market leading features already developed in the present system as well as be user driven in the selection of best-in-class approaches to managing medical incidents in the field. This will be based on the user input of a range of experienced medical professionals with a background in emergency medicine in the pre-hospital care field. Within the project, 2 validation campaigns of 6 weeks each will be carried out in 2 selected sites of International SOS in Algeria and Nigeria involving clinical and remote sites.
The objective of the project is the development, integration, testing and validation of a tele-assistance service, making use of multiple space assets (Satcom, Satnav), for professional clinical users in remote locations using a highly compact device for vital-sign monitoring and remote diagnosis.
Many organisations have a large international presence with staff operating concurrently in a multitude of locations. Examples of such organisations include Governments; Military; NGOs; Charities and Mineral and energy companies.
Such organisations use the services of companies like International SOS to provide them with medical support. Intl. SOS provides medical and security services through an extensive network of offices, staffed with clinical personnel, such as physicians, nurses and paramedics. They are able to provide direct medical care, which is also supported by a network of alarm centres, which are in turn staffed by doctors, nurses and specialist call handlers. These users are targeted to use the proposed system, as shown in the diagram below:
Organisations such as Intl. SOS have a large network of well trained clinical staff delivering high-quality medical care to industrial and governmental organisations across the world. They use conventional communications and conventional medical monitoring products (as are appropriate to the skills and needs of the various users) but do not use any telemedicine technologies to help facilitate and optimise their operations.
Consequently the decisions made to diagnose and care for their patients would be improved by a more integrated use of their existing resources (clinical expertise across their organisation) in real-time care and monitoring of patients.
There exists the need therefore for a system that could enable an organisation such as Intl. SOS to engage its resources (clinical staff) at all of its locations in the care of a patient in any location. Such a system would need to meet the needs of the actors at all locations. These would include:
- Being portable and robust for users at remote sites;
- Being able to operate both as a traditional monitor and a telemedicine device (this is necessary from a logistical as well as an economical perspective);
- Being able to operate over broadband and narrowband satcoms;
- Being able to provide positioning data from GPS location;
- Providing both the monitoring and telemedicine features that all the users would expect.
The project will develop and enhance the existing Tempus IC telemedicine system to allow it to be employed by professional medical users in remote locations.
The enhanced device will include:
- additional diagnostic and monitoring elements (e.g. 3 and 5 lead ECG ElectroCardioGram, contact temperature sensors, invasive blood pressure, remotely viewable and configurable alarms),
- integration with other systems (e.g. digital stethoscope, digital X-Ray images; data sharing with third-party electronic patient records),
- multimodal space-based services (satellite broadband / narrowband and terrestrial communication capabilities, location-based patient information, including VoIP, streaming of data and medical imagery, video, GPS positioning)
- physical and environmental parameters (e.g. water, sand, power consumption, environmental conditions)
The project plan envisages an initial stage where detailed user requirements will be captured. This will involve a group of medical experts with a great degree of experience in this application.
Product development will follow; this will be broken into 3 separate stages of system development. 3 user trials will be performed to obtain feedback on the developed system.
The plan follows ESA’s project management methodologies including the ongoing development of a business plan, which will feed into the validation requirements for the field trials.
Currently, clinical staff operating in remote locations are only offered vital signs monitoring solutions or telemedicine systems. The former are designed primarily for the needs of hospital users and the latter are always un-integrated collections of various different products that together allow the user to transmit medical data. The former are commercially successful simply because there is no alternative, while the latter tend not to be commercially successful because they do not meet all the user requirements. This project envisages a dual-use system: one that provides all the medical monitoring and telemedicine needs, but in a single, integrated package.
A number of commercial and user benefits exist for the proposed system. These include:
- Reduced costs from avoided medical evacuations (MEDEVACs) from remote sites;
The system would enhance their offering in remote sites (through telemedicine) and therefore improves the value proposition of their service;
- The dual-use and ease of use features will allow the use of lower-skilled resource (e.g. nurses instead of doctors) in remote sites, this would improve their margin and also enabling additional sites to take up Intl. SOS service i.e. obtain new customer sites;
- The system would enable them to provide better quality of care at existing sites where they already utilise lower-skilled resource which would lead to improved utilisation of their client‘s workforce;
- The system would improve the value obtained from their existing infrastructure investment in clinics e.g. by the integration and transmission of data from 3rd party ultrasound and blood analysis products;
- Furthermore, the ability to link the remote sites and clinics much more closely into Intl. SOS’s existing Global Alarm centres would improve the value they obtain from their existing infrastructure enabling them to obtain additional value from existing assets;
- The enhanced offering in clinics would improve the overall value proposition;
- The system would allow new services to be offered (from clinics and alarm centres) for remote sites that otherwise would not be staffed.
The integration with different space-based assets in the development of the proposed system is expected to add value to the user in a number of ways.
- Reduced costs from avoided MEDEVACs from remote sites
- Enhanced offering in remote sites (through telemedicine) improves value proposition
- Dual-use and ease of use features allows use of lower-skilled resource (nurse instead of doctor) in remote locations, improving margin and/or enabling additional sites to take up Intl. SOS service
- Better quality of care at existing sites where they already utilise lower skilled resource
- Improvement of value obtained from existing infrastructure investment in clinics
- Enhanced offering in clinics improves value proposition presented by the service provider
- The system would allow services to be offered (from clinics and alarm centres) to new remote sites (typically with no medical staff) which otherwise would not be able to access the medical service.
These commercial benefits will be driven by the integration both of high-quality GPS positioning and real-time communications via satcom.
These, combined with leading medical technologies and a unique feature set based on a flexible platform is expected to create a new level of service delivery in pre-hospital care.
Since the CDR (Critical Design Review), the TEMPUS PRO system went through intensive testing and achieved various certifications such as the fleet-wide Airworthiness Release from the United States Army. An improved version of the product was presented and demonstrated to ESA during the DQR (Demo Qualification Review), which was held at RDT premises, Basingstoke - UK, on 27 November 2012. This milestone meeting was the opportunity to close out the testing phase, thus providing confidence on the maturity of the product and to finalise the preparation for the pre-operational trials, scheduled for the summer 2013. The next project milestone (System Deployment Acceptance) is planned for March 2013.
The Tempus Pro system was also presented in November 2012 at the medical device's largest global industry event, Medica 2012, which is held annually at the Messe in Dusseldorf and includes over 5500 exhibitors and in 2011 included over 134000 visitors. The product launch was extremely successful and achieved significant commercial interest from potential distributors in a range of markets and also attracted strong interest from a number of militaries and civilian ambulance representatives. Such interest comes as an additional reward to the already various awards won by RDT for the TEMPUS system.