Telehealth enabled NASA to care for astronauts in orbit, but agency is eyeing the moon and beyond

Dr. Shannan Moynihan, left, and Michelle Frieling of NASA speak during the HIMSS21 conference in Las Vegas on Wednesday.

Photo: Jeff Lagasse/Healthcare Finance News

LAS VEGAS - Space: It's the final frontier not just for humans, but telehealth as well.

The benefits of telehealth have become widely known here on Earth, and it's been an increasingly accepted treatment modality for patients during the pandemic. Remote virtual care has been a lifeline for scores of people with their feet planted on the ground.

But it's also become a lifeline for astronauts inside the International Space Station, and in some ways, low-Earth orbit has been ground zero for telehealth. NASA began treating space-goers remotely as early as 2002, a necessity given that astronauts are uniquely isolated from the world. The lessons learned in that time will be a launchpad for the future as NASA contemplates sending humans beyond low-Earth orbit, and further into the depths of the solar system.

Michelle Frieling, program manager for human health and performance contract at NASA, and Dr. Shannan Moynihan, deputy chief medical officer at the NASA Lyndon B. Johnson Space Center, were on hand at HIMSS21 in Las Vegas to talk about that future in their session, "Caring for Astronauts in Space: NASA's Experience With Telemedicine."

Of course, the treatment of people in space looks a bit different than the terrestrial version, since astronauts experience maladies that are unique to space travel. In addition to the usual sicknesses and injuries that can occur on Earth, these astronaut-specific conditions are linked to the adaptations the body makes in response to low-gravity environments. 

"We send up very healthy people," said Moynihan. "That's always the goal. (But) normal physiology is being put into an abnormal environment. It works well while you're up there, but when you come back, those adaptive changes are not always a positive thing."

One of the big adaptive changes that can occur is SANS, or Spaceflight Associated Neuro-ocular Syndrome, an optic disc anemia that can cause temporary vision issues among people who have been on prolonged space missions. 

"We don't have a corollary here on Earth," said Moynihan. "It teaches us a lot about the physiology that happens here in space, and my hope is that it helps us understand physiological issues here on Earth."

Other issues include neurovestibular ailments, which can affect an astronaut's balance and posture, causing them to sway while walking when they're back on solid ground. It's a condition that can last for up to two weeks after returning from a flight. Then there are fluid shifts, in which the body's fluids, generally pulled toward the feet by gravity, settle instead around the chest and head. Not a problem for those in space, but certainly an issue for the newly earthbound.

How to treat those conditions, or any other, when a human being is 250 nautical miles away?

Ultrasound machines are the primary imaging devices used on the ISS, according to Frieling. With no CT or MRI machines, the ultrasound machines are used in novel ways, able to give clinically relevant exams in space with the ability to send that information to people on the ground.

These people on the ground – who NASA refers to as "remote guiders" – are the key. In most other respects, telehealth in space looks like telehealth on the ground: video or audio encounters in which a patient consults with a medical expert. What the remote guiders do is direct astronauts through procedures, in layman's terms, to ensure that clinical robust data is being collected and relevant procedures performed aboard the space station.

"We don't always have a physician on board the space station," said Frieling. "So we're asking somebody who's had maybe 45 minutes of training on the ultrasound device and asking them to get clinically relevant results while learning other stuff too, like ISS systems and the science experiments and activities they're going to do. The remote guiders come in. They walk the crew through various procedures. They're on the ground talking to the crew in real time … in order to get the images we need on the ground for clinical diagnoses, or research studies as well."

Ophthalmologists and other specialists examine the data as it's coming down and give tips and techniques to the remote guiders. An important thing for the remote guiders to consider is their own disposition. Since many of these interactions take place via video, the crew onboard the ISS can pick up on smiles and frowns, and these indicators of a person's mood can have an effect on those traversing the vacuum of space.

What telehealth does, essentially, is free astronauts from having to undergo hours of medical training. Instead, they can focus their time and attention on the mission. 

Equipment considerations are unique, though, since there's a lot of planning and logistics involved in certifying a medical device to be flown up to the space station. Data needs have to be considered carefully, as well as the compatibility with other devices and technology aboard the ISS. Since the space station is a closed environment, crews have to take into account how something like an ultrasound machine will affect the atmosphere. 

For now, the telehealth approach works well as intended. 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 as long as three years.

That will result not only in significant physiological changes for the astronauts, but a rethinking of how telehealth communication will take place. The further away from the planet a crew is, the longer it takes to send and receive data, meaning communications will no longer be in real time.

These will be challenges, but NASA understands these issues and has a rough game plan for how to address them. 

"We're going to think about how we do these medical conferences very differently," said Frieling. "We need to develop things like software systems that help make diagnosis 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 we can put the power in the crew's hands."

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com