Telemedicine on Earth can learn from Spaceflight

Telemedicine has become widely used, primarily following or during the COVID pandemic. However, it was used a long time ago in specific cases, like submarines and space. Telemedicine has been developed to facilitate diagnosis and treatment in areas without physicians, either because the area is isolated without a medical doctor (as in submarines and space) or because we need expertise. This article is a review using studies selected via PubMed to collect generic knowledge on some technical details on both sides: Earth and Space, where telemedicine activity is regularly provided. The goal was to compare tools, data collected, and ways of improvement in each area. As experienced on both sides, indeed, the author has already worked in the spaceflight area with astronauts as well as doing teleconsultations with patients nowadays, which allows us to see how we could improve the way we are doing teleconsultation on Earth by teaching the users as done with the astronauts in the pre-flight period. It seems telemedicine will still be mandatory for a while because as seen in many countries even out of the scope of isolated area (or very difficult to be accessed (like mountains, desert …), more and more small cities and even bigger are lacking general practitioner (GP) as well as some specialists. Taking into account the time needed to have a functional doctor (for a GP mainly 8 years and for specialists longer, up to 12 years), telemedicine should improve and take a real place in the health system. This review gives a few definitions, also the term telehealth or e-health is widely used. It refers to the use of an internet communication system to transmit data, receive data, communicate in real time, and guide and provide healthcare services to the patient remotely. Improvements in technologies have mainly been done for Earth applications, and tools are becoming smaller and more resistant. The different purposes of using telemedicine are increasing nowadays, and it is not used only because of a lack of physicians but to teach remotely and avoid travel, as well as to have direct access /advice with a specialist. We can find a lot of reasons to use it. Living in space is a real challenge for the human body used to gravity. As explained in a lot of reviews, the body in space loses bone, muscle, and has changes in heart volume and excitability. All the body systems will suffer from microgravity. Other factors impacting the body in space are the high level of ionized radiation, plus isolation. This is why, since the beginning of space flight, the so-called flight surgeon (more GP of the astronaut than a surgeon) is using telemedicine with the astronauts to prevent disease and, in case a medical event happens, to help the astronaut receive a diagnosis and efficient treatment. The actual ISS, International Space Station, allows real-time communication with the astronauts. This will be used for direct discussion or conferences to check the medical/psychological/fitness status. In other cases, remote access can always be done to communicate pictures or movies to provide advice on health or science. Furthermore, some medical tests will be done to guide the astronauts because some tools need real expertise to be interpreted correctly. In that case, eye exam is a good example: an astronaut uses devices following the recommendation of the specialist based on the NASA Console in Houston. Of course, new improvements are needed to facilitate the next challenges of spaceflight, also going a step further beyond LEO (Low Earth Orbit), like doing an interplanetary trip and going to Mars. In that next scenario, to allow the mission where the Earth will not be seen anymore, when the real-time exchange will not be feasible, a new autonomy of the astronauts will be required. As on Earth, space with all technologies like satellite is not only used as for direct health care facility with the astronauts but also in a more preventive way. It is possible to follow changes on the ground, climate changes too, as a witness to a possible new epidemic, and another specific use is to help in locating people. Finally, we see how the way telemedicine is done in space could help improve telemedicine on the ground. First of all, we could improve telemedicine in many ways on Earth for classical consultation by increasing the utilization of simple tools like otoscope and… more in that case we need to train the patient like the astronauts are trained on ground before flying, this has a huge positive effect in allowing easier diagnostic and then better treatment for example when good pictures are provided. The new tools as Artificial Intelligence (AI) or Virtual Reality (VR), on trial if needed for long-duration missions and specifically for missions beyond low Earth orbit, should be beneficial as well on Earth. Maybe the big challenge for Earth’s Telemedicine is increasing the trust in practitioners who are still convinced that this way of providing medicine could be a competitor, and for that reason, they are reluctant to use it. Nowadays, it should become more and more obvious that we need to work on some specific weak points, like security, training in using tools to make sure telemedicine is efficient and useful, where we have a lack of physicians.