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Challenge

To design and develop an onboard and on-demand medical education and real time care-delivery guidance system (referred to as Augmented Clinical Tools or ACT in this document) that will empower a multi-disciplinary team of astronauts to provide precision medical management in the autonomous and untethered environment of a deep space mission.

 

TRISH is soliciting proposals to establish the capacity for augmented medical knowledge and guidance to empower a multi-disciplinary team of astronauts to rapidly and effectively provide precision medical management in the autonomous and untethered environment of a deep space mission.

This capacity requires the availability of medical knowledge and skill sets to triage, perform differential diagnosis, reach treatment decisions, apply appropriate interventions, monitor responses to treatment and also establish recovery and return-to-duty plans. This planned composite medical education and real time care-delivery guidance system, referred to here as Augmented Clinical Tools (ACT), will leverage advanced technologies such as mixed reality (AR/VR/MR), haptics, mobile monitoring, AI-augmented Clinical Decision Support and will access individual-level reference data.

The comprehensive Augmented Clinical Tools (ACT) system includes education and real time guidance for specific clinical scenarios and will include the following:

  • Preparation – onboarding of basic knowledge and the ACT system (preflight training and review of modules at determined intervals in flight),
  • Point of Care (POC) or “on demand” knowledge reinforcement – rapid refresh  
  • Deployment and “closed loop” interpretation of diagnostics
  • Clinical Decision Support (CDS) to establish treatment plans
  • Real-time guidance for needed procedural interventions
  • Plans for Monitoring and metrics to assess outcome of intervention
  • Plans for Recovery tracking and criteria for return to duty

Background

A primary goal of deep space missions is to maintain optimal health and human performance of astronauts who are existing in autonomous and artificial (or non-terrestrial) environments for periods of up to four to five years. Due to the prolonged nature of the mission and the inherent risks of the environment in which the astronauts will exist, it is anticipated that clinical conditions will arise. “Rapid recognition and effective response” are absolutely essential to minimize negative consequences of these inevitable clinical scenarios.

Key Concepts

  • Lower earth orbit missions such as to the International Space Station have synchronous communication with medical experts at the base station as well as real-time transmission of data (from physiologic monitors or imaging for example). 
  • The distance to Mars prohibits real-time or truly synchronous communication or data sharing with medical experts on earth. Therefore, the clinical recognition and response system on Mars missions must be based on untethered and autonomous capabilities. Asynchronous clinical data-sharing will be leveraged in other ways but cannot relied upon for onboard medical management.
  • The Mars crews will be composed of astronauts with varying amounts of clinical knowledge and procedural experience.  To “level set” autonomous clinical capabilities onboard the long duration missions will require provision of not only appropriate medical supplies, but also the augmentation of clinical knowledge and skills to ensure rapid recognition and effective response to anticipated medical scenarios.
  • There are specific environmental conditions or constraints on deep space missions to consider when planning the Augmented Clinical Tools. Design of the education and simulation modules as well descriptions of actual diagnostic techniques and procedures must take into account at least three unique environments, that of the space capsule, extravehicular space walks, and the surface of Mars. Some of the challenges to consider include microgravity in the capsule and 3/8 of earth’s gravity on Mars, as well as the limited allowances of volume, mass, and power consumption.
  • The environmental conditions of deep space travel also create changes in the anatomy and physiology of the astronauts (i.e., fluid shifts, shape of heart) which will need to be accounted for as the instructional and guidance modules are being designed.
  • In considering appropriate education/simulation modalities, miniaturization of hardware and efficient management of data will be key considerations. Sensor and imaging systems should have low power needs, use renewable power or be self-powered where possible. 
  • Another constraint is time. Real-time clinical or point of care scenarios will require rapid setup and transfer of clear needs-driven knowledge in easily visualized or sensed (haptics) user-interfaces and closed-loop clinical decision support.
  • In situations not requiring real-time clinical response, the astronauts have a multitude of tasks to accomplish. Therefore, inflight clinical training or refresh modules must be condensed, easy to operate, engaging, interactive and tailored to learning styles of various astronauts.
  • It is anticipated that the ACT system will leverage advanced technologies such as mixed reality (AR/VR/MR), haptics, mobile monitoring, AI-augmented Clinical Decision Support to provide a library of modules that address the most anticipated and the most potentially devastating clinical scenarios anticipated on deep space missions.
  • The education modules will have stored content but care guidance modules will be a combination of stored content that interacts with live fed data where appropriate (ie, pt signs/symptoms, imaging, baseline health surveillance data).  For Precision Healthcare to be provided, the individual astronaut data will need to be incorporated and referenced to guide assessment (variants from baseline), care planning and return to function goals. Individual astronaut sensor data and medical histories will be incorporated into care-delivery guidance (CDG) and clinical decision support (CDS) tools.
  • Integration of ACT with planned onboard clinical care tools (Medical kit) and is essential
  • Individuals assimilate information differently. To ensure effectiveness of ACT at the individual level, development plans should include:
    • evidence-based educational principles,
    • human centered design or stakeholder input incorporated into the design,
    • methods to profile learning preferences,
    • capability to assess individual engagement and comprehension.

It is anticipated that the ACT system will leverage advanced technologies such as mixed reality (AR/VR/MR), haptics, mobile monitoring, AI-augmented Clinical Decision Support to provide a library of modules that address the most anticipated and the most potentially devastating clinical scenarios anticipated on deep space missions. The education modules will have stored content while the care guidance modules will be a combination of stored content that interacts with live fed data and the onboard Medical Kit (ie, signs/symptoms, imaging, astronaut health sensor data).

Examples of projects that COULD be considered:

  • Proposals that seek to adapt and test existing, well validated, medical education software platforms, content, hardware, user interfaces (audio, 3D+ visualization, haptics) to environmental constraints and conditions unique to deep space travel.
  • Proposals that seek to adapt (and validate) existing content modules for the specific clinical education and real time guidance needs of deep space missions. These should have potential to become content components of the Augmented Clinical Tools (ACT) system. Proposals should address one or more of these areas:
    • Preparation – onboarding of basic knowledge and the ACT system (preflight training and review of modules at determined intervals in flight),
    • Point of Care (POC) or “on demand” knowledge reinforcement – rapid refresh 
    • Deployment and “closed loop” interpretation of diagnostics
    • Clinical Decision Support (CDS) to establish treatment plans
    • Real-time guidance for needed procedural interventions
    • Plans for Monitoring and metrics to assess outcome of intervention
    • Plans for Recovery tracking and criteria for return to duty
  • Proposals that seek to validate the needed technical components or infrastructure of Augmented Clinical Tools (ACT). These solutions are expected to have successfully developed and deployed similar solutions and should incorporate:
    • software platforms,
    • medical content,
    • hardware,
    • user interfaces such as AR/VR/MR (audio, 3D+ visualization, haptics)
    • robotics
    • integrated data systems to incorporate disparate data systems
    • interactive/responsive/learning capabilities

Examples of projects that WILL NOT be considered:

  • Proposals that leverage technologies not feasible for use within the constraints of deep space mission conditions.
  • Proposals that do not address or cannot be modified to address topics of concern as stated on the NASA's Medical Conditions List.

 

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