Telemedicine partnership combines video, chat into ‘virtual ER’

The evolution of satellite networks and portable communication devices has taken maritime telemedicine well beyond the phone. Internet video is a reality, along with remote monitoring of vital signs and now the “virtual ER” — live video streaming with a “chat” function that allows an array of practitioners to weigh in on a diagnosis at the same time.

The service, Future Care Live, is the result of a partnership between Future Care Inc., a provider of health care services for seafarers, and Globecomm Maritime. Globecomm supplies the software and communications expertise. Future Care provides the onshore medical network and an onboard equipment kit to aid in diagnoses.

In the event of an emergency at sea, the captain of the ship would call Future Care Live’s 24-hour service and relay the information to a first responder. The first responder would then determine if the injury or illness warrants the involvement of one of the company’s network physicians, who are on call in locations around the world.

In the case of a mariner with an injured leg, the physician might view the live video and decide to consult an orthopedist in the network for a more informed diagnosis. If it is determined that the leg is broken, the mariner could either be medevaced or the ship deviated to the nearest port. If it is determined that the injury is not that serious, emergency action would be avoided — saving time and often considerable expense.

“The live chat literally brings our physician on board through a (computer) screen. Through the use of electronic diagnostic tools such as the ones that are in our medical kit, he can make a fairly sophisticated diagnosis even though he may be several thousand miles away,” said Lawrence Jacobson, managing director of P&I for New York-based Future Care.

One of the biggest benefits of the software is that it can accommodate as many as 20 participants at one time during a live video session, Jacobson said. The conversation could include a first responder, general physician, specialist, hospital care staff, Future Care case manager and representative from the shipping company.

“Now obviously you don’t have 20 people talking at once,” Jacobson said. “You can set the picture so the speaker is in one quarter of the screen and three people are in the remaining three quarters, or you can have the speaker take up the screen completely. But you can have as many as 20 participants watching, communicating and contributing on this one satellite bandwidth line.”

Advances in how bandwidth is used provide the key to the live video chat capability, said Martin Killian, director of managed network sales in the Americas for New Jersey-based Globecomm. Future Care Live utilizes Globecomm’s Access Chat Plus software, which allows the customer to choose a bandwidth to help maintain video integrity. The software also has a compression algorithm to get the most out of the bandwidth available.

“If you’re using something like Skype or FaceTime or one of those off-the-shelf technologies, those softwares will usually just grab as much bandwidth as possible,” Killian said. “With Access Chat Plus, you have the ability to go and select what bandwidth you’re going to use. If you have a 100-kilobit connection and you try to use it on Skype, it’s probably not going to work very well. But if you have a 100-kilobit connection and use it with Access Chat Plus, and you have your setting at 100 kilobits, it’s going to work much better. It’s really about maintaining quality with limited bandwidth.”

Killian said the maritime industry is five to eight years behind many other industries in terms of its appetite for data, but change is on the way that will increase demand for services like Future Care Live.

“Skype and smartphone usage started to take off about six years ago, and now it’s starting to become very popular and desired in the maritime environment,” he said. “People want to do Skype when they’re at sea, but it’s too much of a bandwidth hog for most systems. (Future Care Live) is an alternative that shipowners can actually do on a lot of systems right now.”

Coverage for the service depends on the shipping company’s satellite provider. Killian said that if the shipowner is using Inmarsat FleetBroadband, then coverage is global with the exception of the polar regions. Future Care Live is compatible with other networks and with any type of Internet connection, but its use in the maritime realm tends to be dependent on satellite service.

Maersk Line Ltd. has been using a similar telemedicine service since last year in conjunction with George Washington University (GWU). GWU provides the medical network for Maersk ships and DigiGone provides the software, the same encrypted product that is used for Future Care Live. Globecomm distributes DigiGone’s software under the Access Chat Plus name.

While GWU provides onshore medical guidance, Jacobson said it does not provide case management and other follow-up services covered by Future Care. He also cited the company’s experience in the maritime environment, with most of the physicians in its network having practiced telemedicine “for the better part of 10 years.”

“It’s a bit of an art as well as a science in endeavoring to draw the line as to whether or not in a serious case a guy should be hauled off a ship,” he said. “It’s not something that every physician can do or is willing to do.”

Regardless of the money that can be saved by avoiding a medevac or course deviation, Jacobson said risks are never taken with the health of crewmembers when it comes to diagnoses.

“That’s not what we’re about,” he said. “However, if the guy isn’t desperately ill or he can sit in the bed for another day or two, then first of all it’s probably less traumatic for him than getting into a helicopter, and secondly it obviously cuts costs. There’s no benefit to the crewman if his employer has to continually run up unnecessary medical charges. It doesn’t improve the quality of care individually for him or for his compatriots.”

By Professional Mariner Staff