https://ntrs.nasa.gov/search.jsp?R=20160005245 2018-03-22T17:53:36+00:00Z Exploration Medical Data Architecture Big Data Big Think Forum Erik Antonsen MD, PhD, FAAEM Element Scientist April 6, 2016 Sandeep Shetye Chief Data Architect
Exploration Medical Capabilities – Data is a Challenge • ISS and exploration: Different Medicine requires different capabilities • What can we learn from ISS? • A vehicle and a ground challenge • Risk Modeling – what are we worried about? • Needs Analysis – what do we think we need? • Data Architecture – Medicine as a system 2
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Motivation Medical Risk: Given that medical conditions will occur during human spaceflight missions, there is a possibility of adverse health outcomes & decrements in performance during these missions and for long term health The medical system supports healthy crew to enable completion of mission objectives. We are concerned with health and prevention, not just catastrophic events. To minimize mission medical risk through medical system design and integration into the overall mission and vehicle design. 4 4
Mission Constraints Exploration missions are different: - Harsher environmental constraints - Shrinking resources (mass, volume, power, etc.) - No evacuation option Exploration may require “Stay and Fight” Medicine, not - Limited if any resupply “Retreat” Medicine. - Delayed or absent communications - The only resource growing is data handling capability (Moore’s Law ) 5 5
Medical and Research Data Processing • Mission Associated Summary of Health – Detailed Medical Report – 500 page pdf – Takes a team 6 months to create • Biomedical Data Reduction and Analysis Some version of both of these – Around 100 pages pdf processes will need to be – Preparation is pre- incorporated and automated in exploration missions. mission through 45-60 days post flight 6
Challenges • No single medical database stores all information that is complete • Leveraging extensive quantity of medical research being published on an ongoing basis • Integrating new data sources into existing medical systems • Existing industry systems have limitations • Limited utilization and scope • Design for specific purpose and difficult to personalize • Access to knowledge base and other medical data • Machines can assist but can’t replace humans 7 7
How do we get there? • Risk Mitigation Strategy – Planning • Concept of Operations Development (Ops Risk Reduction) – Characterization of Risk • Models and Metrics – Integrated Medical Model (IMM), MONSTR prototype • Active Data Gathering – Medical Consumables Tracker (MCT), biosensors, Flexible Ultrasound Medical System Development – Active Risk Reduction • Medical Data Handling – Exploration Medical System Demonstrator (EMSD), Medical Data Architecture • Technology Development – Oxygen Concentrator Module, Medical Suction, IVGen… • Training • Medical Decision Support • Integration of Medical with Vehicle Designers and ECLSS SMTs 8
The Goal Provide the crew with the best chance to accomplish mission and get home healthy Comm Delay No Evac No Resupply Medical Operations • Nominal Operations • Contingency Operations • Routine • Urgent Medical System? • Emergent 9
Risk Characterization • Identify the medical conditions that are likely to occur. Medical Optimization Network for Space Telemedicine • Identify how likely and how often they might occur. Resources (MONSTR) • Identify what resources are desired to address them. Event Probability (IMM) Medical Capability Notional (MONSTR) 10 Draft Data Only
The IMM Medical Conditions PSYCHIATRIC Insomnia (Space Adaptation) SKIN Late Insomnia NEUROLOGIC Anxiety Burns secondary to Fire Space Motion Sickness (SA) Behavioral Emergency Skin Abrasion CARDIOVASCULAR Head Injury Skin Laceration Depression Angina/Myocardial Infarction Seizures Atrial Fibrillation / Atrial Flutter Headache GENITOURINARY EYES Cardiogenic Shock secondary to Stroke Myocardial Infarction Abnormal Uterine Bleeding Acute Glaucoma Paresthesia Hypertension Acute Prostatitis Eye Corneal Ulcer Headache (SA) Sudden Cardiac Arrest Eye Infection Nephrolithiasis Neurogenic Shock Traumatic Hypovolemic Shock Urinary Incontinence (SA) Retinal Detachment VIIP (SA) Urinary Retention (SA) Eye Abrasion GASTROINTESTINAL Vaginal Yeast Infection Eye Chemical Burn MUSKULOSKELETAL Constipation (SA) Eye Penetration Back Pain (SA) Abdominal Injury INFECTION Abdominal Wall Hernia Acute Cholecystitis Herpes Zoster (shingles) EARS, NOSE, THROAT Acute Arthritis Acute Diverticulitis Influenza Barotrauma (sinus block) Back Injury Acute Pancreatitis Mouth Ulcer Nasal Congestion (SA) Ankle Sprain/Strain Appendicitis Sepsis Nosebleed (SA) Elbow Dislocation Diarrhea Acute Sinusitis Skin Infection Elbow Sprain/Strain Gastroenteritis Urinary Tract Infection Hearing Loss Finger Dislocation Hemorrhoids Otitis Externa Fingernail Delamination (EVA) Indigestion IMMUNE Otitis Media Hip Sprain/Strain Small Bowel Obstruction Allergic Reaction Pharyngitis Hip/Proximal Femur Fracture Anaphylaxis Knee Sprain/Strain Pulmonary Skin Rash DENTAL Lower Extremity Stress fracture Choking/Obstructed Airway Medication Reaction Abscess Lumbar Spine Fracture Respiratory Infection Caries Shoulder Dislocation Toxic Exposure: Ammonia ENVIRONMENT Exposed Pulp Shoulder Sprain/Strain Smoke Inhalation Tooth Loss Acute Radiation Syndrome Acute Compartment Syndrome Chest Injury Altitude Sickness Crown Loss Neck Injury Decompression Sickness (EVA) Filling Loss Wrist Sprain/Strain 11 Headache (CO2) 47 have occurred in spaceflight Wrist Fracture
Without IMM What is the likelihood of a What is the risk of Loss of Crew What medical devices should What should be in the medical evacuation? Life due to illness on ISS? we have on ISS? Exploration Medical Kit? Clinical Outcomes and Mission Impact ISS Medical System Mission Duration and Resources Profile ? ? Medical Condition Crew Member Attributes Incidence Data Flight Surgeon Risks due to Extravehicular Activities Functional Impairments (EVAs) Medical Resource Diagnosis and Treatment Attributes of Medical Conditions 12 12
Provides a tool to help informed decision making Mission Specific Inputs Monte Carlo Simulations Quantified Outputs Informed Analysis CliFFs Crew Member Attributes Type and Quantity of all Medical Events Crew Composition Integrated Risk of EVAC Medical Model Mission Duration and Risk of Loss of Crew Profile Flight Surgeon 13,500+ data Quality Time Lost elements ISS Medical System Resources Medical Resources Used Diagnosis and Treatment of Medical Conditions Optimized Medical System within Vehicle Constraints Medical Condition Incidence Data Risks due to EVAs IMM Relational Database Crew Training 13 13
MONSTR • MONSTR provides a way of quantifying a ‘Needs Analysis ’ • Uses the same 100 conditions as IMM • Identifies resources ‘desired’ for diagnosis and treatment (In an ideal world) • Ranks those resources on: – Medical criticality and generalizability to multiple conditions – Incorporates Probability of Occurrence – Provides a ‘value’ estimate to help prioritize research investments 14
MONS ONSTR TR - Visu sual l Network orks s – DRA RAFT T DATA A ONL ONLY All Conditions & Resources Filtered on Advanced Airway Advanced Airway – Worst Case Advanced Airway – Best Case 15
What’s Next? • Once you've characterized the medical risk and assessed what you need to address it, what is next? Put those needs together in a system designed to maximize good outcomes and minimize medical errors. MEDICAL DATA ARCHITECTURE 16
Active Risk Reduction • A comprehensive medical system to support the crew in Exploration Missions targeting autonomy. • In order to do this, ExMC will need integration with vehicle systems – single point solutions are not desirable for Exploration Missions. • Medical System – Provide for centralized medical care – Enhance available knowledge base – Provide for electronic training needs – Monitor supplies for crew – Monitor crew as needed – Streamline communication with ground flight surgeons – Decrease likelihood of medical errors 17
Medical System Integrates with other needs • Behavioral Health and Performance – Dashboard program – Actiwatch – Technology for monitoring and intervention needs to communicate with this system • Human Health and Countermeasures – Exercise countermeasures and monitoring – Laboratory and analysis capability – These tools provide early warning for medical issues and crossover for rehabilitation needs • Space Human Factors and Habitability – Training methods and procedures – Crew interface for the medical system – Medical Hab design • Space Radiation – Radiation monitoring – Long-Term Health Effects • Other Vehicle Systems – Environmental sensors (CO 2 levels, cabin temperature, etc.) – Vital signs monitoring via use of vehicle cameras – Medical system integrated with vehicle data, hardware and information systems 18 18
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