Dr. Phil Sharples, Senior Medical Director, UnitedHealthcare Global Medical, discussed how mainstream healthcare is embracing technology to deliver higher quality medical care and how some of these initiatives could apply to the maritime industry. These initiatives include the utilization of low bandwidth video consultations to improve accessibility of medical care onboard, as well as electronic medical records systems to secure seafarer heath data.
Firstly, to understand how mainstream healthcare technology can be applied in maritime, we need to know how often do medical emergencies occur at sea? A study in 2014, revealed that over a quarter of 465 German maritime officers who received medical care aboard ship training at Hamburg from 2006 to 2013 had been involved in a serious incident. The International Maritime Health Association, at a workshop in 2015, estimated that on average a ship experiences one serious medical incident every two years. Finally, a 2013 paper in the International Maritime Health journal, which sampled 23,299 commercial ships with 420,000 crewmembers, found that one in five ships was forced to divert course for medical reasons each year. This equated to a annual cost of $168m for this sample which constituted about a third of the global maritime fleet.
In conclusion, a medical emergency happens at seas more frequently than anticipated.
Dr Sharples used an example of a tragic incident in which UnitedHealthcare Global Medical had recently been involved to identify to four areas where technology may improve healthcare:
- Video consultations with a Doctor;
- Utilization of electronic medical records;
- Remote refresher medical training;
- Utilization of wearable technology and Apps.
Video Consultation with Doctor
Access to doctors for face to face consultations is becoming more challenging to provide in healthcare systems. Trying to provide access in a remote setting is much more difficult. In 2014, it was estimated that globally just fewer than 20 million video consultations took place between a health care professional and patient. In 2020 this figure is expected to be around 170 million video consultations. Mainstream healthcare is adopting video conferencing to provide medical support via equipment which is not expensive but commonplace by using smart devices to deliver this intervention. Video enabled consultations with Maritime Telemedical Assistance Service doctors could be used not only for medical emergencies but also to provide access to chronic disease management for conditions such as high blood pressure, heart disease or diabetes whilst at sea.
The annual cost to the global maritime fleet of diversions and helicopter evacuations is estimated to be $760m; access to video consultations can be a cost-effective way of providing medical care for seafarers.
Electronic Medical Record
This is an electronic system to keep health data about patients. Providing seafarers with access to a cloud based Electronic Medical Record (EMR) system, would provide access anywhere there is internet. It would allow storage of all interactions with healthcare providers, for example, results of their seafarers medical or outcomes of any visits to a doctor either at home or during a port call or care provided to them aboard. In a medical emergency, the Maritime Telemedical Assistance Service would be able to view the seafarer’s past medical history. Utilization of an EMR system would improve the quality of healthcare provided to seafarers.
Remote Refresher Medical Training
Health professionals are required to attend regular clinical skill training on a frequent basis. But how do they retain their skills? Not very well. Studies from health professionals that have received adult life support training there is significant skill decay six months to a year after the training.
In trained first responders, a study revealed that CPR practical skill retention had deteriorated to the extent that they would not adequately manage a real life cardiac arrest.
These are just some examples of evidence that has demonstrated that the requirement for all types of responders in a medical emergency to have regular opportunities to practice their critical skills. This skill decay is very important.
Mainstream medicine has adopted the benefits of providing training remotely via telemedicine for years. For example, in Scotland there are rural doctors who support the ambulance service in emergencies by providing pre hospital emergency medical care. Video training is used on a regular basis to provide simulated scenarios which enables that doctor to keep up to date with their hands-on clinical skills. Considering the reported frequency of medical emergencies encountered aboard a vessel, the 5 yearly interval of mandatory medical training without any form of refresher course appears to be too long to guarantee adequate medical treatment. Utilizing training videos accessible from an eLearning platform or video real-time simulation on board from land based experts in maritime medical emergencies would assist in combating this skill decay
Wearable Technology and Apps
The Wearable Technology market is increasing. In 2016, it is estimated that over 300m Wearable devices were on the market. By 2020, it is estimated that 830m devices are going to be sold. That is nearly 1 in 7 people on the planet. The most interesting feature of these devices is that they are not going to be fitness driven. They will collect health data. These devices will be able to monitor people’s heartrate, blood pressure, or even blood sugar. This will transform healthcare as this clinical-grade patient data will offer doctor-driven diagnoses and assist in preventing and managing chronic health conditions like diabetes and heart problems
This is important as our life style changes have now lead to cardiovascular diseases such as coronary artery disease, stroke and high blood pressure being the leading cause of morbidity and mortality worldwide since 2015. This looks unlikely to change in the near future.
Using these devices with selected apps, will improve health and wellness. If a company wishes to improve health and wellness management of its crew, these devices could help reduce the cost from these chronic health conditions as studies on male seafarers have shown that there no major differences in rates cardiovascular disease compared with males in land-based occupations
In summary, the maritime industry has the opportunity to embrace health technology. It is not expensive. Bringing in these interventions could help provide better access to healthcare to seafarers and meet the MLC 2006 requirements on healthcare aboard a vessel. Utilizing this technology could help reduce costs by improving the management of chronic diseases as these diseases. If you do not manage them adequately when on board, these diseases can cause unnecessary medical diversions which cost money. But most importantly, by using this technology it could help save a life.
Above text is an edited version of Dr. Phil Sharples presentation during the last SAFETY4SEA Conference in Athens
You may view his video presentation herebelow:
The views expressed in this article are solely those of the authors and do not necessarily represent those of SAFETY4SEA and are for information sharing and discussion purposes only.
Dr. Phil Sharples, Global Senior Medical Director, UnitedHealthcare Global Medical
Dr. Phil Sharples has been Senior Medical Director at UnitedHealthcare Global Medical since 2006 and is responsible for the clinical care delivery to UnitedHealthcare Global Medical clients. Phil is responsible for healthcare governance and clinical excellence working closely with other clinical functions in UnitedHealthcare Global in order to deliver quality healthcare solutions to clients. He has demonstrated the ability to facilitate and manage numerous projects whilst maintaining excellent client and colleague relationships.
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