Navigating health at sea: Telemedicine’s voyage into maritime healthcare

Telemedicine, the remote diagnosis and treatment of patients through telecommunications technology, has found a promising niche in the maritime industry, particularly cargo ships with remote itineraries. In an environment where access to traditional medical care can be limited, telemedicine offers a lifeline to crew members, ensuring timely and efficient healthcare delivery, regardless of the ship’s location.

Developing a telemedicine program for cargo ships is crucial in providing remote medical care for crew members.

Life at sea presents unique challenges for healthcare delivery. Cargo ships often navigate through vast expanses of ocean, far from medical facilities or specialists. Even minor medical concerns can escalate rapidly without prompt attention. In such circumstances, telemedicine may bridge the gap between the ship and shore-based healthcare providers, offering real-time medical consultations, diagnoses, and treatment recommendations.

Case Study Examples

Imagine a scenario aboard a ship where a crew member experiences severe chest pain, indicating a potential cardiac issue but with an EKG that does not indicate an acute myocardial infarction (heart attack). With telemedicine-equipped vessels, onboard the medical officer can quickly connect with cardiologists ashore for immediate guidance.

Through video conferencing and medical data sharing, the cardiologist can assess the situation, provide treatment recommendations, guide the administration of medications until the ship reaches port for further medical assistance and advises as to whether the ship needs to speed up, divert or just continue to the next port. 

Perhaps a crewmember is having severe intermittent headaches and there is no neurologists in any port on the ship’s itinerary or the next crewmember has a blistering rash the ship’s doctor has never see.   Another crewmember has signs of depression and has issues he does not want to discuss with the onboard staff he sees every day – a telemedicine psychiatry appointment is arranged.

On a transoceanic voyage, two days from port, a crew member on a tanker sustains a deep laceration while performing maintenance tasks. There is no doctor and there are limited medical supplies and expertise onboard. The ship’s most experienced crew member (medical officer) can use telemedicine to consult with a shore-based surgeon.

By sharing high-resolution images and vital signs data, the surgeon can assess the wound’s severity and provide detailed instructions for wound care and suturing techniques, minimizing the risk of infection and ensuring optimal healing or instruct the ship medical designee on proper wound management until arrival in post, possibly avoiding a diversion and decreasing long-term disability for the crewmember.

Remote Healthcare Infrastructure

The ability to even consider implementing telemedicine on maritime vessels has evolved rapidly over the past few years as bandwidth has improved and costs have come down through advances such as Starlink. Telemedicine requires a robust infrastructure comprising specialized equipment and reliable communication systems. Modern ships are equipped with satellite communication technology, enabling seamless connectivity even in remote regions.

Medical facilities onboard can be equipped with telemedicine equipment stations featuring high-definition cameras, secure data transmission capabilities and diagnostic tools including digital stethoscopes, ECGs, dermatoscopes and even ultrasound (another future topic). The ship becomes the eyes and hands of the clinician at the other end of the call.

Benefits of Maritime Telemedicine

• Timely Intervention: Telemedicine enables timely medical intervention, reducing the risk of complications and improving patient outcomes. By accessing specialized medical expertise remotely, maritime healthcare providers can make informed decisions and initiate appropriate treatments promptly.
• Cost-efficiency: In addition to enhancing patient care, telemedicine offers cost savings for ship operators. By avoiding unnecessary medical evacuations and minimizing port diversions for medical emergencies, telemedicine helps optimize voyage schedules and reduce operational expenses.  Costly and logistically difficult shoreside consultations arranged directly or through port agents may be avoidable as the consults take place via telemedicine.
• Crew health and well-being: Crew members spend extended periods at sea, facing occupational hazards and health challenges. Telemedicine supports crew health and well-being by providing access to preventive care, routine medical consultations, and mental health support services, fostering a healthier and more resilient maritime workforce. A well crew is a happy crew.  Additionally, crew awareness that telemedicine consultation is available in emergency situations and for specialty consultation is reassuring and validates the interest of the ship’s operator in the crew’s well-being.

Implementation

Implementation of a telemedicine program involves many steps including a needs assessment.  What services are needed and wanted primary care only, specialty service only, second opinions; specialty services only such s Dermatology, Neurology, or Psychiatry vs full service; critical care for diversion decisions, etc. 

Once the scope is decided, a provider who can provide those services with access for the hours needed, usually 24/7/365 must be selected and credentialled.  Access to needed and designated specialists must be insured.  Systems of cameras and communication need to be developed and implemented.  Interactions must be recorded in the medical record and a system of reimbursement developed.

AP Companies provides Telemedical services for the Maritime Industry, offering round-the-clock support from a diverse team of specialists. We understand the common conditions that may arise on board, tailored to each shipping company’s activities and vessel type.

Our services include initial triage and telemedical assistance whenever possible. For serious cases, we manage treatment onshore. Our data shows that timely telemedical assistance eliminates the need for further in-port medical interventions in 85% of cases.

Here are some of the specific steps in developing a telemedicine at sea program:

1. Conduct a needs assessment: Start by identifying the specific healthcare needs of crew members on the ships. Consider factors such as the types of medical conditions commonly encountered, the availability of on-board medical staff, and the limitations of healthcare resources on the vessel’s itinerary.
2. Identify key stakeholders: Involve relevant stakeholders in the planning and development of the telemedicine program, including medical professionals, ship operators, IT specialists, P&I Clubs and regulatory agencies if applicable. Collaboration with multiple stakeholders will ensure a comprehensive, effective and well-accepted telemedicine program.
3. Define the scope of services: Determine the range of medical services that can be delivered remotely through telemedicine, such as virtual consultations, remote monitoring of vital signs, remote diagnostics, and mental health support. Define the limitations of the telemedicine program and establish protocols for emergency vs urgent vs elective situations.  Determine of comprehensive services are needed or specific services through a gap analysis.
4. Select telemedicine technology: Choose a telemedicine platform that is secure, user-friendly, and compatible with the communication systems on the ships. Consider factors such as connectivity at sea, ease of use for both patients and healthcare providers, and data privacy and security measures.  Decide what diagnostic equipment is to be added to the platform.
5. Train medical staff: Provide training for relevant personnel on how to use the telemedicine technology effectively, including conducting remote consultations, interpreting medical data, and ensuring patient confidentiality. Ensure that all relevant staff are familiar with the telemedicine protocols and procedures.  In the case of cargo vessels with no health care personnel on board, two individuals should be well-trained as to how to work with the system and obtain needed consults and direction.
6. Establish communication protocols: Develop clear communication protocols for initiating telemedicine consultations, transferring medical records securely, and coordinating care between on-board medical staff and remote healthcare providers. Establish guidelines for follow-up care and patient monitoring after telemedicine consultations.  Ensure that telemedicine providers have full access to the ship’s medicine chest/formulary.
7. Ensure regulatory compliance: Ensure that the telemedicine program complies with applicable regulations and licensing requirements for providing medical care at sea, if any. Consider both international maritime regulations and telemedicine regulations specific to the countries in which the ships operate.
8. Conduct pilot testing: Before full implementation, conduct pilot testing of the telemedicine program on select cargo and cruise ships to identify any technical or operational issues. Gather feedback from medical staff, passengers, and crew members to optimize the program and address any challenges.
9. Implement the telemedicine program: Monitor the program’s effectiveness, gather feedback from users, and make adjustments as needed to improve the delivery of remote medical care.
10. Evaluate and continually improve: Continuously evaluate the telemedicine program’s performance by tracking key metrics such as patient satisfaction, clinical outcomes, efficiency of care delivery and potential cost savings (ROI).  

Selecting the appropriate partner for such services is crucial. With numerous companies offering telemedicine services, each with its own background, AP Companies takes pride in its decade-long experience in supporting the maritime industry with various medical services, including telemedicine. As a result, we are well-positioned to be regarded as a reliable partner for this service.

The advantage of utilizing AP Companies for Telemedicine and port of call medical appointments lies in the continuity of care. Our doctors initiate the case management process while on board, and if necessary, arrange for the crew member to receive further treatment ashore.

Upon the crew member’s return to the vessel, treatment continues seamlessly. In contrast, when Telemedicine is conducted by one provider and port appointments are managed by port agents, the flow of information is disrupted, often resulting in less efficient treatment follow-up.

Future applications for telemedicine will continue to evolve in maritime healthcare including the integration of artificial intelligence for medical diagnostics, interpretation of bedside diagnostic ultrasound, and expanded tele-education initiatives to train onboard medical personnel in specialized medical procedures.

Telemedicine has emerged as a game-changer in maritime healthcare.  By harnessing the power of telecommunications technology, maritime operators can ensure the well-being of both crew members and passengers.  As the maritime industry embraces innovation, telemedicine will undoubtedly play an increasingly vital role in navigating the complexities of healthcare delivery at sea. Smooth sailing ahead, with telemedicine at the helm.

The views presented are only those of the author and do not necessarily reflect those of SAFETY4SEA and are for information sharing and discussion purposes only.