Table 1 Clinical scenario grouped by acuity level with example CDSS assistive functionality.
From: The value of a spaceflight clinical decision support system for earth-independent medical operations
Scenario | CMO goals of care | CDSS assistance | Rationale |
|---|---|---|---|
Any Medical event | Automation of information flow between vehicle and MCC | Collect, collate and communicate with MCC | Reduce operator time and cognitive load. |
Emergency e.g., Cardiac arrest, unexpected life threats Delayed comms to MCC makes this a priority | • Stabilize patient to allow time for full analysis by CDSS, crew, and ground teams and allow further complex treatment • Reduce crew workload • Perform procedures correctly • Acquire and comprehend data from multiple sources | • Easy to access and follow protocols • Prioritized and clutter-free essential information • Electronic procedures; • Just in Time Training • Vital signsa collection and display | • Predetermined protocols for fast-paced, life-threatening scenarios, e.g., ABCDE32. • Assist with procedures as required. e.g., intubation • Feedback on success of treatment to inform next step in protocol |
Routine – Diagnosis e.g., Headache, Lower back pain Problematic communication delay between each question and answer during a PMC with Earth | • Assess severity • Perform a differential diagnosis • Determine highest probability condition | • Supports clinical workflow • Dynamically adjusts to novice or expert user • Probabilistic engine calculates next best question with highest positive predictive value | • Diagnosis is a complex task • System should support caregiver’s mental model |
Routine - Treatment e.g., Headache, Lower back pain Delayed comms make this problematic | • Treatment and care plan • Treat with best practice and minimal use of resources • Manage medications • Manage patient records • Ensure tailored, precision-based medicine • Facilitate efficient and prompt care | • Therapeutic advice based on evidence with ranked options crew can choose from. • Offer a variety of pharmacologic and alternative treatments • Automatic patient record retrieval including allergies, existing treatment and conditions • Provide information on stowage location of medications, supplies, equipment | • A large knowledge base in CDSS is required to give all possible options (e.g. Merck manual5) supplied as needed based on diagnosis • Crew personal preferences • Medical errors can easily be mitigated with automatic record retrieval and checking • A simple and extremely valuable task in a space vehicle full of equipment • Trade-off side effects or performance deficits • Options dependent upon limited supply |
Routine - Observation Rich data best analyzed on vehicle due to low transmission bandwidth Prompt response to emerging issue | • Assess initial care plan effectiveness • Recognize change in status to higher or lower acuity and adapt plan as needed | • Update previous decisions based on new observations | • Clinical practice treats ‘most likely/severe diagnosis.’ New or persistent symptoms can offer information for new diagnosis or change to emergency scenario |
Prevention e.g., Kidney Stones Rich datasets created on vehicle best residing locally due to narrow comms bandwidth | • Anticipate threats to health to reduce medical events over time • Mitigation strategies to enhance and/or prevent decrements in performance • Measure the crew with least possible distractions to operational activities • Accurately record data in medical records | • Prediction of performance decrements or potential medical events • Ambient Monitoring33 • Automated record keeping | • Long term issues such as kidney stones, bone loss, behavioral and cognitive deficits can be mitigated with diet, sleep, exercise • Ambient monitoring data collection and analysis reduces workload |
