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Medical System Concept of Operations for Mars Exploration Missions

Future exploration missions will be the first time humanity travels beyond Low Earth Orbit (LEO) since the Apollo program, taking us to cis-lunar space, interplanetary space, and Mars. These long-duration missions will cover vast distances, severely constraining opportunities for emergency evacuation to Earth and cargo resupply opportunities. Communication delays and blackouts between the crew and Mission Control will eliminate reliable, real-time telemedicine consultations. As a result, compared to current LEO operations onboard the International Space Station, exploration mission medical care requires an integrated medical system that provides additional in-situ capabilities and a significant increase in crew autonomy. The Medical System Concept of Operations for Mars Exploration Missions illustrates how a future NASA Mars program could ensure appropriate medical care for the crew of this highly autonomous mission. This Concept of Operations document, when complete, will document all mission phases through a series of mission use case scenarios that illustrate required medical capabilities, enabling the NASA Human Research Program (HRP) Exploration Medical Capability (ExMC) Element to plan, design, and prototype an integrated medical system to support human exploration to Mars.

Urbina, M.↗

Medical Optimization Network for Space Telemedicine Resources

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. NASA recognizes the need to improve capabilities for autonomous care on such missions. As the medical system is developed, it is important to have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources was developed for this reason, and is now a system to gauge the relative importance of medical resources in addressing medical conditions. METHODS: A list of medical conditions of potential concern for an exploration mission was referenced from the Integrated Medical Model, a probabilistic model designed to quantify in-flight medical risk. The diagnostic and treatment modalities required to address best and worst-case scenarios of each medical condition, at the terrestrial standard of care, were entered into a database. This list included tangible assets (e.g. medications) and intangible assets (e.g. clinical skills to perform a procedure). A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program ranked each of the items listed according to its criticality. Data was then obtained from the IMM for the probability of occurrence of the medical conditions, including a breakdown of best case and worst case, during a Mars reference mission. The probability of occurrence information and criticality for each resource were taken into account during analytics performed using Tableau software. RESULTS: A database and weighting system to evaluate all the diagnostic and treatment modalities was created by combining the probability of condition occurrence data with the criticalities assigned by the physician team. DISCUSSION: Exploration Medical Capabilities research at NASA is focused on providing a medical system to support crew medical needs in the context of a Mars mission. MONSTR is a novel approach to performing a quantitative risk analysis that will assess the relative value of individual resources needed for the diagnosis and treatment of various medical conditions. It will provide the operational and research communities at NASA with information to support informed decisions regarding areas of research investment, future crew training, and medical supplies manifested as part of the exploration medical system.

Shah, R. V.↗

Medical System Concept of Operations for Mars Exploration Missions

Future exploration missions will be the first time humanity travels beyond Low Earth Orbit (LEO) since the Apollo program, taking us to cis-lunar space, interplanetary space, and Mars. These long-duration missions will cover vast distances, severely constraining opportunities for emergency evacuation to Earth and cargo resupply opportunities. Communication delays and blackouts between the crew and Mission Control will eliminate reliable, real-time telemedicine consultations. As a result, compared to current LEO operations onboard the International Space Station, exploration mission medical care requires an integrated medical system that provides additional in-situ capabilities and a significant increase in crew autonomy. The Medical System Concept of Operations for Mars Exploration Missions illustrates how a future NASA Mars program could ensure appropriate medical care for the crew of this highly autonomous mission. This Concept of Operations document, when complete, will document all mission phases through a series of mission use case scenarios that illustrate required medical capabilities, enabling the NASA Human Research Program (HRP) Exploration Medical Capability (ExMC) Element to plan, design, and prototype an integrated medical system to support human exploration to Mars.

Urbina, Michelle↗

Medical Data Architecture Project Capabilities and Design

Mission constraints will challenge the delivery of medical care on a long-term, deep space exploration mission. This type of mission will be restricted in the availability of medical knowledge, skills, procedures and resources to prevent, diagnose, and treat in-flight medical events. Challenges to providing medical care are anticipated, including resource and resupply constraints, delayed communications and no ability for medical evacuation. The Medical Data Architecture (MDA) project will enable medical care capability in this constrained environment. The first version of the system, called "Test Bed 1," includes capabilities for automated data collection, data storage and data retrieval to provide information to the Crew Medical Officer (CMO). Test Bed 1 seeks to establish a data architecture foundation and develop a scalable data management system through modular design and standardized interfaces. In addition, it will demonstrate to stakeholders the potential for an improved, automated, flow of data to and from the medical system over the current methods employed on the International Space Station (ISS). It integrates a set of external devices, software and processes, and a Subjective, Objective, Assessment, and Plan (SOAP) note commonly used by clinicians. Medical data like electrocardiogram plots, heart rate, skin temperature, respiration rate, medications taken, and more are collected from devices and stored in the Electronic Medical Records (EMR) system, and reported to crew and clinician. Devices integrated include the Astroskin biosensor vest and IMED CARDIAX electrocardiogram (ECG) device with INEED MD ECG Glove, and the NASA-developed Medical Dose Tracker application. The system is designed to be operated as a standalone system, and can be deployed in a variety of environments, from a laptop to a data center. The system is primarily composed of open-source software tools, and is designed to be modular, so new capabilities can be added. The software components and integration methods will be discussed.

Data architecture↗

Supervisory Control of a Humanoid Robot in Microgravity for Manipulation Tasks

Teleoperation is the dominant form of dexterous robotic tasks in the field. However, there are many use cases in which direct teleoperation is not feasible such as disaster areas with poor communication as posed in the DARPA Robotics Challenge, or robot operations on spacecraft a large distance from Earth with long communication delays. Presented is a solution that combines the Affordance Template Framework for object interaction with TaskForce for supervisory control in order to accomplish high level task objectives with basic autonomous behavior from the robot. TaskForce, is a new commanding infrastructure that allows for optimal development of task execution, clear feedback to the user to aid in off-nominal situations, and the capability to add autonomous verification and corrective actions. This framework has allowed the robot to take corrective actions before requesting assistance from the user. This framework is demonstrated with Robonaut 2 removing a Cargo Transfer Bag from a simulated logistics resupply vehicle for spaceflight using a single operator command. This was executed with 80% success with no human involvement, and 95% success with limited human interaction. This technology sets the stage to do any number of high level tasks using a similar framework, allowing the robot to accomplish tasks with minimal to no human interaction.

Farrell, Logan C.↗

Medical Data Architecture Capabilities and Design

Mission constraints will challenge the delivery of medical care on a long-term, deep space explorationmission. This type of mission will be restricted in the availability of medical knowledge, skills, procedures and resourcesto prevent, diagnose, and treat in-flight medical events. Challenges to providing medical care are anticipated, includingresource and resupply constraints, delayed communications and no ability for medical evacuation. The Medical DataArchitecture (MDA) project will enable medical care capability in this constrained environment.The first version of thesystem, called Test Bed 1, includes capabilities for automated data collection, data storage and data retrieval to provideinformation to the Crew Medical Officer (CMO). Test Bed 1 seeks to establish a data architecture foundation and developa scalable data management system through modular design and standardized interfaces. In addition, it will demonstrateto stakeholders the potential for an improved, automated, flow of data to and from the medical system over the currentmethods employed on the International Space Station (ISS). It integrates a set of external devices, software andprocesses, and a Subjective, Objective, Assessment, and Plan (SOAP) note commonly used by clinicians. Medical datalike electrocardiogram plots, heart rate, skin temperature, respiration rate, medications taken, and more are collectedfrom devices and stored in the Electronic Medical Records (EMR) system, and reported to crew and clinician. Devicesintegrated include the Astroskin biosensor vest and IMED CARDIAX electrocardiogram (ECG) device with INEED MDECG Glove, and the NASA-developed Medical Dose Tracker application.The system is designed to be operated as astandalone system, and can be deployed in a variety of environments, from a laptop to a data center. The system isprimarily composed of open-source software tools, and is designed to be modular, so new capabilities can be added. Thesoftware components and integration methods will be discussed.

Exploration medical system↗

Integrated Systems Health Management for Sustainable Habitats (Using Sustainability Base as a Testbed)

Habitation systems provide a safe place for astronauts to live and work in space and on planetary surfaces. They enable crews to live and work safely in deep space, and include integrated life support systems, radiation protection, fire safety, and systems to reduce logistics and the need for resupply missions. Innovative health management technologies are needed in order to increase the safety and mission-effectiveness for future space habitats on other planets, asteroids, or lunar surfaces. For example, off-nominal or failure conditions occurring in safety-critical life support systems may need to be addressed quickly by the habitat crew without extensive technical support from Earth due to communication delays. If the crew in the habitat must manage, plan and operate much of the mission themselves, operations support must be migrated from Earth to the habitat. Enabling monitoring, tracking, and management capabilities on-board the habitat and related EVA platforms for a small crew to use will require significant automation and decision support software.Traditional caution and warning systems are typically triggered by out-of-bounds sensor values, but can be enhanced by including machine learning and data mining techniques. These methods aim to reveal latent, unknown conditions while still retaining and improving the ability to provide highly accurate alerts for known issues. A few of these techniques will briefly described, along with performance targets for known faults and failures. Specific system health management capabilities required for habitat system elements (environmental control and life support systems, etc.) may include relevant subsystems such as water recycling systems, photovoltaic systems, electrical power systems, and environmental monitoring systems. Sustainability Base, the agency's flagship LEED-platinum certified green building acts as a living laboratory for testing advanced information and sustainable technologies that provides an opportunity to test novel machine learning and controls capabilities. In this talk, key features of Sustainability Base that make it relevant to deep space habitat technology and its use of these kinds of subsystems previously listed will be presented. The fact that all such systems require less power to support human occupancy can be used as a focal point to serve as a testbed for deep space habitats that will need to operate within finite energy budgets.

Systems Health Management↗

Development and Testing of a Vehicle Management System for Autonomous Spacecraft Habitat Operations

As the increased distance between Earth-based mission control and the spacecraft results in increasing communication delays, small crews cannot take on all functions performed by ground today, and so vehicles must be more automated to reduce the crew workload for such missions. In addition, both near-term and future missions will feature significant periods when crew is not present, meaning the vehicles will need to operate themselves autonomously. NASA's Advanced Exploration Systems Program pioneers new approaches for rapidly developing prototype systems, demonstrating key capabilities, and validating operational concepts for future human missions beyond low-Earth orbit. Under this program, NASA has developed and demonstrated multiple technologies to enable the autonomous operation of a dormant space habitat. These technologies included a fault-tolerant avionics architecture, novel spacecraft power system and power system controller, and autonomy software to control the habitat. The demonstration involved simulation of the habitat and multiple spacecraft sub-systems (power storage and distribution, avionics, and air-side life-support) during a multi-day test at NASA's Johnson Space Center. The foundation of the demonstration was ‘quiescent operations' of a habitat during a 55 minute eclipse period. For this demonstration, the spacecraft power distribution system and air-side life support system were simulated at a high level of fidelity; additional systems were managed, but with lower fidelity operational constraints and system behavior. Operational constraints for real and simulated loads were developed by analyzing on-orbit hardware and evaluating future Exploration capable technology. A total of 13 real and simulated loads were used during the test. Eight scenarios including both nominal and off-nominal conditions were performed. Over the course of the test, every application performed its desired functions successfully during the simulated tests. The results will inform both future tests, as well as provide insight to NASA's domestic and international partners, as they construct the next generation of space habitats to be used on beyond-Earth missions.

Autonomous Systems and Operations↗

AMO EXPRESS: A Command and Control Experiment for Crew Autonomy Onboard the International Space Station

NASA is investigating a range of future human spaceflight missions, including both Mars-distance and Near Earth Object (NEO) targets. Of significant importance for these missions is the balance between crew autonomy and vehicle automation. As distance from Earth results in increasing communication delays, future crews need both the capability and authority to independently make decisions. However, small crews cannot take on all functions performed by ground today, and so vehicles must be more automated to reduce the crew workload for such missions.NASAs Advanced Exploration Systems Program funded Autonomous Mission Operations (AMO) project conducted an autonomous command and control experiment on-board the International Space Station that demonstrated single action intelligent procedures for crew command and control. The target problem was to enable crew initialization of a facility class rack with power and thermal interfaces, and involving core and payload command and telemetry processing, without support from ground controllers. This autonomous operations capability is enabling in scenarios such as initialization of a medical facility to respond to a crew medical emergency, and representative of other spacecraft autonomy challenges. The experiment was conducted using the Expedite the Processing of Experiments for Space Station (EXPRESS) rack 7, which was located in the Port 2 location within the U.S Laboratory onboard the International Space Station (ISS).

Autonomous Mission Operations↗

Inserting New Technologies into Human-Computer Interfaces for Future Lunar and Mars Missions

Plans call for human cislunar operations and lunar surface access, to prepare for eventual Mars missions. NASA will also develop new opportunities in lunar orbit that provide the foundation and act as a gateway for human exploration deeper into the solar system. Current human spaceflight is complex and requires as many as fifty people to support the International Space Station (ISS) Mission Control Center (MCC) in Houston, Texas. These flight controllers in the front and back rooms of the MCC, serve as an extra pair of eyes overseeing the numerous station systems. Deep space missions - to the moon, Mars, and beyond - will be more complex and place challenging mission constraints on the crew. As the round-trip communication delays increase in deep space exploration, more on-board systems autonomy and functionality will be needed to maintain and control the vehicle. These mission constraints will change the Earth-based ground control approach and will demand efficient and effective human-computer interfaces (HCI) to control a highly complex vehicle or habitat system. All of this necessitates a different approach to designing and developing spacecraft and habitats. In the beginning of new human spaceflight programs, focus is typically on launch vehicle and uncrewed spacecraft design and development. The reasoning behind this focus to enable flight testing of an integrated launch vehicle and spacecraft system to ensure it will be safe enough to allow humans on board. This is an essential process for new spacecraft, however, the practical effect is a lack of funding for the spacecraft’s human interfaces development. It can be many years before the human interface development begins, putting it late in the spacecraft lifecycle, when almost all other spacecraft systems and subsystems are already in place. This forces the usage of existing and proven technologies for the HCI interfaces. We posit that putting the human first in a spacecraft design process will yield a more effective spacecraft for exploration and long duration missions. NASA Human Research Program (HRP) has identified inadequate HCI as a risk for future missions. New tools and procedures to aid the crew in operating a complex spacecraft will be required. This paper discusses ongoing activities in the development of the next generation HCI components and systems, and a new approach toward human interfaces for spacecraft.

Salazar, George A.↗

Using Systems Engineering to Develop an Integrated Crew Health and Performance System to Mitigate Risk for Human Exploration Missions

New space exploration missions are currently being designed to take humanity beyond low Earth orbit (LEO) to cis-lunar space, the lunar surface, and eventually to Mars. These missions carry increased risks due to a number of factors, including distance from Earth, exposure to deep space hazards, reduced capacity and ability to resupply and evacuate, and increased communication delays. As distance from Earth grows and mission length increases, a growing proportion of mission risk can be attributed to the “human system.” Almost twenty years ago, the Institute of Medicine in the United States recommended the early and complete integration of the human system into the spacecraft and mission design process to mitigate this increased risk inherent in exploration missions. Exploration missions will require increasing levels of crew self-sufficiency that will challenge the current operational paradigms established in LEO. Enabling progressive Earth independence requires management of the increasingly complex interactions among spacecraft systems and integration of all the data and functions that affect human health and performance into one coordinated system –the Crew Health and Performance (CHP) system. This system is a critical spacecraft system that is analogous to other systems such as propulsion, guidance and navigation, or avionics. Design and integration of the CHP system requires the evidence-based merger of typically disparate disciplines such as medicine, human factors, and life support system design, using systems engineering (SE) practices. SE provides traceability of spacecraft requirements and enables reliable and repeatable trade space analysis of the many competing options for hardware and software to be included in the mission architecture. The approach described here enables spacecraft and mission designers to align the scope of a CHP system with mission specific requirements, decrease risk to the crew, and increase the probability of mission success.

Kerry McGuire↗

Envisioning the Future Role of an Exploration Clinical Decision Support System

The Exploration Medical Capability Element of the NASA Human Research Program seeks to fuse new and existing technologies with practical mission goals into feasible and fiscally realizable human missions to the Moon and Mars. Expected communication delays with Earth-based medical experts will require unprecedented crew self-reliance to rapidly identify and treat anticipated and unforeseen medical conditions using constrained onboard resources with limited crew clinical skill. During this session, the current status of this project will be presented. We will discuss how current modes of decision support (e.g., alerts of critical values, reminders of overdue preventive health tasks, guided clinical workflows, advice for drug prescribing, critiques of existing health care orders, and suggestions for various active care issues) can be tailored to exploration crew needs.

human-system integration↗

Preparing for Human Missions to Mars: The role of ISS and Artemis as Analogs for Research and Technology Testing

The hazards of spaceflight to the human system are present in in varying degrees on different spaceflight platforms: altered gravity, isolation and confinement, distance from Earth, radiation, and hostile closed environments. A strategic view of the fidelity of hazards experienced on different platforms can shape the testing plans for human research and technology demonstration related to crew health and performance. Working across the international partnership, the International Space Station (ISS) is planning periods of modified operations to improve the fidelity of Mars simulations. To understand transit durations as an independent variable, a series of 1-year, 6-month and 30-45 day missions are being planned on ISS. Standard measurements across ISS missions of different durations, lunar missions and ground analogs offers the opportunity to distinguish different hazards and their effects in the context of the relevance to future mission concepts. The ISS partnership is planning for additional test cases that are aligned with Mars mission plans. (1) Evaluating crew performance capabilities when transitioning to gravity after long durations in microgravity representative of a Mars transit. (2) Simulating crew medical care under Mars-like autonomous operations. (3) Identification and testing of operations under communications delay and autonomy expected for Mars missions and the linked effects on behavioral health and performance of the crew. Artemis missions serve as a valuable analogs for Mars surface operations, with partial gravity and deep space radiation hazards, but with crewmembers that are probably more physically capable than their counterparts would be after a Mars transit. Getting unobtrusive data from early Artemis missions, and knowledge gained from operational experience as Artemis operations develop can improve engineering design, medical requirements and countermeasures, and ultimately ensure mission success on Mars. Linking Mars architectures with the plans and capabilities for ISS and Artemis allows us to plan to most operationally relevant tests of crew health and performance on current spaceflight missions to inform planning for future missions to Mars. By using human spaceflight platforms as well as ground simulation in an integrated way, the international community can improve exploration readiness, develop countermeasures and reduce risks of future human space missions.

International Space Station↗

Spaceflight Medical Evacuation Risk Assessment Principles – A Qualitative Investigation

Future human space exploration beyond Low Earth Orbit (LEO) will require innovative solutions in many areas, especially to support the crew medically and optimize their health and performance. Challenges will be numerous, including: extended one-way communication delays, minimal to non-existent resupply and a transit time to a “definitive care” facility ranging from 3-days to 9-months. At the same time, exploration spacecraft will face even more significant restrictions on mass-power-volume-data than in present operational settings. Given these limitations, medical risk assessment is of primary importance, especially evaluating the implications of a medical evacuation of an ill or injured crewmember. Such evacuations are complicated and potentially dangerous, and may be impossible in certain phases of the mission, but this must be weighed against the risks of the injured crew remaining aboard a spacecraft with limited medical resources.

A T Almand↗

Clinical Decision Support - Concepts of Operation

We are entering a new era in space exploration to return to the moon and explore Mars. Crew members operating independently during long duration space exploration missions will require a clinical decision support system (CDSS) to increase autonomy by augmenting their knowledge, skills and abilities in different scenarios. Significant changes to in-flight and habitat medical care due to constraints on mass, volume, power, crew time and medical evacuation capabilities are needed to increase crew autonomy and self-reliance in decision making and task performance. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) pushes the boundary of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit by identifying and testing next-generation medical care and crew health maintenance technologies. Clinical decision support (CDS) presents knowledge and data in a context aware manner to augment a crew members’ knowledge, skills and abilities during the process of observation, orientation, decisions and action. A comprehensive crew health and performance CDSS is required to augment crew capability and will be used in different scenarios for several reasons. In general, the CDSS’s role is to assist the crew in prevention, detection, diagnosis and treatment of crew health and performance related conditions that may arise in exploration spaceflight. For example, CDSS would assist a high acuity scenario such as a heart attack by supplying clear instructions, vital signs and treatment reminders. A lower severity scenario such as kidney stone risk could interface to vehicle systems and display more complex predictive data during a diagnosis. A CDSS needs to contribute to successful missions by maintaining a high performing crew who can potentially exhibit countless medical conditions related to derangements from the space environment (sleep, cognition, nutrition and exercise) as well as conditions intrinsic to humans anywhere. While supporting the crew’s ability to make sound clinical decisions is desirable in any mission, it is essential for exploration missions with significant communication delays, no evacuation capability, and extended exposure to the flight environment. Such missions correspond with medical Level of Care V (LOC V), the highest level specified in NASA-STD-3001. The project focuses on CDS implementation research to derive requirements for LOC V, where the need for increased autonomy results in new practices and the inclusion of non-clinical data, such as vehicle environmental measures and physical exercise results, from other human and vehicle domains and advanced analytics. The CDS project describes how the CDSS is intended to be used by defining concepts of operations (ConOps). The process to derive ConOps focuses on increased autonomy that reduces the likelihood and consequences of accepted medical conditions. These crew health and performance inputs are grouped by common datasets and analysis models. Use cases are derived to research new clinical scenarios, architectural development and workflows. Implementation research is conducted with protypes to inform assumptions and derive requirements. The project also establishes how externally developed analysis and approaches can be added to expand a clinical decision support system and thus highlight how a comprehensive system can be globally developed with collaborators. This presentation will cover example scenarios from the CDS ConOps and the method to derive them. One example scenario will be CDSS alerting an increased kidney stone risk during a mission, with diagnosis and treatment options provided during the intervention.

clinical decision support↗

Monitoring Human Performance on Future Deep Space Missions Abstract

NASA and the commercial spacecraft community are working diligently to put the first woman on the moon in the 2024 timeframe. At the same time, NASA researchers are thinking about how to solve the even larger challenges that future deep space missions will bring. Space travel itself is difficult, but astronauts on deep space missions will face obstacles and unknowns never before experienced. In addition to the altered gravity and hostile/closed environment of a spacecraft, deep space crews will face increased radiation, isolation, and distance from Earth. During Extravehicular Activity (EVA, or “spacewalk”) operations, crew will experience increased physical and cognitive workload due to extended types, frequencies and durations of tasks performed on exploration missions in partial gravity environments. All of these stressors will impact crew physical and mental health and performance in difficult-to-anticipate ways. Crew autonomy may be one of the biggest challenges faced. Communication delays and blackouts will occur, and in those situations, the crew may not have access to the Mission Control Center (MCC). They may be forced to be solely dependent on each other and the available information onboard to stay alive, healthy, and achieve the mission. The only conceivable way to meet the challenges of Earth independence is to enable the crew to monitor their own health and performance -- preferably unobtrusively as they perform their duties. Technologies and techniques must be developed to aid the crew in these assessments. A deep space mission is expected to have relatively short periods of high cognitive demand, stress, and fatigue, alongside potentially long periods of cognitive underload during the transit, where boredom, loneliness, and depression can set in. Both ends of this spectrum are dangerous. Crew must be made aware when their task performance drops significantly, when their cognitive workload is too high, when they have lost situation awareness, or when they are too stressed or too fatigued to perform well. They must be able to identify these risks, and then mitigate them with countermeasures available onboard. A number of self-monitoring technologies are presently being explored by NASA to advance crew state determination capabilities. These range from real-time, physiological workload and situation awareness assessments, to crew health measurements determining physical and mental fitness for duty, to task performance metrics such as suit resource expenditures. For EVA tasks during surface exploration missions, biomedical information such as metabolic rate may be provided to crewmembers for situational awareness related to task performance efficiency. In addition, translation distances, hydration, nutrition, inspired CO2 exposure and other consumables usage rates may be useful input metrics for modeling individualized performance during tasks to inform crew or provide estimates of work efficiency. Oculomotor metrics such as gaze dwell time, pupilometry, and eye tracking collected in advanced helmet mounted displays could potentially be used to characterize crew situation awareness. This paper highlights some of these projects, and provides broader discussion about the need for advanced monitoring and smart technologies, as NASA takes the leap into the next generation of space exploration.

Kritina Holden↗

Clinical Decision Support - Concepts of Operation

We are entering a new era in space exploration to return to the moon and explore Mars. Crew members operating independently during long duration space exploration missions will require a clinical decision support system (CDSS) to increase autonomy by augmenting their knowledge, skills and abilities in different scenarios. Significant changes to in-flight and habitat medical care due to constraints on mass, volume, power, crew time and medical evacuation capabilities are needed to increase crew autonomy and self-reliance in decision making and task performance. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) pushes the boundary of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit by identifying and testing next-generation medical care and crew health maintenance technologies. Clinical decision support (CDS) presents knowledge and data in a context aware manner to augment a crew members’ knowledge, skills and abilities during the process of observation, orientation, decisions and action. A comprehensive crew health and performance CDSS is required to augment crew capability and will be used in different scenarios for several reasons. In general, the CDSS’s role is to assist the crew in prevention, detection, diagnosis and treatment of crew health and performance related conditions that may arise in exploration spaceflight. For example, CDSS would assist a high acuity scenario such as a heart attack by supplying clear instructions, vital signs and treatment reminders. A lower severity scenario such as kidney stone risk could interface to vehicle systems and display more complex predictive data during a diagnosis. A CDSS needs to contribute to successful missions by maintaining a high performing crew who can potentially exhibit countless medical conditions related to derangements from the space environment (sleep, cognition, nutrition and exercise) as well as conditions intrinsic to humans anywhere. While supporting the crew’s ability to make sound clinical decisions is desirable in any mission, it is essential for exploration missions with significant communication delays, no evacuation capability, and extended exposure to the flight environment. Such missions correspond with medical Level of Care V (LOC V), the highest level specified in NASA-STD-3001. The project focuses on CDS implementation research to derive requirements for LOC V, where the need for increased autonomy results in new practices and the inclusion of non-clinical data, such as vehicle environmental measures and physical exercise results, from other human and vehicle domains and advanced analytics. The CDS project describes how the CDSS is intended to be used by defining concepts of operations (ConOps). The process to derive ConOps focuses on increased autonomy that reduces the likelihood and consequences of accepted medical conditions. These crew health and performance inputs are grouped by common datasets and analysis models. Use cases are derived to research new clinical scenarios, architectural development and workflows. Implementation research is conducted with protypes to inform assumptions and derive requirements. The project also establishes how externally developed analysis and approaches can be added to expand a clinical decision support system and thus highlight how a comprehensive system can be globally developed with collaborators. This presentation will cover example scenarios from the CDS ConOps and the method to derive them. One example scenario will be CDSS alerting an increased kidney stone risk during a mission, with diagnosis and treatment options provided during the intervention.

clinical decision support↗