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The Skylab Medical Operations Project: Recommendations to Improve Crew Health and Performance for Future Exploration Missions

From May 1973 to February 1974, NASA conducted a series of three human missions to the Skylab space station, which was a voluminous vehicle largely descendant of Apollo hardware and the first U.S. space station. Crew members of these missions spent record-breaking durations of time in microgravity (28, 59, and 84 days, respectively) and gave the U.S. space program its first experiences with long-duration space flight. The program overcame a number of obstacles to conduct a lauded scientific program that encompassed life sciences, astronomy, solar physics, materials sciences, and Earth observation. Yet Skylab has more to offer than the results of these scientific efforts. The operations that were conducted by the crews and ground personnel represent a rich legacy of operational experience. As we plan a return to the moon and subsequent human exploration of Mars, it is essential to use the experiences and insights of those who were involved in previous programs. Skylab and Skylab Medical Experiments Altitude Test personnel possess unique insight into operations that are being planned for the Constellation Program, such as umbilical extravehicular activity and water landing/recovery of long-duration crew members. The Skylab Program was also well known for its habitability and extensive medical suite.

Scheuring, Richard A.↗

An operational approach to long-duration mission behavioral health and performance factors

NASA's participation in nearly 10 yr of long-duration mission (LDM) training and flight confirms that these missions remain a difficult challenge for astronauts and their medical care providers. The role of the astronaut's crew surgeon is to maximize the astronaut's health throughout all phases of the LDM: preflight, in flight, and postflight. In support of the crew surgeon, the NASA-Johnson Space Center Behavioral Health and Performance Group (JSC-BHPG) has focused on four key factors that can reduce the astronaut's behavioral health and performance. These factors are defined as: sleep and circadian factors; behavioral health factors; psychological adaptation factors; and human-to-system interface (the interface between the astronaut and the mission workplace) factors. Both the crew surgeon and the JSC-BHPG must earn the crewmember's trust preflight to encourage problem identification and problem solving in these four areas. Once on orbit, the crew medical officer becomes a valuable extension of the crew surgeon and BHPG on the ground due to the crew medical officer's constant interaction with crewmembers and preflight training in these four factors. However, the crew surgeon, BHPG, and the crew medical officer need tools that will help predict, prevent, monitor, and respond to developing problems. Objective data become essential when difficult mission termination decisions must be made. The need for behavioral health and performance tool development creates an environment rich for collaboration between operational healthcare providers and researchers. These tools are also a necessary step to safely complete future, more autonomous exploration-class space missions.

Review↗

Exploration Medical Capability - Advancing Medical System Design and Risk-Informed Decision Making for Deep Space Exploration

BACKGROUND: Within NASA’s Human Research Program, the Exploration Medical Capability (ExMC) Element has three primary focus areas: clinical and scientific research, systems engineering and trade space analysis, and technology development and demonstrations. These focus areas feed into the overarching goal of enabling progressively Earth-Independent Medical Operations (EIMO), a new paradigm that will be necessary for future Artemis and Mars medical and vehicle systems. This EIMO end state aligns with NASA’s Moon to Mars Objectives, which clearly outline the need for NASA deep space exploration missions to reduce their reliance upon Earth and become increasingly autonomous, in preparation for the first human Mars mission. OVERVIEW: To advance exploration medical systems and ultimately, integrated crew health and performance systems, ExMC’s portfolio includes: funding ground development & testing of novel medical capabilities; creation of new approaches for the development of medical protocols and procedures; deployment of innovative technologies into analog environments; technology demonstrations in spaceflight; and eventual transition to operations of new capabilities for deep space exploration missions. The portfolio also includes: pharmaceutical research targeting stability, pharmacokinetics, and pharmacodynamics; integrated data architectures and clinical decision support tools; and systems engineering and trade space analysis tools to assist NASA in the development of future medical system models as well as the medical system requirements that can serve as a foundation for deep space exploration missions. All of these investments are done in a collaborative and coordinated fashion with other NASA stakeholders, such as the Environmental Control and Life Support Systems – Crew Health and Performance System Capability Leadership Team and the Health and Medical Technical Authority. DISCUSSION: In this presentation, ExMC will provide an overview of our work from across our portfolio, all of which will inform future EIMO efforts at NASA. ExMC’s research and development investments are targeted to reduce the human system risks associated with deep space exploration to the Moon and Mars.

Kris Lehnhardt↗

NASA Human System Risk Assessment Process

NASA utilizes an evidence based system to perform risk assessments for the human system for spaceflight missions. The center of this process is the multi-disciplinary Human System Risk Board (HSRB). The HSRB is chartered from the Chief Health and Medical Officer (OCHMO) at NASA Headquarters. The HSRB reviews all human system risks via an established comprehensive risk and configuration management plan based on a project management approach. The HSRB facilitates the integration of human research (terrestrial and spaceflight), medical operations, occupational surveillance, systems engineering and many other disciplines in a comprehensive review of human system risks. The HSRB considers all factors that influence human risk. These factors include pre-mission considerations such as screening criteria, training, age, sex, and physiological condition. In mission factors such as available countermeasures, mission duration and location and post mission factors such as time to return to baseline (reconditioning), post mission health screening, and available treatments. All of the factors influence the total risk assessment for each human risk. The HSRB performed a comprehensive review of all potential inflight medical conditions and events and over the course of several reviews consolidated the number of human system risks to 30, where the greatest emphasis is placed for investing program dollars for risk mitigation. The HSRB considers all available evidence from human research and, medical operations and occupational surveillance in assessing the risks for appropriate mitigation and future work. All applicable DRMs (low earth orbit for 6 and 12 months, deep space for 30 days and 1 year, a lunar mission for 1 year, and a planetary mission for 3 years) are considered as human system risks are modified by the hazards associated with space flight such as microgravity, exposure to radiation, distance from the earth, isolation and a closed environment. Each risk has a summary two-page assessment representing the state of knowledge/evidence of that risk, available risk mitigations, traceability to the Space Flight Human System Standards (SFHSS) and program requirements, and future work required. These data then can drive coordinated budgets across the Human Research Program, the International Space Station, Crew Health and Safety and Advanced Exploration System budgets to provide the most economical and timely mitigations. The risk assessments were completed for the 6 DRMs and serve as the baseline for which subsequent research and technology development and crew health care portfolios can be assessed. The HSRB reviews each risk at least annually or when new evidence/information is available that adds to the body of evidence. The current status of each risk can be reported to program management for operations, budget reviews and general oversight of the human system risk management program.

Francisco, D.↗

Food and nutrition in space: application to human health

The National Aeronautics and Space Administration begins the new millennium with the hope of expanding human space exploration beyond Earth's orbit. These extended-duration missions (3-5 years) require an in-depth assessment of the critical risks (referred to as "show stoppers") to humans when exposed to the remote environment and reduced gravity conditions for such long periods of time. Food, and the nutrition it provides, is paramount to crew health. For short-duration spaceflight (30 days), the nutrient requirements pertaining to physiological adaptations are likely to be satisfied without significant impact on crew performance or health. However, prolonged exposure to reduced gravity, or microgravity, and isolation may alter human nutrient requirements as well as increase the psychosocial role of food/meals in daily activities. An outline of critical questions and related research needs in the area of food and nutrition has been drafted (1) at NASA JSC with the help of the National Space Biomedical Research Institute (http://www.nsbri.org). The research areas outlined in this plan will directly impact the success of extended-duration human space missions. Findings from this research will have direct applications to human health issues faced here on Earth.

NASA Discipline Regulatory Physiology↗

A Review of Diagnostic Techniques for ISHM Applications

System diagnosis is an integral part of any Integrated System Health Management application. Diagnostic applications make use of system information from the design phase, such as safety and mission assurance analysis, failure modes and effects analysis, hazards analysis, functional models, fault propagation models, and testability analysis. In modern process control and equipment monitoring systems, topological and analytic , models of the nominal system, derived from design documents, are also employed for fault isolation and identification. Depending on the complexity of the monitored signals from the physical system, diagnostic applications may involve straightforward trending and feature extraction techniques to retrieve the parameters of importance from the sensor streams. They also may involve very complex analysis routines, such as signal processing, learning or classification methods to derive the parameters of importance to diagnosis. The process that is used to diagnose anomalous conditions from monitored system signals varies widely across the different approaches to system diagnosis. Rule-based expert systems, case-based reasoning systems, model-based reasoning systems, learning systems, and probabilistic reasoning systems are examples of the many diverse approaches ta diagnostic reasoning. Many engineering disciplines have specific approaches to modeling, monitoring and diagnosing anomalous conditions. Therefore, there is no "one-size-fits-all" approach to building diagnostic and health monitoring capabilities for a system. For instance, the conventional approaches to diagnosing failures in rotorcraft applications are very different from those used in communications systems. Further, online and offline automated diagnostic applications are integrated into an operations framework with flight crews, flight controllers and maintenance teams. While the emphasis of this paper is automation of health management functions, striking the correct balance between automated and human-performed tasks is a vital concern.

Patterson-Hine, Ann↗

Space Medicine

The National Academy of Sciences Committee on Space Biology and Medicine points out that space medicine is unique among space sciences, because in addition to addressing questions of fundamental scientific interest, it must address clinical or human health and safety issues as well. Efforts to identify how microgravity affects human physiology began in earnest by the United States in 1960 with the establishment of the National Aeronautics and Space Administration (NASA's) Life Sciences program. Before the first human space missions, prediction about the physiological effects of microgravity in space ranged from extremely severe to none at all. The understanding that has developed from our experiences in space to date allows us to be guardedly optimistic about the ultimate accommodations of humans to space flight. Only by our travels into the microgravity environment of space have we begun to unravel the mysteries associated with gravity's role in shaping human physiology. Space medicine is still at its very earliest stages. Development of this field has been slow for several reasons, including the limited number of space flights, the small number of research subjects, and the competition within the life sciences community and other disciplines for flight opportunities. The physiological changes incurred during space flight may have a dramatic effect on the course of an injury or illness. These physiological changes present an exciting challenge for the field of space medicine: how to best preserve human health and safety while simultaneously deciphering the effects of microgravity on human performance. As the United States considers the future of humans in long-term space travel, it is essential that the many mysteries as to how microgravity affects human systems be addressed with vigor. Based on the current state of our knowledge, the justification is excellent indeed compelling- for NASA to develop a sophisticated capability in space medicine. Teams of physicians and scientists should be actively engaged in fundamental and applied research designed to ensure that it is safe for humans to routinely and repeatedly stay and work in the microgravity environment of space.

Pool, Sam L.↗

Air Vehicle Factors Affecting Occupant Health, Comfort, and Productivity

Urban Air Mobility (UAM) vehicles will need to meet the safety and comfort expectations of passengers and crews. However, existing Federal Aviation Administration airworthiness standards for airplanes and rotorcraft are unlikely to adequately address these needs. Some insight into this issue may be gained from research into NASA's approach to human-systems integration standards and guidelines that promote astronaut health, safety, and performance, since both space and UAM vehicles must consider factors such as occupant motion sickness, vibration, and sound levels. Building upon knowledge garnered from the experience of NASA, the U.S. Department of Defense, and other international organizations, this presentation will elucidate: 1) how UAM-induced flight factors can impact occupant comfort, productivity, as well as safety; and 2) how government and industry standards could be developed or revised to help assure passenger acceptance of revolutionary Vertical Take Off and Landing aircraft technologies.

Adelstein, Bernard D.↗

Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions: ExMC Pharmacy Research Plan

The Exploration Medical Capabilities (ExMC) Element of NASA's Human Research Program is charged with identifying medical capabilities that can address the challenges of prevention, diagnosis, and treatment of disease and injuries that could occur during exploration missions beyond Earth's orbit. Faced with the obstacle of access to in-flight medical care, and limitations of vehicle space, time, and communications; it is necessary to prioritize what medical consumables are manifested for the flight, and which medical conditions are addressed. Studies of astronaut health establish the incidence of common and high risk medical conditions that require medical intervention during long-duration exploration missions. In 2000, the Institute of Medicine (IOM) convened a committee of experts, Committee on Creating a Vision for Space Medicine during Travel beyond Earth Orbit, to examine the issues surrounding astronaut health and safety for long duration space missions. Two themes run throughout the committee's final report: (1) that not enough is known about the risks to human health during long-duration missions beyond Earth's orbit or about what can effectively mitigate those risks to enable humans to travel and work safely in the environment of deep space and (2) that everything reasonable should be done to gain the necessary information before humans are sent on missions of space exploration (IOM, 2001). Although several spaceflight focused pharmaceutical research studies have been conducted, few have provided sufficient data regarding medication usage or potency changes during spaceflight. The Du pharmaceutical stability study assessed medications flown on space shuttles to and from the International Space Station (ISS) from 2006 until 2008; of which some medications were still viable beyond their expiration dates (Du et al, 2011). However, as with many spaceflight studies, the small 'n' associated with this study limits the ability to draw strong conclusions from it. Dr. Wotring and others have recently published articles containing information regarding medication usage, indications, and efficacy gleaned from spaceflight records (Wotring et al, 2015, 2016; Barger et al, 2014; Basner and Dinges, 2014). Although some conclusions can be drawn from these studies, the inability to fully quantify medication usage, indications, side effects, and effectiveness, limits insight as to which medications should be prioritized for further research.

Antonsen, Erik↗

Advanced Technologies for Future Spacecraft Cockpits and Space-based Control Centers

The National Aeronautics and Space Administration (NASA) is embarking on a new era of Space Exploration, aimed at sending crewed spacecraft beyond Low Earth Orbit (LEO), in medium and long duration missions to the Lunar surface, Mars and beyond. The challenges of such missions are significant and will require new technologies and paradigms in vehicle design and mission operations. Current roles and responsibilities of spacecraft systems, crew and the flight control team, for example, may not be sustainable when real-time support is not assured due to distance-induced communication lags, radio blackouts, equipment failures, or other unexpected factors. Therefore, technologies and applications that enable greater Systems and Mission Management capabilities on-board the space-based system will be necessary to reduce the dependency on real-time critical Earth-based support. The focus of this paper is in such technologies that will be required to bring advance Systems and Mission Management capabilities to space-based environments where the crew will be required to manage both the systems performance and mission execution without dependence on the ground. We refer to this concept as autonomy. Environments that require high levels of autonomy include the cockpits of future spacecraft such as the Mars Exploration Vehicle, and space-based control centers such as a Lunar Base Command and Control Center. Furthermore, this paper will evaluate the requirements, available technology, and roadmap to enable full operational implementation of onboard System Health Management, Mission Planning/re-planning, Autonomous Task/Command Execution, and Human Computer Interface applications. The technology topics covered by the paper include enabling technology to perform Intelligent Caution and Warning, where the systems provides directly actionable data for human understanding and response to failures, task automation applications that automate nominal and Off-nominal task execution based on human input or integrated health state-derived conditions. Shifting from Systems to Mission Management functions, we discuss the role of automated planning applications (tactical planning) on-board, which receive data from the other cockpit automation systems and evaluate the mission plan against the dynamic systems and mission states and events, to provide the crew with capabilities that enable them to understand, change, and manage the timeline of their mission. Lastly, we discuss the role of advanced human interface technologies that organize and provide the system md mission information to the crew in ways that maximize their situational awareness and ability to provide oversight and control of aLl the automated data and functions.

Garcia-Galan, Carlos↗

NASA’s Top Human System Research and Technology Needs for Mars

NASA is working with industry and international partners to return humans to the Moon and to eventually enable humans to explore Mars. Within NASA, several organizations work together to identify, prioritize, fund, execute, and operationalize the research and technology development (R&TD) that will be necessary to enable crew health and performance (CHP) during these future missions. These organizations include flight programs, the Health and Medical Technical Authority (HMTA), the Human Research Program, the Space Technology Mission Directorate, System Capability Leadership Teams, and other organizations, many of which existed for several years prior to the creation of the Moon-to-Mars (M2M) Program Office in 2023. A variety of constructs, vocabularies, and processes exist for managing risks and supporting strategic planning across these organizations. For example, M2M objectives, program risks, human system risks, human research gaps, capability gaps, and envisioned futures are all constructs currently used within NASA to identify and prioritize R&TD needs. These strategic planning constructs are evolving to allow M2M objectives and R&TD investments to be aligned and traced at a detailed level. A recognized need exists among stakeholder organizations to identify and communicate the highest CHP R&TD priorities in a unified and digestible way that addresses the perspectives of NASA’s CHP community. To achieve this, the HMTA arranged a series of discussions with representatives of NASA’s CHP community, during which the 8 highest priority CHP capabilities that will enable human missions to Mars, referred to as the “top human system capability needs for Mars”, were identified. The list includes Earth-independent human operations; Mars-duration food system; Mars-duration effects on human physiology; risk mitigations for vehicle atmospheres; computational injury and anthropometric models; exploration exercise countermeasures; individual variability in responses to spaceflight; and sensorimotor countermeasures. Existing tools and processes for strategic planning and risk management were evaluated, as well as the technical practicalities, cost, and schedule feasibility associated with potential R&TD investments in different capability need areas. This capability needs report is not owned by any one NASA organization and does not replace existing strategic or program planning processes; rather it aims to complement and inform them with a unified set of community generated priorities. These top capability needs will be re-evaluated periodically based on R&TD progress and the evolving M2M architecture.

technology gaps↗

NASA’s Top Human System Research and Technology Needs for Mars

NASA is working with industry and international partners to return humans to the Moon and to eventually enable humans to explore Mars. Within NASA, several organizations work together to identify, prioritize, fund, execute, and operationalize the research and technology development (R&TD) that will be necessary to enable crew health and performance (CHP) during these future missions. These organizations include flight programs, the Health and Medical Technical Authority (HMTA), the Human Research Program, the Space Technology Mission Directorate, System Capability Leadership Teams, and other organizations, many of which existed for several years prior to the creation of the Moon-to-Mars (M2M) Program Office in 2023. A variety of constructs, vocabularies, and processes exist for managing risks and supporting strategic planning across these organizations. For example, M2M objectives, program risks, human system risks, human research gaps, capability gaps, and envisioned futures are all constructs currently used within NASA to identify and prioritize R&TD needs. These strategic planning constructs are evolving to allow M2M objectives and R&TD investments to be aligned and traced at a detailed level. A recognized need exists among stakeholder organizations to identify and communicate the highest CHP R&TD priorities in a unified and digestible way that addresses the perspectives of NASA’s CHP community. To achieve this, the HMTA arranged a series of discussions with representatives of NASA’s CHP community, during which the 8 highest priority CHP capabilities that will enable human missions to Mars, referred to as the “top human system capability needs for Mars”, were identified. The list includes Earth-independent human operations; Mars-duration food system; Mars-duration effects on human physiology; risk mitigations for vehicle atmospheres; computational injury and anthropometric models; exploration exercise countermeasures; individual variability in responses to spaceflight; and sensorimotor countermeasures. Existing tools and processes for strategic planning and risk management were evaluated, as well as the technical practicalities, cost, and schedule feasibility associated with potential R&TD investments in different capability need areas. This capability needs report is not owned by any one NASA organization and does not replace existing strategic or program planning processes; rather it aims to complement and inform them with a unified set of community generated priorities. These top capability needs will be re-evaluated periodically based on R&TD progress and the evolving M2M architecture.

technology gaps↗

Inflight Medical Conditions Risk – Overview and Strategic Approach

The risk of adverse health outcomes and decrements in performance due to inflight medical conditions is among NASA’s “red” risks for Mars missions, scored at the highest likelihood and consequence on the rating scale. Importantly, this risk encompasses all possible medical conditions that might occur in spaceflight. At thesame time, exploration spaceflight will have significant resource constraints (mass, power, volume, data, etc.) and supplying the full complement of medical capabilities available on Earth will be impossible. Inevitably, medical conditions will develop during a human Mars mission and having inadequate inflight capabilities will have a negative impact on the health and performance of the astronauts, leading to adverse crew and/or mission outcomes.

B D Easter↗

Adventures in Space Medicine

Human space flight experience has demonstrated a variety of hazards and risks to health and performance. In developing ways to help respond to these issues, the field of space medicine has developed a comprehensive program of space flight health risk management that has resulted in positive contributions to medicine and society in general. Examples include accelerated focus on critical health issues such as aging and osteoporosis, and development of new technologies such as non-invasive diagnostic testing for diabetics. The role of health care professionals in human space exploration represents a fulfillment of new adventures and expanding frontiers.

Billica, Roger D.↗

Medical Data Architecture Prototype Development - Summary of Recent Work and Proposed Ideas for Upcoming Work

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions, and in ExMC Gap Med 10: We do not have the capability to provide computed medical decision support during exploration missions. These gaps recognize the need for a comprehensive medical data management system and the accompanying computational support to provide autonomous medical care during long duration exploration missions. As the MDA matures—including the capability to comprehensively process and discover medically-relevant information to support medical operations during exploration missions—project focus will shift to maturing and extending the MDA platform to enable clinical decision support and real-time guidance. To date, the MDA foundational architecture has recommended exploration medical system Level of Care IV requirements through a series of test bed prototype developments and analog demonstrations. The next stage in the development will focus on more autonomous clinical decision making necessary to address challenges in executing a self-contained medical system that enables health care both with and without assistance from ground support. A thorough understanding of current state of medical decision support systems, advanced machine learning algorithms and vast and varied data sources is required. The development of a clinical decision support for exploration missions (Level of Care V) roadmap is needed: one that assesses of current state of the art of clinical decision support systems (CDSS), interoperability issues, identification of challenges in health and performance monitoring, obtaining and processing information from biosensors, knowledge and data management, data integration and fusion, and advanced algorithm development. This roadmap must also include rapid prototype development in the areas of data processing, advanced analysis and prediction of medical events, and treatment based on medically relevant information processing and evidence-based best practices. In this presentation, an overview of the relevant issues and the beginning framework of a Level of Care V CDSS development roadmap will be provided.

Krihak, M.↗

Medical Data Architecture Platform and Recommended Requirements for A Medical Data System for Exploration Missions

Minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically relevant information to support medical operations during exploration missions. This gap identifies that the current in-flight medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are a variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable a more medically autonomous crew than the current paradigm of medical data management on the International Space Station. ExMC has recognized that in order to make informed decisions about a medical data architecture framework, current methods for medical data management must not only be understood, but an architecture must also be identified that provides the crew with actionable insight to medical conditions. This medical data architecture will provide the necessary functionality to address the challenges of executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. Hence, the products derived from the third MDA prototype development will directly inform exploration medical system requirements for Level of Care IV in Gateway missions.In fiscal year 2019, the MDA project developed Test Bed 3, the third iteration in a series of prototypes, that featured integrations with cognition tool data, ultrasound image analytics and core Flight Software (cFS). Maintaining a layered architecture design, the framework implemented a plug-in, modular approach in the integration of these external data sources. An early version of MDA Test Bed 3 software was deployed and operated in a simulated analog environment that was part of the Next Space Technologies for Exploration Partnerships (NextSTEP) Gateway tests of multiple habitat prototypes. In addition, the MDA team participated in the Gateway Test and Verification Demonstration, where the MDA cFS applications was integrated with Gateway-in-a-Box software to send and receive medically relevant data over a simulated vehicle network. This software demonstration was given to ExMC and Gateway Program stakeholders at the NASA Johnson Space Center Integrated Power, Avionics and Software (iPAS) facility. Also, the integrated prototypes served as a vehicle to provide Level 5 requirements for the Crew Health and Performance Habitat Data System for Gateway Missions (Medical Level of Care IV). In the upcoming fiscal year, the MDA project will continue to provide systems engineering and vertical prototypes to refine requirements for medical Level of Care IV and inform requirements for Level of Care V.

Krihak, M.↗

Medical Data Architecture Platform and Recommended Requirements for a Medical Data System for Exploration Missions

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically- relevant information to support medical operations during exploration missions. This gap identifies that the current in-flight medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are a variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable a more medically autonomous crew than the current paradigm of medical data management on the International Space Station. ExMC has recognized that in order to make informed decisions about a medical data architecture framework, current methods for medical data management must not only be understood, but an architecture must also be identified that provides the crew with actionable insight to medical conditions. This medical data architecture will provide the necessary functionality to address the challenges of executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. Hence, the products derived from the third MDA prototype development will directly inform exploration medical system requirements for Level of Care IV in Gateway missions. In fiscal year 2019, the MDA project developed Test Bed 3, the third iteration in a series of prototypes, that featured integrations with cognition tool data, ultrasound image analytics and core Flight Software (cFS). Maintaining a layered architecture design, the framework implemented a plug-in, modular approach in the integration of these external data sources. An early version of MDA Test Bed 3 software was deployed and operated in a simulated analog environment that was part of the Next Space Technologies for Exploration Partnerships (NextSTEP) Gateway tests of multiple habitat prototypes. In addition, the MDA team participated in the Gateway Test and Verification Demonstration, where the MDA cFS applications was integrated with Gateway-in-a-Box software to send and receive medically relevant data over a simulated vehicle network. This software demonstration was given to ExMC and Gateway Program stakeholders at the NASA Johnson Space Center Integrated Power, Avionics and Software (iPAS) facility. Also, the integrated prototypes served as a vehicle to provide Level 5 requirements for the Crew Health and Performance Habitat Data System for Gateway Missions (Medical Level of Care IV). In the upcoming fiscal year, the MDA project will continue to provide systems engineering and vertical prototypes to refine requirements for medical Level of Care IV and inform requirements for Level of Care V.

Krihak, M.↗

Medical Data Architecture Project Status

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current International Space Station (ISS) medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable an increasingly autonomous crew than the current ISS paradigm. The MDA will develop capabilities that support automated data collection, and the necessary functionality and challenges in executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. To attain this goal, the first year of the MDA project focused on reducing technical risk, developing documentation and instituting iterative development processes that established the basis for the first version of MDA software (or Test Bed 1). Test Bed 1 is based on a nominal operations scenario authored by the ExMC Element Scientist. This narrative was decomposed into a Concept of Operations that formed the basis for Test Bed 1 requirements. These requirements were successfully vetted through the MDA Test Bed 1 System Requirements Review, which permitted the MDA project to begin software code development and component integration. This paper highlights the MDA objectives, development processes, and accomplishments, and identifies the fiscal year 2017 milestones and deliverables in the upcoming year.

Data management↗