Long Duration Medical System Foundation for Lunar Orbital and Lunar Surface Exploration Missions - AsMA 2023
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Exploration Medical Capability Science and Research Overview and Update
The mission of the Exploration Medical Capability (ExMC) Element is to advance medical system design and risk-informed decision making for exploration beyond low Earth orbit to promote human health and performance in space. In order to accomplish this mission, the Element takes a progressively Earth-independent approach to three main areas: - Answering key clinical and science research questions that will help to address the challenges of providing medical care in the extreme environment of space - Applying systems engineering processes to medical system design with the goal of developing robust requirements that can be fully integrated into future space exploration vehicle designs - Developing and demonstrating novel medical technologies that will improve future medical capabilities in space This presentation will focus on selected scientific and technical conceptual drivers for the Element, the current and future research risks and gaps, and provide an overview of the Element’s progress in 2022. In particular, it will address the ongoing effort for the IMPACT trade space analysis tool suite, the closeout work on a clinical decision support prototype, potential requirements for a long-duration lunar orbit and lunar surface medical system, and an International Space Station technology demonstration of a point-of-care laboratory analysis capability.
Kris Lehnhardt↗
Exploration Medical Capability Science and Research Overview and Update
The mission of the Exploration Medical Capability (ExMC) Element is to advance medical system design and risk-informed decision making for exploration beyond Low Earth Orbit to promote human health and performance in space. To accomplish this mission, ExMC focuses on several key areas: • Investigating specific risks that are relevant for human exploration spaceflight, including in-flight medical conditions, degraded or toxic medications, and renal stones • Developing medical probabilistic risk analysis tools that are integrated with systems engineering processes to inform the medical system trade space and support the development of robust requirements • Demonstrating and defining requirements for a prototype clinical decision support system • Developing and demonstrating novel medical technologies that will improve future medical capabilities in space This presentation will focus on selected scientific and technical conceptual drivers for the Element and its current and future research risks and gaps while providing an overview of the Element’s progress in 2021 and areas of focus for 2022.
Benjamin Easter↗
Developing a Medical System Foundation for Level of Care IV: Short-Duration Lunar Orbit
The Human Research Program (HRP) Exploration Medical Capability (ExMC) element has developed a Medical System Foundation for Level of Care IV, as defined by NASA’s space flight human-system standards, for short-duration lunar orbit missions by employing a systems engineering approach using model-based systems engineering tools. This Foundation includes a concept of operations, medical system architecture, associated functional and non-functional requirements and rationales, and medical conditions, capabilities, and resources. Collectively, these serve as a starting point (“Foundation”) for a medical system that meets the Level of Care IV requirement. The Foundation also includes traces to the current versions of NASA standards documents and lower (e.g., sub-system) and higher (e.g., vehicle system) level requirements. Stakeholders can use the Foundation to analyze the traces between medical capabilities, medical conditions, medical resources, and requirements; identify medical system interfaces with other vehicle systems/subsystems; and as a basis for performing trades on risks vs. medical system mass and volume allocation. To facilitate communication of the Foundation to stakeholders who do not have access to the modeling tools used, an HTML representation of the Foundation was created. This discussion will focus on the processes through which the Medical System Foundation was developed, how the Foundation builds a bridge between the medical and engineering domains and facilitates communication between these communities, and how these processes can be applied more broadly to a crew health and performance system and other system domains.
S. Lumpkins↗
Exploration Medical Capability Science and Research Overview and Update
The mission of the Exploration Medical Capability (ExMC) Element is to advance medical system design and risk-informed decision making for exploration beyond low Earth orbit to promote human health and performance in space. In order to accomplish this mission, the Element takes a progressively Earth-independent approach to three main areas: 1)answering key clinical and science research questions that will help to address the challenges of providing medical care in the extreme environment of space, 2)applying systems engineering processes to medical system design with the goal of developing robust requirements that can be fully integrated into future space exploration vehicle designs, and 3)developing and demonstrating novel medical technologies that will improve future medical capabilities in space. This presentation will focus on selected scientific and technical conceptual drivers for the Element, the current and future research risks and gaps, and provide an overview of the Element’s progress in 2020.
Kris Lehnhardt↗
Advancing Exploration Medical Capability Through Coordinated Integration of Research, Demonstrations & Systems Engineering
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Jay Lemery↗
Supporting Crew Medical Decisions on Deep Space Missions: A Real-Time Performance Monitoring
Crewed missions into deep space will require astronauts to respond autonomously to safety- and time-critical anomalies. These and other potential issues will require the continuous monitoring and recognition of potentially subtle, but complex, anomalous data patterns. NASA continues to investigate real-time metrics for Extravehicular Operations1 and for providing feedback to improve performance2. Since it is unknown how long-term exposure to deep space will affect crew health, continuous monitoring of clinical and subclinical status is warranted. NASA is characterizing crew medical decision-support needs and identifying the recommended requirements of a Clinical Decision Support System (CDSS) within the Exploration Medical Capability Element (ExMC) of the Human Research Program3. Early detection, and continuous monitoring, of performance may provide an effective prognostic capability for assessing crew health state, and the identified requirements could be provided for an in-vehicle CDSS that acts as an assistant for delivering optimal health and performance and medical care during exploration missions. There is evidence to suggest that automatic, unobtrusive collection of keystroke features, such as alphanumeric key latencies, backspaces or typing rhythm, could be a valuable performance screening tool. Keystroke features show significant differences between control subjects and patients with overt clinical illness, such as multiple sclerosis4 and Parkinson’s disease5, as well as behavioral health and performance issues, such as mild cognitive impairment6 and depression7. This work is exploring a capability for the assessment of early task performance decline in crew as they perform daily activities. Timestamped keyboard entries are continuously collected and stored. Nominal keystroke interactions are compared to those obtained after exposure to spaceflight stressors, e.g., fatigue, to determine the methods sensitivity. This work will pave the way toward an objective detection tool that may be deployed in a spaceflight setting.
clinical↗
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↗
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↗
Medical System Foundation Overview for Long-Duration Lunar Orbit and Surface Operations Missions
The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has developed a Medical System Foundation for Level of Care IV, as defined by NASA’s space flight human-system standards, for long-duration lunar orbit and surface operation missions by employing a systems engineering approach using model-based systems engineering tools. This Foundation model includes a concept of operations; functional decomposition; clinical content (medical conditions, capabilities, and resources); associated functional, interface and non-functional technical requirements; and traces to the current versions of NASA standards documents and parent-level (Program- and Vehicle habitat system level) requirements. Collectively, these components constitute a foundation that serves as a starting point for a medical system that meets the Level of Care IV requirement. The Foundation was developed by a multidisciplinary team consisting of systems engineers, scientists, and clinicians across NASA, and information is presented in an easily accessible format that is understandable across disciplines. Stakeholders can use the Foundation to analyze the traces between medical capabilities, medical conditions, medical resources, and requirements and to identify medical system interfaces with other vehicle systems/subsystems. It can also be used as a basis for performing trades on risks vs. medical system mass and volume allocation. This discussion will focus on the processes through which the Medical System Foundation was developed, how the Foundation builds a bridge between the medical and engineering domains and facilitates communication between these communities, and how these processes can be applied more broadly to a crew health and performance system and other system domains. The presentation also discusses Foundation modifications based on the recently updated versions of the NASA 3001 Standards.
S. Lumpkins↗
Candidate Formulary Development for Exploration Missions
An interdisciplinary team of clinician, pharmacist, and system engineer subject matter experts (SMEs) collaborated to match pharmaceutical resources to the medical conditions anticipated to occur during exploration class missions. This effort began by using a SME generated Exploration Medical Conditions List and the associated medical system capabilities necessary to treat them. Using the systems engineering software MagicDraw™ and knowledge of pharmaceutical use and efficacy in spaceflight, the team traced appropriate medications to the medical conditions. These traces were used to pilot the process for generating a candidate formulary for level of care 4 and level of care 5 medical systems. This presentation will discuss the collaborative efforts of the team as they developed the content, detail the challenges of utilizing systems engineering software to describe clinical resources, and provide an overview of how the candidate medication formulary for exploration class missions was developed. It will also discuss how the lessons learned from this pilot effort can be applied to streamline future work.
S. Kurian↗
Enabling Human Space Exploration Missions Through Progressively Earth Independent Medical Operations (EIMO)
Goal: Current Space Medicine operations depend on terrestrial support to manage medical events. As astronauts travel to destinations such as the Moon, Mars, and beyond, distance will substantially limit this support and require increasing medical autonomy from the crew. This paper defines Earth Independent Medical Operations (EIMO) and identifies key elements of a conceptual EIMO system. Methods: The NASA Human Research Program Exploration Medical Capability Element held a 2-day conference at Johnson Space Center in Houston, TX with NASA experts representing all aspects of Space Medicine. Results: EIMO will be a process enabling progressively resilient deep space exploration systems and crews to reduce risk and increase mission success. Terrestrial assets will continue to provide pre-mission screening, planning, health maintenance, and prevention, while onboard medical care will increasingly be the purview of the crew. Conclusions: This paper defines and describes the key components of EIMO.
ExMC↗
Autonomous Medical Care for Exploration Class Space Missions
The US-based health care system of the International Space Station (ISS) contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in Low Earth Orbit (LEO) for the ISS is designed to enable a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the Moon are similar to LEO class missions with the additional 4 to 5 days needed to transport an ill or injured crewmember to a DCMF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. NASA has identified five Levels of Care as part of its approach to medical support of future missions including the Constellation program. In order to implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new Crew Medical Officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics.
Hamilton, Douglas↗
Clinical Decision Support Project
As NASA plans for exploration missions into deep space, significant challenges are realized due to the distance from Earth. Beside the effects of microgravity and radiation exposure, the astronauts face the additional constraints of isolation, lack of resupply, increasingly difficult evacuation, and delayed and disrupted communication with ground-based medical care providers. These constraints require a paradigm shift from current medical care where crews rely on the real-time communications with ground-based medical care providers toward Earth-independent medical operations for astronaut medical care. Medical expertise and decision-making are ground-based for current International Space Station and planned Lunar missions. However, a deep space exploration crew will need to autonomously perform the detection, diagnosis, treatment, and prevention of medical conditions. One approach to provide Earth-independent medical operations is to augment the requisite knowledge, skills, and abilities (KSAs) of a time-constrained crew—operating under stressful conditions, combatting fatigue, and facing a potential medical crisis—with a robust clinical decision support system (CDSS). The CDSS is envisioned as an integrated, software-based tool deployed on a laptop computer or handheld device. The CDSS will assist the crew and ground support when interacting with knowledge/data bases (e.g. records, pharmacy, schedule), instrumentation (e.g. imaging, physiological monitoring devices), and habitat (e.g. wellness system, task performance system) and vehicle systems (e.g. environmental system, communication system). In addition, the human interface will employ a context-based approach that accounts for the crew’s situation. Thus, extraneous and clinically/operationally non-relevant information are reduced to avoid an increase in cognitive load. The framework of an ideal spaceflight CDSS is to include core and advanced analytical features that maintain a flexible platform for integrating new technology in the future. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) is expanding the boundaries of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit by actively identifying and testing next-generation medical care and crew health maintenance technologies. The Clinical Decision Support (CDS) project addressed ap Medical-701 within the Inflight Medical Conditions risk: “We need to increase inflight medical capabilities and identify new capabilities that (a) maximize benefit and/or (b) reduce “costs” on human system/mission/vehicle resources.” Though mass, volume, and power will face increasing constraints, the projected computational capabilities of spacecraft systems will increase exponentially as information technology advances in this decade and beyond. Hence, data, software, and computational resources will play an essential and synergistic role in maintaining crew health, wellness, and performance in deep space missions. The focus of the CDS project was to develop recommended requirements for an in-vehicle CDSS that acts as a ‘virtual assistant’ for delivering optimal health, performance, and medical care during exploration missions. In fiscal year 2022 (FY22), the CDS project was chartered to baseline and/or revise all CDS project related documentation and update the CDS project model to include the revised CDSS Concept of Operations, revised systems-based modeling language (SysML) activity diagrams, and baseline requirements. The focus of this presentation will be an overview of the CDS products and CDS model content.
Decision Support↗
IMPACT - Information for the Development of Human Health and Performance Systems
IMPACT is a suite of computational and systems engineering tools. Currently being developed for NASA Exploration Medical Capabilities (ExMC) and could be extended to other Human Research Program (HRP) elements. The purpose is to provide a data-driven means to inform human health and performance risk mitigation during exploration missions considering resource constraints in the medical system. IMPACT enables systematic trade studies to evaluate options. IMPACT uses Probabilistic Risk Assessment (PRA) as a systematic methodology to evaluate risks. IMPACT is currently under development to inform decision-makers the risks involved with trade-options that have likelihoods and consequences backed by scientific research in a medical evidence library. IMPACT supports multi-segment analysis to determine probabilities and risks in different mission segments. There are currently 122 medical conditions and 900 resources in the IMPACT Medical Database. IMPACT modeling is using mission segments and multiple vehicles for the NASA Artemis campaign and could support future complex missions in deep space.
IMPACT PRA↗
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.
Exploration medical system↗
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↗
A Pilot Project for Quantifying the Effect of Medical Provider Knowledge, Skills, and Abilities on Outcomes for Spaceflight Using a Probabilistic Risk Assessment Tool
In order to enable the future of long-duration deep space exploration we must confront the uncertainty in medical risk. Limitations of communication, resupply, and evacuation in deep space will require a high degree of crew autonomy and accurate risk assessment will be critical to ensure adequate crew training and medical system design. To address this, NASA’s Human Research Program Exploration Medical Capability Element has developed the Informing Mission Planning via Analysis of Complex Tradespaces Tool (IMPACT). IMPACT is a suite of tools that can provide evidence-based, data-driven trade space assessments between available medical resources in the mass- and volume-constrained environment of a deep space exploration vehicle. In the current model, medical conditions either can or cannot be treated based on the availability of medical system resources and equipment. However, medical outcomes often depend just as much on the knowledge, skills, and abilities (KSA) of the provider operating the system. This paper presents a method for modeling and quantifying the effect of medical officer KSA on medically relevant mission risk outcomes during spaceflight.
capabilities↗