PassageMaker associate editor, Mark Fusco, sat down recently with Mike Dunleavy, president of DigiGone, a company that has created a system for remote medical care based on some of the same satellite video technology used by U.S. Special Forces on covert operations.
PassageMaker: What’s the value of telemedicine for cruisers?
Mike Dunleavy: Safety is a prime consideration for cruisers. If you plan to do long-range cruising, you naturally have concerns about the availability of quality medical care in case of an emergency. If you or a passenger should suddenly becomes ill or injured, what’s your recourse? You can call for help, but the nearest port may be hours, or even days, away and even then the quality of the healthcare facilities may be uneven at best.
Wouldn’t it be a comfort if you could have the assurance that wherever you go, you can be in instant touch with top-notch, highly trained emergency physicians—not just by radio or satellite phone, but with actual live video streaming—so that the doctors can do a visual diagnosis of the patient and give immediate treatment recommendations on the spot?
PassageMaker: If remote telemedicine at sea is such a great idea, why hasn’t it been done before?
Dunleavy: Until now, this has been impractical if you’re cruising beyond the reach of high-speed Internet connections. Commercial video products like Skype require an enormous amount of bandwidth to transmit images. Most of the satellite communication systems installed on smaller vessels like trawlers simply cannot support that much data, and even if they can, the airtime costs would be extremely high.
Our company has developed sophisticated encryption and compression technology that permits high-quality video streaming on narrowband satellite channels, mostly for U.S. government customers. We were approached a few years ago by Maritime Medical Access (MMA), which is affiliated with the George Washington University Department of Emergency Medicine.
MMA had been offering a marine telemedicine service for ships at sea using radio or satellite phone connections. They were looking for a workable video solution so their physicians could provide better diagnosis and treatment. We partnered to create a telemedicine package called Digi+Doc, combining our video technology with their medical expertise to provide videoconferencing with physicians ashore over marine satellite communication channels.
PassageMaker: What hardware and/or services do cruisers need to take advantage of the telemedicine service?
Dunleavy: The Digi+Doc package for cruising yachts includes a license for the DigiGone software, plus a subscription to the GWU MMA service for a fixed annual fee starting at $2,986 for a boat with fewer than six crew. We also provide an onboard camera kit with a dedicated tablet PC, headset and external camera packaged in a compact rugged case. The tablet is programmed for automatic connection with the GWU 24/7/365 emergency call center. This kit is less than $1,000, one-time purchase, if you subscribe to the Digi+Doc service.
PassageMaker: With skyrocketing data and Internet prices, what makes Digi+Doc a better option than other Internet video solutions?
Dunleavy: Other videoconferencing software has been designed for use on cellular phone networks, where bandwidth is not a serious issue. When you’re beyond the reach of cellular towers, your only option is satellite communications, and satellite airtime can be very expensive. Digi+Doc is optimized for narrowband satellite channels, enabling transmission of high-quality video images using less than 10 percent of the bandwidth needed for other commercial video products. It works very nicely with Inmarsat Fleet Broadband 150/250 or most VSAT satellite antennas—without running up a huge airtime bill.
PassageMaker: What are the geographical limits? Is it possible to be out of range?
Dunleavy: Digi+Doc works with most marine satellite systems, including Inmarsat and most VSAT networks. Coverage is global, although there may be a few gaps at high latitudes near the poles, due to the low look angle at the geostationary satellites over the equator. You should check with your satellite provider for coverage areas.
PassageMaker: Who are the doctors, and can cruisers use a practitioner of their choice?
Dunleavy: The GWU Department of Emergency Medicine has more than 500 physicians and has specialists on call 24/7. They include all major specialties. They can consult with your own physician if needed to obtain medical history and information specific to your healthcare.
PassageMaker: How does the videoconferencing capability enhance diagnosis and treatment?
Dunleavy: Previously, the MMA emergency physicians had to rely on audio communications, severely limiting their ability to diagnose and recommend treatment. They would ask the caller to describe the nature of the illness or injury verbally. Now they can coach the caller to position the camera so they can see and talk directly with the patient.
The physicians say it makes all the difference in the world. Being able to see and hear the patients themselves and perform their examination “firsthand.” In addition, we have had several patients and onsite caretakers tell us that just the ability to see and hear the doctor significantly reduces their stress levels during the consult or crisis. It’s the next best thing to actually being in a hospital emergency room.
PassageMaker: Can you give us a few examples?
Dunleavy: We had a case on a large yacht cruising in the Mediterranean. A young woman fell and hit her head. A call was placed through Digi+Doc to the GWU center. Recognizing the need for a consultation with a specialist in brain injury trauma, they patched the call through to the doctor’s residence. He was able to give the patient a thorough visual exam and determine that the concussion was not severe enough to rush the passenger to a shore hospital. He gave them advice on how to treat the injury on board, and they continued the cruise. She recovered normally.
In another incident—this one on a large ocean-going containership—a crew member had a nasty 3-inch gash on his scalp. The ship was several days away from a port. The MMA physicians determined that stitches were needed to stabilize the wound, and coached the second mate step-by-step as they stitched the patient’s head, watching closely each step of the way through the camera. The ship was able to avoid an expensive diversion from its scheduled passage for a medevac.
PassageMaker: Many cruisers do not carry health insurance and are so-called “self-insured.” Is insurance something they need in order to access the telemedicine service?
Dunleavy: No. The MMA subscription includes full access to the GWU Emergency Department physicians, including unlimited follow-up consultations through Digi+Doc until the patient is transferred ashore. Your only recurring cost is the satellite airtime, which is minimized by the narrowband DigiGone video compression technology.
PassageMaker: What other applications are enabled by your teleconferencing software?
Dunleavy: We have also developed other packages and services using our video compression and encryption software—for instance, remote monitoring of security cameras on board for vessels cruising in waters where piracy is common. Another application is consulting with experts ashore for remote troubleshooting of engines and other onboard equipment. And, of course, just plain old-fashioned videoconferencing with families and friends back home at pennies per minute. You can blow a kiss to the grandchildren, and watch them open their presents at their birthday parties.