Telemedicine: To Mount Everest and Beyond

by Brett Harnett

Most people found at 29,000 feet are usually in the comfortable environment of a modern aircraft. But for those who choose to climb the mighty Mount Everest, this altitude represents a death zone. The Everest Extreme Expedition (E3) has not necessarily made the Everest summit assault any easier but it has added a new dimension to this once isolated frontier: Telemedicine.

In the spring of 1998 and then again in 1999, an elite team of climbers, medical specialists and technicians ushered the technology age to Everest Base Camp which acted as communications central. Connected to the world by portable satellite phones and laptop computers, expedition members were tethered to NASA's Medical Informatics and Technology Applications Consortium (MITAC) at Yale University and a global community who acted as "designated drivers" for the potentially hypoxic team. Using standard off-the-shelf-technologies as well as leading-edge, experimental devices, the physicians at Yale University were able to keep tabs on not only the personnel at base camp but also selected climbers.

Part of the reason Mount Everest was chosen for this test bed was the tragedy in 1996 when five climbers died during an assault on the summit. This brought into focus the extraordinary risks all individuals in remote and extreme environments endure. The accounts, popularized by Jon Krakauer in Into Thin Air and Brougton Coburn and David Beshears in Everest, Mountain Without Mercy, detailed the hardships and circumstances leading to disaster.  Incredibly, two of the climbers died during the snowstorm within proximity of the safety of the camp and another, Beck Wethers, was left for dead but actually survived to walk into camp the following morning with frostbite so severe that he lost his nose, right hand and fingers. 

Unlike most expeditions to the Nepal landscape, E3 had no intentions of summiting the world's highest peak; rather, the purpose was to outfit three climbers with portable sensing devices, global positioning and radio telemetry hardware. These devices developed by Fitsense Technologies were designed to capture an array of clinical data including heart rate, body core and surface temperature and motion detection. The goal was to track a climber's physiologic parameters, location and movement patterns to Camp One at 19,500 feet. In effect, researchers wanted to monitor where climbers were, were they moving, were they overexerting themselves and were there signs of hypothermia.

To transmit the data, creative use of existing infrastructures was employed. Using low frequency radio signals, the continuous data collection was aggregated and sent back to a receiver at base camp. Because of the cavern-like topology of the Khumbu Ice Fall en route to Camp One, a device called a repeater was positioned on a neighboring mountain to assist in the data flow where line of sight was not possible, in effect "bouncing" the signal. Once the data, in the form of American Standard Code for Information Exchange (ASCII), was received at base camp, it was routed to an Internet backbone via the Inmarsat satellite system using portable "B phones" carried to base camp. Using standard Internet Protocol (IP), the data was routed to a fixed IP address of a workstation at Yale University. (See Diagram 1.) To forward the data, commercial off-the-shelf software (COTS) was used. Traveling Software's Laplink was programmed to index the aggregated data, which was collected at five-minute increments. A physician at Yale University downloaded the datasets during the session. At this workstation, a graphical user interface (GUI) was used to graphically display the data for easy reading. (See Figure 1 .)

The goal of the project was not to help people who have the desire to climb Mount Everest. This was an experiment in science. If physicians could monitor climbers at 19,500 feet halfway around the globe, why couldn't the chronically ill patient in downtown anywhere be watched as well? The aging population, increasing medical costs and constant pressure by insurance companies to operate more efficiently will require a percentage of people to be monitored from their homes instead of in the expensive beds at hospitals and clinics.

Developing affordable, non-obtrusive medical sensing hardware and utilizing existing network infrastructures can permit close monitoring
of patients within their homes. Through low frequency radio or infrared signals, basic vital signs of the patient can be picked up within the home or local vicinity and sent incrementally via the Internet. The data, natively lightweight in the form of ASCII, transmits well over low-band topologies like the plain old telephone system (POTS) or cellular technologies. The data can then be sent to a server at a medical center where predetermined algorithms watch the data flow. In the event of an anomaly – a spiked temperature for example – the system would elicit an alarm in the form of e-mail or a page to the on-call physician. It is theoretically possible for remote physicians to know their patients are ill before the patients know themselves.

Data collection in the corporate world has been leveraging similar mechanisms for years. Here it is referred to as data warehousing and data mining. The medical community has been using its own form of data warehousing but it has not yet been implemented on a real-time monitoring level. Because data rates are so low and communication infrastructures are ubiquitous, deployment into the marketplace seems plausible. The four primary data points are pulse, temperature, blood pressure and oxygen saturation. At the time of this writing, a device to capture the basic vital signs - in the form of a wearable system - has not been developed. There are devices on the market that will capture select readings but not all. And these devices are not real time. They collect data of fixed periods of time and patients plug the units into phone lines and upload the data collected for the predetermined time frames.

The network, server technology and desire are in place. MITAC is working with various research and commercial entities and NASA partners to develop the final and most challenging component. We hope that within a few short years, we will have the capability to monitor your health remotely, non-obtrusively and inexpensively, no matter where you are.

Brett Harnett is director, Experimental IT at the NASA Medical Informatics and Technology Applications Consortium at Virginia Commonwealth University, Richmond, VA 23298.