Satellites are playing an increasing role in the support of health and welfare on Earth. In the first of a series of bulletins looking at the range of satellite applications, this brief note summarises how satellite technology can assist in the provision of efficient health care and touches on some relevant legal issues.
The value of satellite applications for health
There has been a limited awareness of space capabilities by the medical/health profession and an equally limited understanding of users’ needs by the satellite industry. However, due to factors such as an ageing-population and a reduction in health practitioners, particularly in rural areas, medical support involving a satellite element is being looked upon as an increasingly feasible solution. It also provides a cost-effective and accessible solution in developing countries where populations lack even basic levels of health care due to remoteness, poverty and lack of availability of local skills.
The use of satellite communications can play a role in several areas. Some examples are mentioned below.
Diagnosis, consultations, treatment and health monitoring
Many isolated and vulnerable people need effective and timely monitoring of their health and tele-diagnosis. This is also useful in emergency situations.
Satellite communications provide the ability for remote medical diagnosis and remote medical care in the home, which is particularly important for the growing ageing society, which may require assisted living. The World Health Organisation recently published the statistic that there are 600 million people globally who are over 60 years of age, and that 860 million people worldwide are living with a chronic condition.
Several satellite communications applications and services are already providing isolated populations with access to healthcare and medical practitioners with second opinions or additional support (e.g. tele-diagnosis in the absence of local expertise and health monitoring to enhance homecare, mobility and the autonomy of the ageing population). This is also coupled with a trend towards greater patient involvement and more general health awareness.
The market for remote patient monitoring services is lucrative, and will only become more so. Such services may include, for example:
(a) the monitoring of elderly or chronically ill patients at home (for example checking blood pressure and cardiac and lung function diagnostics, for the treatment of asthma, etc), and regular diagnosis by telecommunication, allowing patients to stay at home rather than in hospital for lengthy periods; and
(b) the preliminary diagnosis of patients in remote areas to allow an efficient assessment as to whether such patients should be taken to hospital and, if so, to which hospital or centre for treatment.
In general, remote diagnosis through the means of satellite telecommunications with the assistance of expert healthcare professionals will allow for quicker, more accurate and efficient decision-making regarding the treatment or transport of a patient. This may avoid the unnecessary use of expensive rescue facilities.
Emergency Services and Disaster Response
Miniaturised sensing equipment can be used to send data to a medical centre by means of a satellite system during emergencies and in relation to disaster response and rescue activities.
The European Space Agency’s DELTASS (Disaster Emergency Logistic Telemedicine Advanced Satellite System), for example, is a space-based system designed to assist with disaster response operations and the management of medical aid in situations such as earthquakes, storms and floods. In such events, the satellite components may complement damaged terrestrial communications infrastructure. DELTASS allows the transmission of medical data directly from the disaster zone to medical or coordination centres, thus enabling mobile rescue services to co-ordinate their activities. It also enables real time tele-diagnosis through images by specialised medical doctors.
Telemedicine by satellite can also support diagnosis and medical assistance on-board commercial aviation. Such a system could provide a multimedia data exchange between the aircraft and a ground based medical centre to support decisions as to whether to land, divert the flight or what action to take on board the aircraft.
Tele-education can assist health care workers in remote areas with medical tasks and monitoring for which they are not, and perhaps cannot be, adequately trained for. Satellite communications can support the development of, and access to, tele-education, enabling a medical practitioner, or even a patient, to access medical information to improve his or her knowledge and skills remotely, particularly where ground-based internet or other means of communications are not available. This service may also provide longer-term education needs, where no local means are available.
Early Warning System
Satellite communications can also assist in the gathering of data to predict and track disease progression and associated risks of outbreaks.
A satellite system will also provide a resilient and efficient way to distribute warnings and information over large areas to ensure that adequate measures are put in place to safeguard health and to deal with the consequences of catastrophic events.
Relevant legal issues
Satellite and telecommunications regulations, at a national, regional and international level, are clearly relevant to the satellite applications mentioned above. As our general Communications and Satellite Bulletins tend to deal with these industry-specific regulations, it is worth briefly mentioning some more general legal issues in the context of e-health in this note. Such legal issues will, for example, include the following:
The operator of such a system must ensure compliance with data protection regulations in respect to the gathering and storage of personal data, including sensitive personal medical data and ensure that its foreign operations are similarly compliant. Particular issues may concern the transfer of such data inside and outside the European Union.
In the case of processing personal data in various jurisdictions, a consistent approach should be developed to questions of privacy and to defining the responsibilities of those who have access to e-health records and share such records. Legal issues include those of patient access; correction of records; openness and transparency; patient choice; limitations to the collection, use, and disclosure of personal health information; data integrity; safeguards; and accountability.
Data protection supervisory authorities tend to be conservative about the processing of sensitive personal medical data and will examine the necessity and the purpose of the data processing, and ensure that the informed consent of the patients has been given. Therefore, any patients participating in e-health monitoring, or related activities, should be provided with easy-to-read, standard notices about how their personal health information is protected and some assurance that those who misuse information will be held accountable.
The safe-keeping of electronic medical records is also of primary importance. Data processors should be aware of what needs to be done on the occurrence of a data security breach in order to comply with the relevant statutory or contractual notification obligations.
There are several detailed health-related regulations that must be complied with such as those concerning medical devices, and in vitro and implantable medical devices.
Currently, the lack of an overall tele-health reimbursement regulation is an obstacle globally; thus, the regulatory environment is expected to change.
General principles of product liability will be applicable and the concept of strict liability will be relevant in relation to health related products.
The recognition of the presence of patent and trademark issues in the telemedicine sector is also important.
Careful contract drafting is a necessity in the field of e-health as it involves many players, not only from the telecommunications and satellite sector but also from the health care sector. Thus, the responsibilities and the tasks of the parties need to be separated clearly and the liability towards the end-users has to be reflected in the various agreements.