Telemedicine technologies enhance offshore healthcare, reduce illness-related departures

By Oscar W. Boultinghouse, FACEP – NuPhysicia, and Travis G. Fitts Jr, Scorpion Offshore Drilling

Today, HSE decision-makers are looking to create a healthier and more productive workforce while reducing overall medical costs. This challenge escalates as the drilling industry continues to move into more remote parts of the world. In these locations, timely access to quality healthcare is becoming more logistically challenging and expensive.

Currently, a physician who has telephone contact with a paramedic at the patient location makes healthcare decisions on most rigs and worksites. A phone call provides minimal information to support medical decision-making by the physician. The physician is unable to perform an examination, do diagnostic testing, or follow the improvement of treated conditions. These limitations have resulted in case management inconsistencies and overuse of onshore medical resources.

At the same time, the average age of the industry’s workforce continues to increase as more senior individuals stay involved, managing both established and emerging technologies on the rig. These older workers have increased the requirement for effective chronic disease management to assure crew safety and productivity.

These issues, as well as others, call into question whether the current standard of a telephone-supported paramedic remains appropriate for offshore and remote worker welfare. To address this, a recent project applied technologies and process management algorithms developed at an US academic medical institution. This program has, for the first time, allowed shore-side physicians to examine, manage and treat remote site workers in real time.

This methodology has been vetted and scaled by an academic medical institution, which has performed more than 500,000 of these patient encounters over the past nine years.

PROJECT IMPLEMENTATION
Scorpion Offshore became the first drilling contractor to operate this system, called InPlace Medical, for providing enhanced healthcare for its rig workers. In January 2009, the Offshore Courageous rig was equipped with a suitcase video conferencing system outfitted with special instruments for examining patients and used by the medic while working with the crew member. The instruments include a digital stethoscope and a multipurpose medical scope with halogen fiber-optic lighting for otoscope, dermoscope and laryngoscope attachments. These provide complete examinations by the physician – the medic serves as the physician’s “hands.”

Medical-quality live video is sent to the doctor allowing full diagnosis, and, in most cases, initiation of treatment – all while in a real-time conversation with the patient and medic. Using two-way video, the doctor conducts the visit in a real-time conversation with the worker and the medic. With a special electronic stethoscope, the doctor listens to the heart and lungs, the abdomen, and various blood vessels in the body. The special video instruments let the doctor examine inside the ears, nose and throat, and view the skin with high-resolution magnification. The rig medic is also able to perform 12-lead electrocardiograms and laboratory blood tests when indicated.

An electronic medical record keeps all the health information safe, organized and accessible over any distance, and eliminates the problems and delays of a paper-based record system. Strict controls ensure authorized access to the electronic medical record and keep all patient information secure. The technology systems use rig bandwidth only during active clinic cases, and even then constantly adjust to use the minimal amount necessary for medical-quality video. During the project, the medical connections never interrupted phone service or other critical data.

Figure 1: The “telemedicine” system was implemented on Scorpion Offshore’s Offshore Courageous rig in January 2009, allowing doctors to treat patients through medical-quality live video. This graph shows the health-related problems that were addressed on the rig from January through April 2009 using the new service.

RESULTS
As the program commenced, operational data, including rig hospital visit activity, evacuation avoidance and rig worker health status data, and patient and rig leadership satisfaction were collected and analyzed.

Table 1 shows, by month, the visits to the rig hospital and the number of patients treated by doctors over the video telemedicine link during the first four months of the program.

Table 1 shows numbers of visits to the rig hospital and patients treated by doctors over the video telemedicine link during the first four months of the service on the Offshore Courageous.

Figures 1 and 2 outline the problems addressed and treatment medications applied on the rig during this period between January through April of 2009.

Also during the project, careful evaluation was undertaken of the medical transits prevented by the use of the service. On a case-by-case basis, a comparison was made by an independent third party of how a case would have been handled under normal medical services (paramedic supervised by phone) versus with the new video telemedicine service. This information is summarized in Table 2.

Figure 2 shows the treatment medications that were applied on the Offshore Courageous from January through April 2009 using the telemedicine service.

Table 2: Comparisons were made of how a case would have been handled with normal services versus with the telemedicine service. Evacuation is defined as sending someone to shore for medical care and can be by any method or modality.

Additionally, the service allowed ongoing assessment and monitoring of the overall health profiles of the rig workers. Two important parameters under active assessment and management have been blood pressure and body mass index (BMI, or an expression of weight to height) of the workers. Data reflective of this monitoring can be found in Figures 4 and 5.

Additionally, a standardized satisfaction survey was implemented for both the rig workers and the rig leadership. The results of these surveys were positive.

For the patient summary, 93% of crew were aware of the pilot, 69% of the crew reported visiting the medic, 54% saw the MD over video telemedicine, and 100% were satisfied with the care. Additionally, 100% felt the video telemedicine improved the visit, and 79% had no concerns about the video telemedicine service prior to the exam.

Figure 3 shows that fewer personnel departed from the Offshore Courageous due to illness while using the new telemedicine service.

Most importantly, 90% felt the new service made them feel more positive about working offshore, and 97% felt the new service indicated Scorpion was concerned about their individual needs. Finally, 94% felt the new service was better than standard rig medical care.

The survey assessment of the rig leadership provided similarly supportive data. This survey revealed that 100% felt that unwarranted medical evacuations were reduced, 100% felt that the new service was better than standard rig medical care, 100% were satisfied with the care their crew received, and 100% felt the crew benefited from the new service.

Figures 4 (above) and 5 (below) show two important health parameters of rig workers that were continually assessed and monitored by the new service. BMI is body mass index, an expression of a person’s weight-to-height ratio.

Also importantly, 80% noticed improvements in crew productivity due to the new service, and 80% noticed improvements in crew morale due to the new service. Finally, 100% wanted the new service to continue, 100% would recommend the new service to other Scorpion assets, and 100% felt the new service was responsive to the needs of rig leadership.

The new video telemedicine service has contributed positively to the operations of the rig. Scorpion Offshore is continuing the use of this service and is expanding it to additional rig locations.

CONCLUSIONS
The current standard of having the medic onboard has always been viewed as a necessity because the medic has to be physically present for emergencies. With the improvements in industry safety, the medic has begun to take care of more non-work-related ailments and non-emergency episodic care. The majority of these cases are sent to shore for definitive care, then returned to the rig the following day.

Most drilling contractors are under the impression that the majority of the cost associated with personnel leaving the rig are shouldered by the operator. With Scorpion’s assistance during this project, we were able to more clearly define the cost associated with medical evacuations.

We determined that the cost is nearly evenly split between both parties. This meant that the savings accrued during the project was appreciated by both the drilling contractor and the operator. This gives the contractor an opportunity to be a good steward of operator funds as well as their own while doing something positive for the workforce.

InPlace Medical is a trademark of NuPhysicia.

This article is based on a presentation at the 2009 IADC Drilling HSE Europe Conference & Exhibition, 23-24 September, Amsterdam   DC

“This video shows a specialty heart visit between a rig worker offshore and physician onshore using the telemedicine service.”

“This video shows an urgent care visit between a rig worker and physician using the new telemedicine service.”