Space telecommunications: a solution to boost the development of telemedicine

Telemedicine: objectives and challenges

Telemedicine addresses two main objectives. The first, through teleconsultation and tele-expertise, aims to enable isolated persons to have access to a traditional consultation or to benefit from the advice of a specialist. The second, particularly through remote monitoring, aims to improve the care pathway and relieve congestion in hospitals by making it possible to detect clinical signs of hospitalisation or re-hospitalisation at an early stage.

In order for the various telemedicine procedures to be carried safely for the patient, access to a minimum communication speed is necessary. The speed requirement varies according to the procedure performed and can range from 0.5 Mb/s for routine teleconsultation or telemonitoring, to several Mb/s in the case of scanner image analysis or vital emergency (tele-expertise).

A mismatch between required speed and terrestrial telecommunication solutions

When we compare France’s maps of medical and digital deserts, we see that they overlap. The populations most in need of access to healthcare are also the most deprived in terms of telecommunications. Thus, the achievement of one of the objectives of telemedicine is jeopardized by poor network coverage.

In addition, beyond these white areas, other areas may present speed or network problems (so-called grey areas). The most bandwidth-intensive procedures, such as sending medical images in DICOM format, for example, may pose a problem, either because the bandwidth is too low or because it is unreliable (only one operator, frequent interruptions, etc.).

In grey areas, certain acts of tele-expertise that involve a vital prognosis will be difficult to carry out if they require a rapid response (e.g. needing an answer within an hour) from the specialist.

The deployment of terrestrial telecommunication means such as 4G and a fortiori 5G (which requires an even higher density of terminals), well adapted to urban areas, is not a technically viable solution in isolated areas. As for optic fiber, the cost and time of bringing such a device to white areas does not suggest that it can be deployed in the short term.

Space telecommunications: A possible solution but insufficiently implemented

Satellite telecommunications have the advantage of bringing speed to places where terrestrial means of communication are absent or failing. However, apart from a few demonstrative projects, mainly overseas (teleconsultation using satellite antennas in French Guiana, remote monitoring of diabetic patients in Réunion, etc.), space solutions are not sufficiently taken into account by telemedicine players.

Indeed, the business model proposed by the main satellite telecom providers remains unclear. Offers allowing access to unlimited speed, based on the model of Internet boxes, are not widely available or at an unacceptable price. Affordable offers (around €30 per month) exist but limit the available bandwidth (low over long time periods or high over short periods of time), based on the model of modems from the 1990s.

Additionally, spatial solutions are considered as complex solutions to be implemented, especially to capture signal. This idea is partly false because there are fully automated systems that automatically search for the signal. However, these solutions are more expensive (about 10 000€ per antenna) than more complex manual search solutions. While institutional clients (city halls, local authorities, or even EHPAD) could bear the financial and/or technical cost, it is however unlikely that isolated individuals in a weak position would be able to do so.

Space telecommunications are therefore under-used for telemedicine procedures, because of the mutual ignorance of the uses and needs of the medical world (healthcare providers, but also suppliers of medical equipment enabling telemedicine) and of the potential offered by the solutions proposed by space telecommunications players. The communication offer therefore needs to be both disseminated and probably also to become more mature in order to adapt to uses.

Actors such as the CNES (French National Center for Space Studies) or the MEDES (Institute of Space Medicine and Physiology) have a broad vision of the needs of these two sectors and can play a strong role in bringing them together. Professional unions such as the SNITEM (French National Union of the Medical Technology Industry) are key players to be mobilized. There are already dedicated annual events to build on, and whose visibility must be reinforced to encourage exchanges and disseminate practices: the ICT Health Symposium, bringing together digital health manufacturers; symposia on digital and medical deserts, with the aim of raising awareness of connectivity issues among local decision-makers and medical companies; or the International Days of Aeronautics and Space Medicine (JIMAS), co-organized by the CNES and the French Army Health Service.

Bringing telemedicine and space telecommunications together is an interesting way to enable the lifting of this major obstacle to the development of telemedicine, which is access to the communication network. Moreover, in a context of isolation related to the COVID-19 pandemic, where there is an urgent need to establish a remote patient-healthcare provider relationship, space-based technology may be a solution, at least temporarily, to the lack of terrestrial data transmission. At Alcimed, we note the lack of knowledge of these promising communication solutions and additionally note that matching satellite telecom offers with the network speed needs of healthcare players would allow better access to care for all.

About the author

Alexandre, Business Unit Director in Alcimed’s Aeronautics Space Defence team in France