The Virtual Doctor is Always In

Telemedicine provides peace of mind at sea and is seeing a surge in business during social distancing
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DigiGone calls its Five Plus kit a walk-in clinic at sea.

DigiGone calls its Five Plus kit a walk-in clinic at sea.

Telemedicine has arrived. Sure, visiting a doctor or seeking urgent care through a video portal complete with connected diagnostic devices has been a staple of remote living and offshore adventuring for years, but now the practice has gone mainstream. Thank the novel coronavirus, which, at last, is good for something.

As the spread of Covid-19 confined people to their homes or left them unwilling to visit a doctor or hospital, telemedicine filled the void. DigiGone, a device maker that builds a product for the marine market, has watched its overall business quadruple in the United States since the start of 2020. “And it’s not our usual customer,” says founder Michael Dunleavy.

Amwell, one of the nation’s largest telemedicine providers, told Forbes it has seen patient visits increase about 257 percent year over year. GoodRx, a site that offers comparative shopping for prescription drugs, noted such a jump in telemedicine demand that it recently added a portal that allows patients to comparison shop for telemed services.

Being prepared for a medical emergency at sea begins with instruction.

Being prepared for a medical emergency at sea begins with instruction.

“In the past when we talked to people about telemedicine, they viewed it as something for emergencies only, but we’ve always looked at it like walk-in care,” Dunleavy says. “Covid has forced people to realize that potential. As people have become more familiar with it and realized its capabilities, it’s becoming more the norm. Now, people expect it.” And they no longer have to be 100 miles offshore to seek it out.

Someone relaxing at the dock can get help with a minor injury rather than ruining their afternoon with a trip to the emergency room. Boatbuilders can save time and money by offering on-site care instead of seeing employees take time off for trips to the doctor. Charter operators and yacht management companies can offer a level of service and safety that augments sales.

“Especially for smaller boaters, people with family cruisers or people going on charters, they still want to travel, but they want to make sure that if someone does get sick, they know how to care for them,” says Rebecca Castellano, a registered nurse and U.S. sales rep for U.K.-based Medical Support Offshore (MSOS).

Specialized for the Sea

“I look at telemedicine as a three-legged stool,” Castellano says. “There’s access, equipment and training.”

With telemed companies that specialize in marine environments, the access comes via a service contract. Its terms can vary by duration of time away from shore, size of vessel and number of passengers or crew, among other considerations. The investment buys blanket coverage, with medical professionals on call 24/7/365 and, usually, access to a variety of specialists. The service is meant to fill the gap when standard, land-based medical coverage is unavailable or minimal, so it is sometimes (but not often) covered by medical or travel insurance plans. A health savings account could pay for the service.

3_digimed-Five-Plus-Ver-2-facing-left

Besides MSOS, telemedicine companies specializing in marine include Praxes, George Washington Maritime Medical Access and MedAire. They typically service everything from fishing trawlers to container ships, while their connection to recreational boating has traditionally been with superyachts.

“I think more and more boaters are going to opt in, especially small boaters,” Castellano says. “The cost can be off-putting, but if you consider the cost of a lost vacation or flying someone out, it’s a bargain. And it’s unlimited calls. You could call every day if you needed to.”

MSOS’s top-of-the-line Category A plan, which usually applies to commercial ships, starts at $8,000 per year, while its Near Ocean plan extends to 60 nautical miles offshore and goes for about $2,500. Praxes and MedAire offer plans that run less than $1,000 a year, and Praxes allows customers to purchase plans for a shorter period — say, for a three-month cruise.

The value goes beyond care to advice on how to handle a variety of situations. “A lot of yachting folks came back to shore when Covid started,” says Derek Andresen, program manager at GW Maritime. “But they’ll be getting back out to sea soon, and when they do, they’ll face a lot of questions. How do we make sure everyone is healthy when they get on board? How do we keep the crew healthy? Six months ago, if someone on the boat had a cough, it didn’t rise to the level of a call, but now we get that call and we help people figure out what’s going on and the best way to keep everyone on board safe.”

Equipment bundles range from medical supplies to DigiGone’s unit that has a thermometer, pulse oximeter, blood-glucose meter, blood-pressure monitor, and a single-lead ECG, all Bluetooth-enabled.

Equipment bundles range from medical supplies to DigiGone’s unit that has a thermometer, pulse oximeter, blood-glucose meter, blood-pressure monitor, and a single-lead ECG, all Bluetooth-enabled.

Addressing specific needs, such as crew safety and customs requirements, sets the specialty marine providers apart. “What you want when you’re at sea is a provider who’s available at all times and familiar with the environment,” says John Ross, medical director of Praxes, which is based in Canada.

Those who don’t deal with on-board staff or foreign entities but want to stay safe while staying closer to shore, can explore land-based telemedicine outfits, too. There are dozens of options, and while they may not be as quick to recognize ciguatera poisoning (which comes from contaminated reef fish), they do provide more economical, per-service pricing and will often be covered by medical insurance. They’re great for everything from advice on removing a splinter to detecting the difference between seasickness and food poisoning.

“With Covid, these services are even more popular,” Castellano says. “Most patients are now seeing their doctors via devices, and it’s working.”

U.K.-based Medical Support Offshore provides clients with training seminars. 

U.K.-based Medical Support Offshore provides clients with training seminars. 

The Tools for the Job

The remaining two legs of Castellano’s stool often go together, as the equipment boaters might carry often comes with training.

“The good news is that there are more and more devices available that can make a user’s capabilities more robust, and they’re getting more accessible from a cost proposition,” Ross says. “We’ve seen increasing quality and miniaturization of devices, from a small ultrasound that plugs into your phone to a smaller EKG.”

Equipment bundles offer a range of devices packaged with communications gear. Such platforms typically come in cases or padded bags that contain the standard equipment needed to address medical problems. They include or can be expanded to include secure satellite video conferencing as well as voice, text and email. And they have a range of digital medical equipment that might include a blood-pressure cuff, thermometer, pulmometer (for measuring respiratory pressures), EKG, glucose meter, stethoscope, pulse oximeter (for measuring blood-oxygen level) and otoscope (for looking into the ears and nose).

These platforms allow an on-board caregiver to have live, hands-free video and voice contact with a medical pro while diagnosing and treating a patient, with the caregiver acting as the doctor’s hands. The devices are Bluetooth-enabled, so the data collected feeds directly into the information stream going to the doctor.

MSOS’s Themis TCP platform, which is similar to what emergency medical technicians use to consult physicians when providing treatment on-site or during transport to a hospital, sells for about $30,000. Florida-based DigiGone offers a Five Plus kit that provides a different combination of equipment and technology; it sells for less than $20,000. Both companies offer free online training videos.

For someone building a superyacht or even a large cruiser, $20,000 is a rounding error, but for those with less to spend and no plans to wander too far from shore, there are cheaper alternatives. An Apple Watch and many fitness bands can measure heart rate, detect arrhythmias and pick up changes in body temperature. Ross has often advised boaters to go to a good pharmacy or medical outlet and buy an off-the-shelf blood-pressure cuff, thermometer, blood-glucose device and pulse oximeter, which shouldn’t run more than a few hundred dollars.

MSOS’s Themis TCP kit is similar to what emergency medical technicians use for on-site treatments or during hospital transports. 

MSOS’s Themis TCP kit is similar to what emergency medical technicians use for on-site treatments or during hospital transports. 

“They’re foolproof, inexpensive and nearly unbreakable,” Ross says. “They can provide vital information to help make a diagnosis, and people can rely on that.”

For communications, a cellphone or laptop equipped with FaceTime, Skype or Zoom can provide video access, although cell service on the water depends on a many variables, including the provider, distance to the closest tower, elevation and weather. In the United States, cell service can extend to 10 miles offshore, but it’s inconsistent and spotty. Three miles is more likely. Otherwise, there are satellite phones and ocean cell plans, or, for voice only, VHF radio. For voice and text, a ham radio setup can provide global connectivity.

With some store-bought equipment, an enhanced cell plan, a telemedicine service and a good first-aid kit, boaters can cover a lot of circumstances. Telemedicine providers can also fill or issue prescriptions.

The greatest benefit of telemedicine for boaters is one that can’t really be measured. As Castellano says, “There’s a calming effect that comes from having a doctor on the phone when you need one.” 

This article originally appeared in the August 2020 issue.

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