Mak­ing IT work on a cruise ship

Cruise lines us­ing IT to im­prove sea­far­ing care

Modern Healthcare - - Front Page -

No one goes on a cruise with the in­ten­tion of fall­ing ill, but bad things hap­pen even to fun­seek­ing peo­ple. Since the av­er­age age of a cruise ship pas­sen­ger is 46, and an es­ti­mated 14.3 mil­lion peo­ple— the pop­u­la­tions of the Los An­ge­les and Mil­wau­kee metro ar­eas com­bined—saun­tered up the gang planks of 220 North Amer­i­can cruise ships last year, based on cruise in­dus­try data, sick pas­sen­gers are a math­e­mat­i­cal cer­tainty.

And when cruise ship pas­sen­gers be­come ill, health­care in­for­ma­tion tech­nol­ogy is be­gin­ning to emerge in the cruise ship in­dus­try as part of the arse­nal of care.

Sick­ness aboard ship oc­ca­sion­ally makes the head­lines, par­tic­u­larly when there is an in­fec­tious-disease out­break. In 2010, ac­cord­ing to the Cen­ters for Disease Con­trol and Preven­tion, more than 2,600 pas­sen­gers and 230 crew mem­bers were stricken with gas­troin­testi­nal dis­or­ders in 14 cruise ship in­ci­dents se­vere enough to re­quire re­port­ing un­der U.S. law. But these se­ri­ous bouts of the bug are an aber­ra­tion.

What are far more com­mon are the gamut of in­juries and ill­nesses one would ex­pect from such a siz­able pop­u­la­tion of trav­el­ers, says Dr. Carter Hill, an emer­gency physi­cian and a 22year vet­eran of the cruise ship busi­ness who serves as chief med­i­cal of­fi­cer of the Seat­tle­based Hol­land Amer­ica cruise line.

Hill says Hol­land Amer­ica has 15 ships sail­ing 51 weeks a year on about 450 voy­ages a year and com­bined, its med­i­cal fa­cil­i­ties “prob­a­bly have 100,000 vis­its a year.”

Hol­land Amer­ica is one of the 11 cruise ship com­pa­nies owned by Car­ni­val Corp. and Car­ni­val PLC, based in Mi­ami and Southamp­ton, U.K., re­spec­tively. Taken to­gether, the Car­ni­val com­pa­nies, the largest cruise op­er­a­tion in the world, own 96 ships.

Ship­board med­i­cal fa­cil­i­ties are called in­fir­maries or clin­ics, Hill says, but they look very much like a hos­pi­tal emer­gency room. And some­times, there is just as much med­i­cal drama on board as there is in a land-based ER.

“We have ICU beds,” Hill says. “We have ca­pa­bil­i­ties to do all of the car­diac en­zymes and tests you need in heart con­di­tions. But it’s still not home.” When you’re in the ocean be­tween Hawaii and San Diego, mov­ing at 20 to 22 knots, or up­wards of 25 mph, it takes 4½ to 5 days to reach port, but not nearly that long to get out­side of he­li­copter range, ac­cord­ing to Hill.

“We’ve had a sit­u­a­tion where we’re a day and a half out of Hawaii (and) some­body cuts loose with mas­sive GI bleed­ing,” Hill says. “We can trans­fuse their blood (sev­eral crew mem­bers are des­ig­nated uni­ver­sal donors, but the ship doesn’t carry its own blood bank). We get a call say­ing we have this mas­sive bleed­ing, here’s the clin­i­cal sit­u­a­tion. We can speed it up, or we can turn around and go back to Hawaii and they can meet us with a he­li­copter in maybe a day.”

Just such a turn­around will make the ship at least two and some­times three days late reach­ing the West Coast, and the de­lay will cost the line “maybe be­tween $2 mil­lion or $3 mil­lion” in ho­tel ac­com­mo­da­tions and other make­good pay­ments to pas­sen­gers, Hill says. “But, if that’s what you do, that’s what you do. That re­ally hap­pens.”

Ac­cord­ing to Hill, who still pulls mid­night shifts in the ER at 160-bed High­line Med­i­cal Cen­ter in Burien, Wash., a Seat­tle sub­urb, emer­gency physi­cians are the doc­tors of choice to staff ship­board clin­ics and in­fir­maries, be­cause even in the age of jet travel and res­cue he­li­copters, the world re­mains a very large place when you’re sick and aboard a ship far out at sea.

“I’m still work­ing full time in emer­gency medicine and those are the docs that we hire,” Hill says. “The skills of the peo­ple we have are quite good. They know how to do the rou­tine pro­ce­dures they used to do in emer­gency rooms.”

Im­proved tele­health com­mu­ni­ca­tions be­tween ship­board health­care providers and spe­cial­ists as well as in­for­ma­tion ser­vice providers “have dra­mat­i­cally changed the prac­tice,” Hill says. “We used to just send peo­ple out there,” he says. If there was a se­ri­ous ill­ness or in­jury, “we would just get a mes­sage through to them and tell them, ‘Do the best you can.’ ”

“Now, we can help them, be­cause there is ac­cess to good com­mu­ni­ca­tion,” he says. “I would not con­sider it high-speed In­ter­net con­nec­tiv­ity like we are used to” on land. “But it’s still pretty good. All of our X-rays are done dig­i­tally, and we send those to the Univer­sity of Texas and in 24 hours get over­reads. They read all the Xrays for us. We get spe­cialty con­sults with those folks as well. If you have a skin rash, I can get a jpeg and get a con­sult and prac­tice pretty good medicine. But we can’t get them to op­er­ate, we can’t get CAT scans, but still, hav­ing ac­cess to that

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