New position paper on telemedicine, digital patient models, and autonomy in space and Earth medicine

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After my time at the European Space Agency, I am very glad to be moving closer to space medicine again.

Together with colleagues from Hahn-Schickard, ESA’s longest-serving Flight Surgeon and long-time Medical Advisor to NASA, we published a position paper on telemedicine at SpaceCHI / Schloss Dagstuhl – Leibniz Center for Informatics. The paper with the title "Digital Health for Space: Towards Prevention, Training, Empowerment, and Autonomy" explores how telemedicine changes when communication delays, limited medical infrastructure, and growing autonomy become defining conditions.

Paper link:https://drops.dagstuhl.de/storage/01oasics/oasics-vol130-spacechi2025/OASIcs.SpaceCHI.2025.33/OASIcs.SpaceCHI.2025.33.pdf In summary:

A central idea of our work is that medicine should not rely only on isolated snapshots from clinical visits. Instead, I am interested in digital patient models that map health trajectories more continuously and in a context-sensitive way, including data from telemedicine and remote monitoring. This can support a better understanding of individual disease progression and help create more adaptive forms of care.

The paper proposes four levels of autonomy, ranging from near real-time telemedicine in Earth orbit to fully autonomous health management in deep-space missions. These levels are not only relevant for space exploration. I believe they also provide a useful framework for care on Earth, from urban hospital systems to remote regions and settings with limited specialist availability. In this sense, space medicine makes visible how complexity, responsibility, trust, and patient involvement change when telemedical systems become more independent.

For me, this also raises broader questions: When should patients be able to understand and manage their own situation more actively? How strongly should they be involved? And how much autonomy is appropriate when AI systems increasingly support medical decisions? Our position paper is intended as a contribution to this discussion.

In the context of demographic change, workforce shortages, and the need for resilient and human-centred healthcare systems, these questions are becoming increasingly relevant not only for space travel, but also for medicine on Earth.

I would like to thank my highly esteemed co-authors Oliver Amft, Ulrich Straube, and Russell Andrews for the excellent collaboration.