When oil rig workers in the middle of the Gulf of Mexico need to see a doctor, they turn to a unique telehealth solution designed by XstremeMD and ISI. 


XstremeMD connects patients who work offshore on oil rigs and in other remote environments primarily in the oil and gas industry with physicians who are trained to handle health issues common with labor intensive workers. According to their website, “XstremeMD is the only telemedicine provider with a staff composed of Board Certified Emergency Medicine Physicians with extensive training in occupational medicine.” (www.xstrememd.com

The founder of XstremeMD, Dr. Joseph Pearson, who practiced emergency medicine for 10 years in a community of oil and gas workers, had seen countless patients coming into the ER with health problems that could’ve been treated more easily if caught early. Along with the direct health consequences of delayed care and misdiagnosis, there was also the expense. Not only were ER visits expensive but many of these workers were being flown in from the oil rigs they worked on at a cost of $60,000 a trip. 


ISI was brought in to consult with XstremeMD back in 2010 due to their deep expertise in the telemedicine industry and their ability to create custom technology solutions. XstremeMD knew that their challenge was to connect their network of doctors with these patients who were in remote areas. They also knew that telemedicine could be the solution but they needed assistance with the execution. 

Like a typical ER, patients could show up at all hours of the day or night with a variety of illnesses that varied in seriousness. Just like a hospital, the patients needed to be triaged or prioritized due to the severity of their illness. Except, in this case, the triage would have to be done in a virtual environment so that the workflow could be easily managed by the doctors on-call.  The doctors were used to this system of assigning patients priority in the real world but doing it digitally was different. 

In addition, they wanted the solution to be user-friendly enough that the oil rig workers could even use the machine themselves without the assistance of an on-site medic or trained medical personnel. It was important for the interface to have as few buttons as possible. 

Given all of these challenges, the answer could not be an out-of-the-box solution and would instead need to be a fully customized telemedicine system unlike anything on the market. 


Through a joint design effort between the team at XstremeMD and ISI, they were able to develop the XMD Responder. This unit housed a PTZ camera (pan, tilt, zoom), medical instruments for observation and diagnosis, and color-coded medications all housed within a compact and mobile storage device in case it needed to be moved to another room or different location. (XMD Responder

The PTZ camera was also important because it allowed the doctor to have control of the camera from the far-end. Therefore, if they couldn’t see the patient at the proper angle, they could move and zoom in as needed with minimal instruction to the patient. The other medical instruments housed in the unit included a stethoscope, EKG, blood pressure monitor, thermometer and otoscope. All of these readings could be transferred to the doctor digitally so that he could have all of the same information he would normally have as if he were in the room. 

Another important aspect of the fully integrated solution was the organization of the workflow. ISI had helped develop a similar workflow for a previous client that they were able to apply to this situation. Here is how a patient interacted with the portal from the moment they arrived:

  • When a patient needs to see the doctor, they enter the room with the XMD Responder and click one button on the remote that places them in a “virtual waiting room.”
  • Once in the waiting room, the doctor on-call would in turn receive a call on all of his or her devices (PC, tablet, mobile phone) notifying him that there is a patient that needs to see them. 
  • The doctor would accept the call and would see the patient in the waiting room and would move them to a “virtual exam room” which connects the doctor directly to the patient in a 1on1 call.
  • The doctors can easily click and drag their virtual presence from one exam room to another if a more severe case comes in that needs to be addressed. 

The benefit of this system is that it keeps all patients separate at all times so that they are maintaining patient privacy while balancing it with efficiency. Giving the patient a waiting room instead of just letting the call ring until they reach a doctor allows the patient to be kept at ease while also alerting the doctor allowing him to prioritize his patients by their needs – just like they would do in a real hospital. 

Troy Istre, General Manager of XstremeMD, had this to say about his experience working with the ISI team on this unique project: 

“When we were setting up our infrastructure, [ISI] helped us get up and running. The guys...Brad Kirby and John Emery, those guys really are good. They work really well with us. Anytime we have issues…they are there. It has been a great working relationship.” 

Currently, ISI has helped deploy XstremeMD deploy telemedicine units at 30 different sites including various oil rigs, on-shore fracking locations, etc. 


XstremeMD had a unique challenge and they knew technology could overcome this challenge but they needed help to execute. ISI was able to provide not only installation and support services but also acted as a consultant by utilizing their vast experience in telemedicine to provide a solution that was creative both from the technical and workflow aspects. 

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