The Robot at the Bedside

By David Ollier Weber

In some U.S. hospitals, physicians are making rounds remotely, via a robot.

David Ollier Weber

Recently I wrote about a group of doctors who have taken as their model the constantly self-improving, defect-intolerant production system famously developed by Japan’s Toyota Motor Corporation. I facetiously labeled those physicians, at Seattle’s Virginia Mason Medical Center, “robodocs” because they strive for the same repetitive precision in caring for patients that is programmed into robots on automobile assembly lines.

In fact, there are real robots at work in American hospitals. And you can expect to encounter more of them as physician shortages pinch tighter. But it is important to emphasize that these robots do not practice medicine—any more than doctors who strive for patterned, 100 percent adherence to best practices have turned themselves into mindless automatons. The robots are tools, physician extenders in a literal sense. They allow doctors to reach out, to “project [themselves] to another location,” as described by one leading medical robot maker, “to move around, see, hear, talk and interact as though they were actually there.”

Introducing Lenny

Walk into the intensive care unit at St. Joseph Mercy Oakland hospital in Pontiac, Mich., and your eye might well be drawn to Lenny. He’s built like a pint-sized linebacker—5 feet 4 inches tall, 225 pounds—and he shuttles with an athlete’s quiet grace among the patients, greeting and chatting with them by name, checking their vital signs, confidently issuing instructions to nurses and other clinicians.

What’s striking about Lenny is that his “face” is a TV screen. When he’s at work, his screen is filled by the face of the physician Lenny is assisting, who sits far away at an office desktop console or perhaps even at a laptop at home or in a convenient Wi-Fi-equipped coffee shop. Lenny’s “eyes” are a quick-focusing pan-tilt-zoom camera mounted atop the screen. He has no arms or legs—he maneuvers smoothly among the beds on three ball-bearing “feet,” and he dodges collisions through an array of sensors positioned around his “waist.” He hears and speaks through audio receivers and microphones, and he even has his own built-in printer so he can spit out hardcopy orders or prescriptions on the spot. His handwriting is unfailingly legible.

Lenny, as you’ll have guessed, is a robot—an RP-7 (RP stands for remote presence) manufactured by InTouch Health of Santa Barbara, Calif. He’s one of more than 100 of his kin currently stationed in some 40 hospital systems in the United States and internationally, according to Jennifer Neisse, marketing and communications manager at InTouch Health. Like Lenny, most of these clever machines have been given human names by their fond flesh-and-blood colleagues. Some robots even visit patient bedsides with a white lab coat draped around their “shoulders.”

The RP-7, manufactured by InTouch Health, enables physicians to provide timely patient care from a remote location.

A Fine Stand-In

How do doctors feel about delegating some previously hands-on patient contact to intermediation by a versatile droid?

At Shawnee Mission (Kan.) Medical Center, where five RP-7s have plied the cardiovascular, orthopedic, critical care and general surgery floors since 2005, almost three-quarters of the physicians who had recorded some 850 robot-assisted interactions reported the remote visits had sped up patient discharges. (Reducing unnecessary lengths of stay translates to money in the bank for the hospital. One physician calculated that the use of a robot at his institution shaved an average of 0.17 days from his patients’ LOS, adding up to savings of $750,000 over the course of a year.) Moreover, the physicians were virtually unanimous in declaring that they had saved their own precious time—robotic visits proved eight times more efficient than personal rounds during “off hours.” The doctors had “learned more about the patient” through use of a robot, they acknowledged, and remote interaction, they judged, had “advanced” care.

A question at least equally important is how patients feel when a Lenny shuttles into the room in place of a living, breathing doctor.

The answer, according to the first multisite patient satisfaction study of remote presence rounds, is “Quite content, thank you.” Only 10 percent of 135 patients who’d been attended by a robot at Johns Hopkins, UC Davis Medical Center and Eastern Virginia University suggested their care had been inferior. Two-thirds thought telerounding should become a regular feature of hospitalization. Almost 90 percent agreed that communicating with their doctor through a robot had been easy (and 75 percent said they’d rather talk with their own doctor that way than have an unfamiliar doctor drop by). Overall, no difference in satisfaction with their physician’s concern and care, skill, communication, awareness, personal attention or availability was reported between patients who’d experienced robot rounding and a control group who’d received conventional in-person oversight.

Satisfaction is one thing; safety is another. But the same three-hospital study detected no disparity in post-op morbidity and mortality among 135 patients whose recovery from urologic surgery had been monitored via robot and an equal number whose hadn’t. No patient died in either group.

Rural Stroke Specialists

St. Joseph Mercy Oakland is a comparatively large community hospital, a prominent member of Trinity Health, the nation’s fourth largest Roman Catholic hospital system. It’s a teaching institution and a center of excellence in several clinical areas, including cardiology and orthopedics. It was the first of two Michigan hospitals to receive certification from the Joint Commission as a primary stroke care center. So you might not be altogether surprised to find an innovation like Lenny roving its halls.

But look. Here’s an identical robot at 25-bed Hills & Dales General Hospital in little Cass City, Mich., population 2,600. And another at 43-bed McKenzie Memorial in Sandusky, Mich., population 2,745. Both hospitals are members of the Michigan Stroke Network, which is spearheaded by St. Joseph Mercy Oakland and will soon number 30 hospitals statewide.

St. Joseph Mercy Oakland picks up the tab for all these bots—they’re leased from InTouch for $5,000 a month apiece. That’s a big hunk of change for a hospital to spend on the unusual mission of seeding other institutions with high-tech equipment. They’re not all Trinity members, either. But it pays off handsomely in every direction, says St. Joseph CEO Jack Weiner.

First, it’s important to note that stroke is the third leading cause of death in the United States after heart disease and cancer, and the leading cause of long-term disability. Some 750,000 Americans suffer a stroke in any given year, and more than 150,000 prove fatal.

Strokes may be caused either by a clot that suddenly cuts off blood to the brain (ischemic stroke) or by bleeding into the brain from a ruptured vessel (hemorrhagic stroke). Prompt administration of the clot-dissolving drug tPA can prevent many deaths from the former—but its blood-thinning properties can worsen or even kill a victim of the latter. Rapid and accurate diagnosis of the cause of a stroke, and administration of tPA if appropriate within no more than three hours, can make the difference between life and death. But few hospitals, especially in rural areas, have the neurovascular expertise in-house to make and expedite the critical judgments.

And that’s where Lenny and his robotic cousins at hospitals across Michigan come into their own. When a stroke victim is brought into the emergency department of Hills & Dales, for example, a call goes out to St. Joseph Mercy Oakland while the local robot—Hilda is her name, naturally—speeds to the patient’s bedside.

“It takes only three or four minutes to get online—the specialist at the console here and the robot at the local hospital,” says Weiner. “In most major citiesyou can’t get [a stroke team to the patient] in that time no matter what.”

Local Treatment

Using Hilda’s eyes and ears and working with on-site ED personnel who have received advanced stroke care training (part of the quid pro quo for the satellite hospitals is that they will fulfill the requirements and qualify for Joint Commission certification as primary stroke centers), one of three neuroendovascular specialists 80 miles away in Pontiac determines what treatment the patient needs and where.

If Hills & Dales, a critical access hospital, can handle the case, the patient is spared an expensive and needless precautionary transfer to a hospital far from home. If the consultant decides that more urgent and intensive intervention is essential, an air ambulance is immediately dispatched to Cass City and the patient is whisked to St. Joseph Mercy Oakland. In exchange for the robots, the small hospitals send their intensive-intervention stroke victims to St. Joseph—an agreement that allows the hub hospital to afford robots for the satellite hospitals.

Payments for the stroke victims’ care far exceeds the cost to distribute robots to the outlying, spoke communities, Weiner explains. “It’s a win-win,” he declares. “We’re helping small hospitals keep patients where appropriate. It’s very cost-efficient, and we’re avoiding duplication and proliferation of resources.

“Ninety-five percent of stroke victims can be treated in their own communities,” Weiner notes, adding that his hospital receives about 20 cases a month of the intensive-care stroke patients.

“Small hospitals love the idea!” he adds. “They struggle to access consultive services, and with robots those are very easy to structure in everything from infectious diseases to psychiatric services. We use ours in the ICU as well as for stroke care, and we use them for computer training. I know of one 64-bed hospital that’s starting a cardiology clinic supported by a robot, including doing diagnostic tests.... [Robots] allow small hospitals to serve their community much better in ways they never dreamed of.”

Stroke patients benefit, needless to say, from fast state-of-the-art treatment—although the impact on outcomes is only now being studied. “Because people walk home from the hospital after a stroke rather than being wheeled out for year-long rehabilitation,” argues Weiner, “we have a much healthier society—at lower cost!”

In fact, he exclaims, “we’re just starting to scratch the surface of what robots can do as a tool to extend critical manpower resources to communities that would be without access if it weren’t for this technology.”

Lenny, meet Hilda. Be fruitful and multiply.

David Ollier Weber is principal of The Kila Springs Group in Placerville, Calif. He is also a regular contributor to H&HN OnLine.

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This article 1st appeared on July 24, 2007 in HHN Magazine online site.

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