Intelligent Machines

Domo Arigato, Doctor Roboto

Hospitals across the country are examining whether video-enabled robots can help doctors extend their rounds safely and with patients’ acceptance.

It’s a routine that anyone who’s been hospitalized will be familiar: the doctor rounds.

But for a smattering of patients recovering at a handful of hospitals across the country, including Johns Hopkins Medical Center in Baltimore and the University of California at Davis Medical Center in Sacramento, the experience is taking a decidedly high-tech turn as the patients come face to face with the brave new world of “telerounding” – where the follow-up physician bares more resemblance to Robbie the Robot  than Noah Wyle.

Hospitals are experimenting with these robots as a way to let doctors meet with patients more frequently, or conduct virtual visits at multiple hospitals from one location

The robo-docs looks – and move – more like an over-sized steam cleaner than android’s of Isaac Asimov..The 5-foot, 200-pound robot is equipped with a screen, zoom video camera, microphone and speakers that allow a physician to speak with and examine their patient and review charts, all while being remotely steered by doctors using videoconferencing and movement controls run through a secure Internet connection that is dropped into a wireless network at the hospital site where the robot is working. 

If patients are receptive and doctors are able catch as much as they would during a conventional in-person visit – which initial studies indicate is true – the use of these robots could not only give patients more face time with practitioners but also save hospitals money by allowing patients check out sooner and extend specialized medical care to more rural areas.

“It’s much less impersonal than people give it credit for,” says Dr. Lars Ellison, an assistant professor at U.C. Davis who designed the robot study which analyzes the effectiveness of this technology.

Ellison concedes that, before the study began a few years back, he thought people would think the use of robots for these tasks was “stupid or impersonal, that they would want to have a warm body at the bed regardless.” But, after reviewing feedback from dozens of patients, he says, “we found quite the opposite.” 

Indeed, half of the patients surveyed said they would prefer a telerounding visit from their own doctor to an in-person visit from another physician. And 8 out of 10 patients thought the use of these would make their doctors more accessible. More than three-quarters said that the technology will give doctors the ability to share medical information more readily.

“People would rather be seen by their own doctor, even if it’s through the robot,” Ellison says. “The rapport is what’s important.”

But doctors and hospitals need to concern themselves with more than just what the patient will accept, they also need to consider what is safe and effective.

The prompted the second study, which focused on diagnostic safety. Based on preliminary results, Dr. Louis Kavoussi, professor of urology for Johns Hopkins Medical Center and another architect of the study, says telerounding is “about equivalent” with in-person visits in determining a patient’s progress.

Most of the patients in both studies on telerounding have undergone laproscopic surgery for urologic issues and tend to experience relatively quick recovery.

In general, Ellison notes, it is in treating the patients “who are the least sick and the ones who are the most sick” where telerounding will be most useful.  For robo-docs, that means their immediate future is likely confined to seeing patients who might not experience much condition change – such as those in intensive care units – as well as patients who are recovering from routine procedures that may only need to be questioned to make sure they are recovering as expected.

Renata Bushko, director of the Future of Health Technology Institute in Hopkinton, Mass., is not surprised that people have reacted so positively to the robots because the technology is not only offsetting the increasingly critical shortage of health care professionals, but also gives patients more options.

Although Ellison says he “initially saw this as a way for physicians and patients to communicate more freely outside of traditional rounds,” he now sees the robots as a boon to hospitals in remote or rural settings, where doctors may have wider coverage areas.  The robots also could be sent into situations where a contagious disease or a biohazard is present, to treat people without exposing medical professionals directly.

Dr. Yulun Wang, chairman and CEO of InTouch Health Inc., which makes the robots, says that his company is in discussions with Johns Hopkins about a larger deployment.

But not everyone is applauding the rise of the machines.  Ellison said that some doctors are afraid that the robo-docs could open them up to litigation, particularly if there is a misdiagnosis that happened while they were on tele-rounds.

Ellison has met the criticism, though, with the argument the use of the robot provides greater protection since the remote visit could be recorded as part of the electronic medical record and it increases the number of times a patient might see a doctor.

The irony, though, is that it’s not the new technologies that are proving the big impediments to telerounding. The robots also still face some issues in terms of maneuvering capability.

“The robots sometimes need human assistance to open a door,” says Kavoussi, unswayed by the problem, “but none of these are insurmountable issues.”

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