Ro­bots get to work

More hos­pi­tals are us­ing au­to­mated ma­chines, but jury’s still out on suc­cess

Modern Healthcare - - TECHNOLOGY - Jaimy Lee

Agrow­ing num­ber of hos­pi­tals are de­ploy­ing ro­bots that au­to­mate sim­ple op­er­a­tional tasks or pro­vide new ways for physi­cians to in­ter­act with pa­tients be­yond the bed­side. Health­care providers say that the ro­bots—or ma­chin­ery with vary­ing types and de­grees of robotic au­to­ma­tion—can help re­duce costs, make op­er­a­tions more ef­fi­cient and serve as a mar­ket­ing tool to po­si­tion hos­pi­tals as early adopters of cut­ting-edge tech­nol­ogy.

Yet ques­tions re­main about whether the pricey new tech­nol­ogy can de­liver on those prom­ises.

It’s be­com­ing more com­mon, for ex­am­ple, to see Tugs, made by Pitts­burgh­based Aethon, hum­ming around U.S. hos­pi­tals, us­ing el­e­va­tors to move floor to floor as they haul drugs, linens and lab re­sults. They re­place the role of run­ners pre­vi­ously re­spon­si­ble for such de­liv­er­ies. Den­ver-based Swiss­log Health­care So­lu­tions-North Amer­ica’s RoboCouri­ers carry out many of the same tasks.

“No hos­pi­tal wants to cut cor­ners for the sake of au­to­ma­tion or for the sake of tech­nol­ogy,” said Char­lie Whe­lan, se­nior an­a­lyst in Frost and Sul­li­van’s health­care group. “At the same time, they are look­ing for ways to make things eas­ier and cheaper.”

The ro­bots that have joined the U.S. hos­pi­tal work­force tend to fall into two cat­e­gories: ones that re­place a job pre­vi­ously han­dled by an em­ployee, such as pack­ag­ing drugs or de­liv­er­ing lab re­sults, and telemedicine-based tech­nolo­gies that con­nect clin­i­cians and pa­tients in ways that pre­vi­ously didn’t ex­ist.

Adop­tion has gen­er­ally been limited to aca­demic med­i­cal cen­ters, which are more likely to have the scale, bud­get and op­er­a­tional mo­bil­ity to in­vest in the tech­nol­ogy.

Ro­bot man­u­fac­tur­ers and some providers say that broad ef­forts to im­prove clin­i­cal qual­ity and re­duce costs may boost uti­liza­tion of th­ese ro­bots over the next few years and could spur new de­vel­op­ment of more in­no­va­tive tools that will help hos­pi­tals be­come fur­ther au­to­mated.

GE Global Re­search an­nounced this year that it will work with the Vet­er­ans Af­fairs Depart­ment to de­velop an in­tel­li­gent sys­tem that will sort, ster­il­ize and track sur­gi­cal tools. The sys­tem is ex­pected to be tested at a VA hos­pi­tal in 2015.

“We’re uniquely po­si­tioned to con­struct a smart so­lu­tion that can make op­er­at­ing rooms run more ef­fi­ciently, save mil­lions of dollars in health­care costs and lead to bet­ter pa­tient out­comes,” Lynn DeRose, prin­ci­pal in­ves­ti­ga­tor and auto-ID tech­nol­ogy ex­pert in GE Global Re­search’s dis­trib­uted in­tel­li­gent sys­tems lab, said in a news re­lease.

The prom­ise of bet­ter out­comes, in­clud­ing re­duc­tions in med­i­ca­tion er­rors, has trig­gered in­ter­est in phar­macy au­to­ma­tion ro­bots, such as In­tel­li­gent Hos­pi­tal Sys­tem’s RIVA and McKes­son Corp.’s Ro­bot-Rx. The ro­bots take on tasks such as break­ing down drugs into unit-of-use doses or ex­pi­ra­tion dat­ing. Like the de­liv­ery ro­bots, they, too, can re­duce la­bor costs.

Only hu­man er­rors

St. Mary Med­i­cal Cen­ter, a 165-hos­pi­tal in Long Beach, Calif., that is part of Dig­nity Health, bought the McKes­son ro­bot more than a decade ago. The only er­rors that can oc­cur now are hu­man er­rors, said Cather­ine Hirokawa, St. Mary Med­i­cal Cen­ter’s di­rec­tor of phar­macy.

Other sys­tems, such as Xenex’s room dis­in­fec­tion sys­tem, which can kill Clostrid­ium dif- fi­cile and me­thi­cillin-re­sis­tant Staphy­lo­coc­cus aureus, take on an­other chief con­cern of hos­pi­tals: in­fec­tions. Those sys­tems are also of­ten mar­keted as ro­bots, al­though they lack the au­to­ma­tion typ­i­cally as­so­ci­ated with the term.

Adop­tion of robotic au­to­ma­tion will likely hinge on whether hos­pi­tals are con­vinced the tech­nol­ogy mean­ing­fully ad­dresses their top con­cerns, such as med­i­ca­tion er­rors, in­fec­tions and ris­ing la­bor costs.

The ro­bots are “try­ing to over­ride some of the lapses that can oc­cur with hu­man er­rors and

mis­takes,” said Dr. Eric Topol, di­rec­tor of the Scripps Trans­la­tional Science In­sti­tute in San Diego. “If ro­bots can help in that re­gard, which re­mains to be fully proven—which could be fully pos­si­ble—that could be a good thing.”

The mar­ket for th­ese ro­bots is still fairly new. While aca­demic med­i­cal cen­ters and large health sys­tems have been early adopters of ro­bot tech­nol­ogy, smaller hos­pi­tals have been less likely to in­vest in ro­bots, which can, in some cases, cost more than $1 mil­lion.

“More than half of U.S. hos­pi­tals have 150 beds or less,” Frost and Sul­li­van’s Whe­lan said. “I guar­an­tee they don’t have a lot of ro­bots in those hos­pi­tals.”

Some ro­bot man­u­fac­tur­ers, though, are start­ing to re­port the new tech­nolo­gies are mak­ing their way into some of those hos­pi­tals.

About 800 hos­pi­tals in the U.S. are us­ing telemedicine sys­tems, in­clud­ing two ro­bots, that have been de­vel­oped by InTouch Health, a Santa Bar­bara, Calif.-based telemedicine de­vel­oper.

Those ro­bots are usu­ally in­cor­po­rated into tele­stroke or tele-ICU pro­grams and are of­ten used by smaller hos­pi­tals to con­nect pa­tients with spe­cial­ists. Dig­nity Health’s Mercy San Juan Med­i­cal Cen­ter, a 359-bed hos­pi­tal in

Carmichael, Calif., is one of about a dozen hos­pi­tals in the U.S. to ac­quire the RP-Vita since it en­tered the mar­ket this year.

The Food and Drug Ad­min­is­tra­tion cleared the RP-Vita’s au­ton­o­mous nav­i­ga­tion fea­ture in Jan­uary of this year, ac­cord­ing to a com­pany spokes­woman.

InTouch Health’s Chair­man and CEO Yu­lun Wang said he “would ex­pect the ma­jor­ity of hos­pi­tals to have this type of tech­nol­ogy” over the next three to five years. The adop­tion, though, re­quires hos­pi­tals to ad­dress the im­pact on its tra­di­tional work­flow and can raise ad­di­tional ques­tions about re­im­burse­ment and in­creased in­ter­ac­tion be­tween providers.

The health­care in­dus­try has been slow to move to­ward ro­bot­ics even as other in­dus­tries have moved for­ward with adop­tion. But, as more providers seek out new ways to re­duce costs and im­prove ef­fi­ciency, some au­to­ma­tion and telemedicine tools may help. “We’re still at such an early stage of fig­ur­ing things out,” Whe­lan said.

REED HUTCHIN­SON/UCLA

Prod­uct: RP-Vita and RP-7i

Made by: InTouch Health, Santa Bar­bara, Calif.

On the mar­ket: RP-7i, 2008; RP-Vita, 2013

What it does: The InTouch Health suite of ro­bots al­lows physi­cians to con­nect with pa­tients and other health­care providers as part of telemedicine pro­grams for stroke, in­ten­sive care, men­tal-health and pe­di­atric care. The RP-Vita, de­vel­oped in part­ner­ship with Roomba maker iRobot Corp. and cleared by the Food and Drug Ad­min­is­tra­tion in 2013, is the first to use au­ton­o­mous nav­i­ga­tion tech­nol­ogy.

Cost: $4,000 to $6,000 a month (RP-Vita), $2,000 to $5,000 (RP-7i)

Users in­clude: Mercy San Juan Med­i­cal Cen­ter, Carmichael, Calif.; Ohio State Univer­sity Wexner Med­i­cal Cen­ter, Colum­bus; Rea­gan UCLA Med­i­cal Cen­ter, Los An­ge­les

Prod­uct: Robotic IV Au­to­ma­tion (RIVA)

Made by: In­tel­li­gent Hos­pi­tal Sys­tems, Win­nipeg, Man­i­toba

On the mar­ket: 2008

What it does: The RIVA sys­tem pre­pares IV sy­ringes and bags. The tech­nol­ogy al­lows hos­pi­tal pharmacies to com­pound ster­ile in­jec­tions in an en­vi­ron­ment that meets the strict U.S. Phar­ma­copeia 797 stan­dards.

Cost: $1.35 mil­lion

Users in­clude: Chil­dren’s Hos­pi­tal of Or­ange County in Or­ange, Calif.; Pri­mary Chil­dren’s Med­i­cal Cen­ter, Salt Lake City; UCSF Med­i­cal Cen­ter, San Fran­cisco

Prod­uct: Un­named

Made by: GE Global Re­search, Niskayuna, N.Y.

On the mar­ket: In de­vel­op­ment

What it does: Sci­en­tists are en­gi­neer­ing a pro­to­type sys­tem that em­ploys ro­bot­ics, ra­dio fre­quency iden­ti­fi­ca­tion tech­nol­ogy and com­puter vi­sion to lo­cate, sort, de­liver and ster­il­ize sur­gi­cal tools.

Cost: Un­known

Users in­clude: GE plans to test the sys­tem at yet-to-be de­ter­mined VA hos­pi­tal in two years.

Prod­uct:

VGo Made by:

VGo Com­mu­ni­ca­tions, Nashua, N.H. On the mar­ket:

2011 What it does:

The VGo acts as a per­sonal avatar—or, as the com­pany says, “repli­cates a per­son in a dis­tant lo­ca­tion”—via the ro­bot’s cam­era, mi­cro­phones and video dis­play. The re­mote user can move the VGo around a fa­cil­ity. The ro­bot has ap­pli­ca­tions in telemedicine, and the com­pany also pitches it to hos­pi­tals and nurs­ing homes as a way for fam­ily mem­bers to vir­tu­ally visit their loved ones. Cost:

Starts at about $6,000, plus an an­nual ser­vice con­tract of about $1,200 Users in­clude:

Ore­gon Health & Science Univer­sity, Port­land; El Camino Hos­pi­tal, Moun­tain View, Calif.; In­ter­moun­tain Health­care, Salt Lake City; Casa Grande (Ariz.) Re­gional Med­i­cal Cen­ter; Rady Chil­dren’s Hos­pi­tal-San Diego

Prod­uct:

RoboCourier Made by:

Swiss­log Health­care So­lu­tions-North Amer­ica, Den­ver On the mar­ket:

2010 (the next gen­er­a­tion ver­sion of RoboCourier will be avail­able late sum­mer 2013) What it does:

The au­ton­o­mous mo­bile ro­bot fer­ries sup­plies with pay­loads weigh­ing up to 50 pounds. It can man­age au­to­matic doors and el­e­va­tors to nav­i­gate across units and floors. A se­cure con­tainer can safely trans­port con­trolled sub­stances and per­sonal health in­for­ma­tion. Cost:

$75,000 for the ba­sic unit. Pric­ing varies with ac­ces­sories (i.e., door, el­e­va­tor and mul­ti­ple ro­bot in­ter­faces). It’s also avail­able for lease or rental, with leases as low as $1,500 per month. Users in­clude:

Florida Hos­pi­tal Or­lando; Scotts­dale (Ariz.) Health­care Shea Med­i­cal Cen­ter in Scotts­dale; Me­mo­rial Sloan-Ket­ter­ing Can­cer Cen­ter in New York

AP PHOTO

Prod­uct: Paro

Made by: Paro Ro­bots U.S., Schaum­burg, Ill.

On the mar­ket: 2009 in the U.S., but has been used in Ja­pan and through­out Europe since 2003

What it does: The Paro is a ther­a­peu­tic ro­bot baby harp seal en­gi­neered to de­liver the ben­e­fits of an­i­mal ther­apy to pa­tients in hos­pi­tals and long-term-care fa­cil­i­ties where live an­i­mals can’t be used. It senses when some­one is hold­ing or stroking it and rec­og­nizes names, greet­ings and praise. It can learn to be­have in ways that its user en­joys—ac­cord­ing to the com­pany, the Paro “re­sponds as if it is alive.”

Cost: $6,000

Users in­clude: Alzheimer’s As­so­ci­a­tion; Wash­ing­ton D.C. VA Med­i­cal Cen­ter

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