Telemedicine
Robo-doc makes hospital rounds

A new mobile robotic doctor is doing trial patient rounds at a handful of hospitals in the United States and United Kingdom. If successful it could change the face of doctor-patient consultations. Callan Emery reports.

Imagine you are a patient lying in bed in the Intensive Care Unit recovering from an operation and, in place of your physician, a silver metallic robot just over five feet tall rolls into your room. It moves to your bedside and asks how you feel. It listens to you and replies. It reads your medical chart and checks your vital signs on the bedside monitor. It then advises your nurse about adjusting your medication before spinning around and zooming out of your room and down the corridor to the next room where it checks on more of its patients. Sound like science fiction? It’s not.

A robot, named RP-6, (makes you think of R2D2 of Star Wars fame) is currently making rounds at a handful of hospitals in the United States and the United Kingdom where it is being tested.

RP-6, however, is not an entirely independent robot. It has not been designed to totally replace the doctor. Rather it is remotely controlled by a doctor based at another location and acts as his eyes and ears at the bedside when he cannot be present. It gives the doctor “remote presence” or “RP”.

“Our robots certainly would never replace all doctors on ward rounds, but they are a communication tool which allows a doctor to have direct contact with their patient if they are unable to get to them,” explained Parv Sains, project lead, Surgical Specialist Registrar and Research Fellow, who is overseeing the UK trial at St Mary’s Hospital’s General Surgery Ward and Accident & Emergency Department as well as at Imperial College’s Academic and Clinical Skills Unit. The integration of tele-technology into healthcare is a key focus of research for Professor Sir Ara Darzi, head of Imperial's Division of Surgery, Anaesthetics and Intensive Care and a practising surgeon at St Mary's. The RP-6 robots are the latest development in his pioneering work.

“This is a revolutionary concept which opens new avenues for telemedicine research and integrates technology with healthcare at a grass roots level, increasing the interface between patients, clinicians and teaching staff,” said Sir Ara Darzi.

Sains added: "If we look at a lot of the current strains on the NHS (British National Health Service) many senior doctors with skills and knowledge are required to be in several places at once. This is a solution in potentially providing their expertise from a remote location and may be a significant step for patient care.

“If a specialist is at a conference in California but their medical opinion is needed for a St Mary's patient or to deliver a lecture to junior doctors the RP-6 robot provides an instant and global link at any time of the day or night.”

The United States-based company, InTouch Health, which is pioneering the use of remote presence in healthcare with its RP-6 robotic system says this sophisticated technology has been developed to meet the challenge posed by an impending demographic crisis in acute care where there are too few doctors to manage the ever increasing patient load. The idea behind RP-6 is to extend the reach of the physician by enabling him to see more patients by cutting out time consuming travel.

In the US , the neurosurgery department at the University of California Los Angeles (UCLA) Medical Center was the first hospital to begin clinical trials of the RP-6 in the Intensive Care Unit (ICU). The robotic system has been installed in the ICU so neurosurgeons, working from their homes or offices, can provide additional monitoring of ICU patients. The ICU was chosen because in the US there is a nationwide shortage of intensivists -- the physicians who specialise in the care of critically ill patients -- and studies have shown that increased intensivist presence in ICU can decrease morbidity, mortality, length of stay and cost of care.

In the US there are fewer than 6,000 practicing intensivists and more than five million patients admitted to ICUs annually. Thus, only about 37% of ICU patients receive intensivist care.

So what is RP-6?

At bare basics, RP-6 is a broadband wireless video conferencing unit on wheels. It is driven by a joystick operated from a remote Control Station. The head of RP-6 is actually a monitor which shows a live video image of the physician's face. Above the monitor is mounted a video camera with 12X optical zoom. It is used for both visual communication and navigation by the doctor at the remote Control Station who watches the video images it records on the control station monitor. There is a speaker on the front torso of the robot and a separate microphone up near the camera. The robot the same one people use to connect their wireless laptops to the Internet.

According to InTouch the rechargeable battery lasts up to eight hours depending on usage.

The head (monitor and camera) has a pan range of around 170° and a tilt range of 45° up and 60° down.

RP-6 travels at a maximum speed of just more than three kilometres per hour in any direction and uses a holonomic drive system, which means it is capable of rotating while on the move in any direction.

“The Holonomic Drive System allows RP-6 to move under an operator's control in any direction across a flat surface. Unlike driving a car, RP-6 does not need to be parallel parked. RP-6 can simply slide sideways or in any direction required to navigate tight spots,” a spokesperson for InTouch Health told Middle East Health.

“The drive system is powered by two lead gel batteries which can be recharged by plugging the robot into a standard US wall plug (AC power). The batteries last up to 8 hours depending on usage.”

The patient sees, hears and interacts with the doctor via RP-6. The physician, seated at a remote Control Station, a computer console, also sees and hears the patient through a live video image projected on his monitor. By manipulating a joystick the physician drives the robot to the patient’s bedside, controls movements of RP-6’s head and zoom in to take a closer look at the patient and bedside monitors, all the while talking and listening to the patient.

Each robot costs around £50,000 (about US$90,000). InTouch says they are available globally and are being used in the US, UK, Japan, Italy and France.

“InTouch Health staff provide training for the use of the RP-6 robot. In general there is a 45 minute training session where a user becomes licensed to drive the robot,” the spokesperson for the company said.

Professor and chief of neurosurgery Dr Neil Martin, one of the leaders of the project at UCLA, said: “The RP-6 robot will increase doctor access for patients, their families and hospital staff, and UCLA is excited to test the newest addition to our intensive care team.

"We recognise that leveraging the healthcare expert's time offers the possibility of improved patient care, reduced length of stay and cost savings. UCLA has combined our in-house electronic medical information system, Global Care Quest, with the RP-6 remote presence system, and we are able to monitor and access our patients anytime from our homes and offices in a way not previously possible.”

According to a study by Johns Hopkins Hospital in the US (“Telerounding and Patient Satisfaction after Surgery, Kavoussi et al, JACS Oct 2004”), patient and family reaction to the robot has been very positive. Half the patients preferred a remote presence of their own doctor to a "real" visit by another physician. And 80% of the patients felt that the robot increased physician accessibility.

Asked about the success of the trials, InTouch told Middle East Health, that they have not encountered any significant problems and that, in fact, patient and physician response has been particularly positive.

“There have been numerous trials, studies, and publications on the robot over the past three years. Since our product is essentially a communications device (an alternative to using the phone) it does not require FDA [US Food and Drug Administration] approval therefore we do not have the kind of formal clinical trial process that a new drug or medical device would have. However, early users have first tested the system, performing a trial or a study, before adopting the technology for routine use.

“Additionally, we have several studies underway which are designed to further quantify the value of new interventions now possible through remote presence technology,” said the InTouch Health spokesperson.

These studies are looking at elements such as: the impact of Remote Presence rounding on patient time of discharge and length of stay; clinical equivalency between inperson and remote presence surgical rounds and; patient and family satisfaction in a children’s hospital setting.

“We expect studies to continue for a long time. As the technology advances new possibilities will be made available and more studies will be performed.”

Also in the US, the Detroit Medical Center (DMC) announced earlier this year that it plans to deploy 10 mobile robots throughout six of its hospitals. The robots will be installed in trauma, ICU, paediatrics, medical/surgical and general medicine.

Dr Yulun Wang, chairman and CEO of InTouch Health, summed it up succinctly saying the DMC’s introduction of this unprecedented number of robots “marks a new paradigm for the way healthcare will be delivered in the near future”