Thursday
March 9, 2006
In the opening scene of the TV show ER last Nov. 3, an attending physician who had been home sick comes back to work via a robot.
His unexpected voice interrupts a meeting of ER nurses. Then a diminutive machine rolls into view. On its “head” (a video screen) is the doctor’s smiling face.
“This device was designed to offer remote surgical consults,” the doctor/robot explains. “I thought I would give it a test drive.” Unimpressed, everyone walks away, while the device beseeches, “Nurses, nurses!”
In real life, the remote presence robot, or RP-6, has generated substantially more enthusiasm at hospitals such as the 383-bed Shawnee Mission Medical Center, Merriam, Kan., near Kansas City.
Sherry Lee, R.N., a charge nurse for the med-surg unit at the hospital, says her patients immediately took to visits from doctors wheeling into their rooms in the form of robots. They had seen the device on the local news channel, and “to have it in the room with them was exciting,” she says.
Shawnee Mission has been using four RP-6 robots for only a matter of months, but even after the initial hoopla fades, hospital officials expect they will continue to please patients while saving money and improving quality of care.
Solid benefits, they say, include speeding up discharges, allowing more frequent doctor-patient interaction, improving outcomes in the intensive care unit and making emergency calls more convenient for specialists.
Lee works with Joseph B. Petelin, M.D., a general surgeon on staff who originally asked management for the robots. She explains that Petelin has an extremely busy schedule that makes it hard to see patients in the hospital and still maintain an office practice. With the robot, he can make an extra set of hospital rounds from his office. Before the RP-6 arrives, Lee steps into the patients’ rooms to let them know and move furniture, then stays to assist. With the doctor physically absent, Lee says, nurses take on more duties, such as some physical examinations.
Lee says the robot also comes in handy when a patient’s condition changes and the doctor must be contacted to make a decision about care. The robot brings the doctor much closer to the situation, she says. “Until physicians actually interact with a patient,” Lee explains, “they may not know what needs to be done.”
And compare that with the alternative. When the phone is the only option for communicating, sometimes “you can report on a patient until you’re blue in the face” and doctors still may not feel they have enough information, Lee says.
Yulun Wang, the CEO of InTouch Health, Goleta, Calif., maker of the RP-6, says the new robot “allows busy doctors to be in two places at once.” With doctors under increasing demand, this new tool helps leverage hospital resources.
Two years after the robot’s introduction, Wang reports that almost 60 are in use at more than 24 hospitals nationwide.
The 5-foot-4-inch, 220-pound device has a two-way audio/video system. The camera, mounted on the video screen, can tilt, pivot and zoom in. RP-6 can move forward, backward or sideways, or turn in any direction. The doctor steers it with a joystick at a remote computerized station. Lee says experienced video game players may find it easier to learn the ropes; it was a little difficult for her because, “I’m not a Game Boy kind of person.”
The robot also can display medical data such as X-rays, and the doctor can even draw on the video image for a patient.
In addition, Shawnee Mission is testing a robot with a built-in stethoscope that has to be set up by an accompanying nurse.
Each robot costs between $100,000 and $150,000 or can be leased for about $3,000 a month. Wang says the sales price includes updates of existing software functionalities and an initial on-site visit by company reps to plug the device into a hospital’s wireless network, which is necessary for RP-6 to work.
Shawnee Mission reports the new robot is used virtually everywhere in the institution. Hospital President and CEO Samuel H. Turner says: “The RP-6 robot is one of only a few pieces of equipment available today that is useful to almost every physician in our hospital, regardless of specialty.”
Using money from its fund-raising arm, the Foundation for Shawnee Mission Medical Center, the hospital bought its first RP-6 in March 2005 for use by Petelin, then three more in June for other doctors. Key areas where the robot is used include:
“To move patients through the hospital, that’s revenue,” Lee says. For example, a patient may be ready to go home at 7:30 a.m., but the doctor won’t arrive until the afternoon—too late in the day to make the room ready for another patient.
Studies on the robot are beginning to show substantial savings by speeding up discharges. In the Jan. 12, 2005, issue of The Journal of the American Medical Association, Michael Fabrizio, M.D., a Norfolk, Va., urologist, reported that robots at 569-bed Sentara Norfolk General Hospital reduced length-of-stay for his patients by 0.17 of a day, translating into $750,000 in savings a year. Wang says subsequent studies found even greater cuts in length of stay for Fabrizio’s group practice.
Shawnee Mission reports that the robot also has been used by interpreters who cannot be on-site, and Lee says the hospital is considering using the robots to provide prerecorded discharge instructions from a patient’s own physician.
Physicians at 2,000-bed Detroit Medical Center, where the robot also has been used, have discussed using RP-6 to update patients’ families in the waiting room.
When Shawnee Mission executives first learned of the robot, they weren’t sure how patients would react to a machine replacing their flesh-and-blood doctors. “I was a little skeptical in the beginning,” CEO Turner concedes. But patients quickly embraced the new contraptions. Larry D’Angelo, a patient of Petelin’s, told the hospital that he would rather see his own doctor via the robot than an unfamiliar physician in person.
“I felt more comfortable that my physician—who was aware of my condition and had been with me each step of the way—was in charge of every aspect of my care,” he says.
The robot could reduce the need for hospitalists who do not know the patient. A study at 848-bed Johns Hopkins Hospital & Health System, Baltimore, found that half of patients seen by their own doctor via the RP-6 robot preferred the robot over an actual visit by another physician. (Wang says unpublished follow-up surveys at Johns Hopkins show a higher percentage now.) In addition, 80 percent of the Hopkins patients say the robot increased physician accessibility.
On the other hand, doctors at 595-bed UCLA Medical Center, Los Angeles, where the robot also is being used, report that patients are less thrilled when the doctor at the other end of the robot is also a stranger or cannot speak a patient’s native language.
Various claims have been made about impact on quality of care. Some think increased doctor-patient communication could improve quality, while others fear that possible communication mix-ups using a robot could negatively impact quality.
A study by Fabrizio’s group in Virginia found the robots had little impact on quality. Patients seen by their doctors as robots had similar outcomes as those seen by their doctors in person.
Turner also initially doubted that the robots would catch on among doctors.
“I was unsure if our physicians would use the system on a regular basis after the initial excitement wore off,” he says.
So far, the hospital reports, 10 to 15 doctors have signed up and use of the four devices remains high.
Though users are only a small fraction of the medical staff, hospital officials are encouraged, considering that each doctor must put down $1,000 to buy the station that controls the robot.
An early survey at Shawnee Mission found that overwhelming majorities of users think the robots enhance care of patients, improve efficiency and accelerate discharges.
Lee reports that doctors who still hold back seem to find the new technology a little frightening, but the fears can melt away with a simple tryout. She reports that one wary physician gained access to the robot when his partner bought a control station and now is a regular user.
Wang predicts that once RP-6 achieves a critical mass of users, demand will quickly surge in the same way it did with computers and cell phones.
He says the robot will become “a new form of communication.”
Leigh Page is a freelance writer based in Oak Park, Ill.