Monday, July 16, 2007

Remote Presence Robotic System

Today, we look to Yahoo News for an interesting story on robot use for hospital patients recovering from bariatric or weight loss surgery.

"Has it come to this? Robots standing in for doctors at the hospital patients' bedside?
Not exactly, but some doctors have found a way to use a videoconferencing robot to check on patients while they're miles from the hospital. One is at Baltimore's Sinai Hospital. Outfitted with cameras, a screen and microphone, the joystick-controlled robot is guided into the rooms of Dr. Alex Gandsas' patients where he speaks to them as if he were right there. "The system allows you to be anywhere in the hospital from anywhere in the world," said the surgeon, who specializes in weight-loss surgery.

Besides his normal morning and afternoon in-person rounds, Gandsas uses the $150,000 robot to visit patients at night or when problems arise. The robot can circle the bed and adjust the position of its two cameras, giving "the perception from the patient's standpoint that the doctor is there," the surgeon said. "They love it. They'd rather see me through the robot," he said of his patients' reaction to the machine.

Gandsas presented the idea to hospital administrators as a method to more closely monitor patients following weight-loss surgery. Gandsas, an unpaid member of an advisory board for the robot's manufacturer who has stock options in the company, added that since its introduction, the length of stay has been shorter for the patients visited by the robot. A chart-review study of 376 of the doctor's patients found that the 92 patients who had additional robotic visits had shorter hospital stays. Gandsas' study appears in the July issue of the Journal of the American College of Surgeons.

Nicknamed Bari for the bariatric surgery Gandsas practices, the RP-7 Remote Presence Robotic System by InTouch Technologies is one of a number of robotic devices finding their way into the medical world. Across town at Johns Hopkins, for example, a similar robot is used to teleconference with a translator for doctors who don't speak their patient's language. Robotic devices have also been used to guide stroke patients through therapy and help them play video games."

Let's try to get behind the information presented in the article. Our aim is to better understand such issues as patient privacy, consumer acceptance of "virtual services", and cost versus benefit assessments.
1. According to a January 2007 report published by the Agency for Healthcare Research and Quality, the total number of bariatric surgeries in the US increased nine-fold from 1998 to 2004. Across all age groups, the fastest growth in bariatric surgery occurred among adults aged 55-64. And, in 2004, 78% of these surgeries were covered by private insurance, with Medicare and Medicaid covering roughly 7% and 5% respectively.
2. The robot stands 5 1/2 feet tall and has a computer screen where a person's head would be. The screen broadcasts the face of a physician, who controls the device remotely. In addition to a screen, the device includes cameras and a microphone. According to the article, the device cost $150,000. About 120 of the robots are being used in hospitals worldwide.
3. The device was purchased by the Sinai Hospital in Baltimore. Patients using the device were discharged sooner than patients who didn't, yielding the hospital more than $200,000 in new admissions and saving some $14,000 in room and board costs, according to an article in the July 16, 2007 edition of Modern Healthcare.
4. The patients were hospital based, and not home based, and bore no added cost for the service. Apparently, they had positive reactions to the device, and there was no indication that privacy infringement was an issue. I'd like to see further studies of in-patient reactions, and also, am curious whether nursing home or home bound patients would have the same positive reactions.
5. The attending physician made normal morning and afternoon rounds, and used the device at night, or when problems arose and he was not immediately available. Thus, there was a mix of high touch and high tech.
6. The attending physician indicated that he was an unpaid advisory board member of the manufacturer and had stock options in the company.
7. A study by the attending physician in a peer reviewed journal cited a decrease in patient stay for patients who experienced robotic visits. If the results are replicated elsewhere, significant system cost savings could be achieved.
8. The robot was being used at Johns Hopkins Hospital to overcome language barriers with patients and for guiding stroke patients through therapy. It's hard to imagine there couldn't be a more cost effective way to deal with the former use, and the latter use would suggest a broader application to other patients with chronic conditions.
9. For the time being, the device would appear to be available for hospital inpatients only, less available to nursing home residents, and not a financially feasible alternative for the home bound.

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