Anyone who has visited a healthcare Web site, watched a medical news segment or even picked up a copy of the New York Times in the last month or two has undoubtedly come across a story involving a hospital robot system. Health systems across the country are reaping the benefits of these high-tech devices, which can manage mundane tasks with limited or no supervision and, as a result, free up valuable clinician time.
Forget any of the preconceived notions about robots working in a hospital and let the Star Wars jokes go; robot systems are being leveraged for functions like asset utilization, surgical assistance, transporting of laboratory specimens and supplies, and telemedicine. And what's more, they're becoming more affordable, offering smaller hospitals a chance to compete without breaking the bank. Last but certainly not least, in many facilities, robot systems are being integrated with EMR systems, RFID asset tracking, resource management systems, and pharmacy distributors.
Asset utilization
For Dave Dillehunt, CIO at FirstHealth Moore Regional Hospital, a 385-bed acute care facility in Pinehurst, N.C., the decision to adopt a robot system had less to do with wowing patients and competing with neighboring health systems, and more to do with revamping the hospital's asset utilization process.
Moore Regional implemented the combined Homer/Tug system from Pittsburgh-based Aethon in the summer of 2007. Tug is an automated courier system for the delivery and tracking of supplies, while Homer is an RFID-based asset management solution that locates and recovers hospital equipment. Dillehunt says the two systems working in tandem were able to improve materials utilization by incorporating RFID into the delivery process.
Prior to the implementation, the pharmacy staff at Moore Regional was having trouble allocating medications to the various floors and nursing stations “in a timely, effective and consistent manner,” according to Dillehunt. The Tug was able to address the problem, and soon after its deployment, the IT staff started examining other ways it could leverage the technology. As Dillehunt was considering the possibility of using RFID for asset tracking, Doug Keeney, director of materials management at the facility, was exploring the feasibility of using Tug to replenish materials from the warehouse to the floors and nursing units.
They found the robot system was able to perform both tasks simultaneously.
“At that point,” Dillehunt says, “everything really just came together. We were able to right that train and solve an asset tracking-RFID issue at the same time.”
With the added functionality, the road was now paved for Tug to expand its duties to include the pickup and delivery of lab specimens, a task that has yielded significant time savings for the staff, Dillehunt says.
“The perception within our organization was that in terms of lab specimens, we have volunteers in the hospital that really do all the pick-up of that and carry specimens down to the lab,” says Dillehunt. “The reality, though, was that we actually had high-paid RNs doing that a majority of the time. Having a Tug available for that frees up a significant amount of nursing time.”
And because the robot uses its own broadcasting and receiving capabilities, it keeps the majority of traffic off the data network, says Dillehunt. After the data is collected, a burst is sent through the network to the asset tracking system, and the network bandwidth isn't completely occupied.
“I didn't have to put in a separate RFID network or give up my bandwidth, and those two things, from a CIO standpoint, are huge,” he says.
Because the robots are being used as delivery or retrieval systems, and none of the data needs to be documented in an EMR, there isn't a need to interface with the EMR system, Dillehunt says. It does, however, interface directly with the hospital's asset tracking system. When the Tugs are making rounds and reading the asset tags, the information is being fed into the system so, at any time, a clinician can access the asset's status online.
Having that Web-based capability has enabled Moore Regional to realize lower costs and increased overall efficiencies, says Dillehunt, who justifies the cost of the technology with the marked reduction that the hospital has seen in the purchasing of IV pumps.
“Without asset tracking, most facilities probably have anywhere from 30-40 percent more devices than they really need,” Dillehunt says.
In terms of improving the workforce, Tugs can work three shifts a day, 365 days a year, and for a significantly lower price than staff employees, Dillehunt says. While robots could never replace clinicians or other healthcare professionals in terms of the care they deliver, he says of the robots, “There is definitely a place for them” in the health system.
And that place — at least at Moore Regional — is constantly expanding. In the near future, he anticipates the Tugs will be further leveraged to pick up and deliver meals and linens in patient rooms.
Surgical assistance
While the Tug actually resembles a robot (or at least what robots looked like on The Jetsons), the da Vinci Surgical System, a robotic-assisted surgery system from Sunnyvale, Calif.-based Intuitive Surgical, looks more like the monitors that referees use to review plays during NFL games. But the purpose it serves is far more important, as it combines 3D visualization with precision and control in an interface with surgical capabilities.
It is a system that Steve Garske, vice president and CIO at 286-bed Children's Hospital Los Angeles, predicts will make a significant impact on the hospital's staff, both in terms of assistance for surgeons and notoriety for the facility.
“We can't wait to get it in the door,” says Garske of the platform, which will operate on the facility's 802.11b wireless network. “Our doctors are extremely excited and, on the IS side, it's going to give us a lot of visibility.”
The appeal of assistive surgery robots, according to John Hummel, CTO of Plano, Texas-based Perot Systems Corporation, is easy to see.
“If we can get smaller devices into the patient with less intrusion, then it's better for them in the long-term,” says Hummel. “The da Vinci robots are designed to be a more finite control apparatus for the doctors,” and therefore, they provide a level of precision that can reduce recovery times and lead to improved clinical outcomes.
Children's is hoping to reap those benefits as quickly as possible. According to Garske, da Vinci is expected to be up and running in the minimally invasive surgical (MIS) suite this summer. Because the platform is “fairly plug-and-play,” Garske says he expects the deployment to be a smooth one, particularly since the hospital is in the process of installing a new network that he hopes will facilitate future implementations.
Another important component with robot systems is the ability to integrate with the existing hospital information system. Children's has implemented the Millennium suite from Kansas City, Mo.-based Cerner Corporation, which includes EMR, CPOE, pharmacy, decision support and HIM.
“Right now, we're determining what we want interfaced,” says Garske. “Within the robot system, the vitals and everything else will have to be run off the monitoring devices. But those need to be interfaced into our EMR and then displayed on multiple screens in different places, so all those connection points need to be made and the interfaces built, and we're working on that.”
After the system has been successfully deployed in the MIS suite, Garske expects that it will be expanded into other departments, depending on the needs and wants of surgeons and chiefs.
According to Hummel, just having this type of system deployed is a big selling point with surgeons; extending it to other areas of the hospital is icing on the cake.
“Hospitals say they're losing revenue because they can't attract the surgeons to come into their shop because they don't have the right technology,” he says. “With these tools, they can compete for patients with the bigger fish. It becomes sort of a defensive medical business tool.”
Preventing pharmacy errors
There are other ways in which robot systems can aid in defensive strategies.
While some health systems are adopting robots for the purposes of improving asset tracking utilization or the accuracy of surgical procedures, Loyola University Hospital (Maywood, Ill.) implemented the PillPick automated drug management system from Switzerland-based Swisslog to help cut down on errors. A 570-bed teaching hospital, Loyola is part of the Loyola University Health System, based in the western suburbs of Chicago.
“The PillPick has been tested with all kinds of scenarios to make sure it doesn't pick the wrong device, the wrong pharmacy or the wrong drug,” says Loyola CIO Art Krumrey. PillPick is a dose packaging, storage and dispensing system that utilizes bar code technology to improve the pharmacy's productivity and enhance patient safety.
The key, he says, is that it adds an additional layer to the reporting process, which can help to prevent mistakes.
The pharmacy application at Loyola is built into the health information system from Epic Systems Corporation (Verona, Wis.). When a physician places an order in Epic, the robot system fulfills it, sending the patient a pre-packaged first dose in a bar-coded envelope. “It's all done electronically,” says Krumrey, which has “minimized, or in some cases, eliminated the opportunity for errors because there's a direct interface from the pharmacy order in Epic to the robot.”
Although the most comprehensive reporting of a patient is done in the Epic system, according to Krumrey, the robot itself develops reports focused primarily on drug replenishment, as it is also integrated with the enterprise resource management system from Lawson Software (St. Paul, Minn.).
“Lawson does our inventory control purchasing, so if the robot detects that it's running low on something, it places a replenishment report automatically into Lawson, which can then replenish the order,” he says, adding that PillPick also has an interface with Cardinal Health (Dublin, Ohio), the hospital's pharmacy distributor.
Through these interfaces — particularly Epic, which is the core system — PillPick is able to help reduce errors by performing functions like checking a medication's weight to make sure that it is the correct pill type and dosage. However, Krumrey is quick to add that it is able to achieve this because it works with clinicians and isn't a replacement for staff workers.
“We're adding a check to this process, we're not automating the checking,” says Krumrey. “The nurse still has the responsibility of fully checking the medication, but now the distribution of the right medication should be much more reliable.”
The next step at Loyola, says Krumrey, is to implement bar code administration, a process that he hopes will further improve the medication distribution system. Krumrey also plans to use robots to fill floor stock.
When it comes to robot systems in hospitals, the possibilities are seemingly endless.
Some facilities are even utilizing robots to make rounds. One example is the RP-7 Remote Presence System from InTouch Health (Santa Barbara, Calif.), a traveling unit that relays information from the physician via a video screen and enables two-way conversations between the patient and physician. With the RP-7, clinicians can control the robot over the Internet through a computer outfitted with a joystick and a microphone. According to a report from Falls Church, Va.-based CSC, entitled, “Extreme Data: Rethinking the “I” in IT,” the system enables clinicians to obtain close views of surgical incisions and listen for symptoms such as weak breath.
Hummel believes that systems utilizing telemedicine technologies will become more commonplace in the future, and points out that some hospitals in Norway have begun videotaping procedures by “using robotics in their surgical centers as a way to document their healthcare.”
He also expects to see increased adoption in robot systems that assist in surgery, particularly in skilled nursing facilities and hospice centers, adding, “It's a tool that's going to be part of the future for healthcare.”
