Just about every job description includes tasks involving repetition, monotony or drudgery. At healthcare organizations, such work often distracts employees from their main responsibilities and can detract from patient care. One solution: Let robots do more of the chores. Machines are even playing a bigger role in clinical decisionmaking.
It's the latest wave of automation and computerization, and the technologies are being installed at more hospitals nationwide in the name of efficiency and patient safety.
Magee-Women's Hospital in Pittsburgh is among the healthcare organizations that have joined the age of robotics. "Some (employees) like to push the medical record carts around," says Linda Antonelli, vice president of facilities and support services at Magee-Women's. However, she realizes it's certainly not the most efficient use of their time.
In an effort to keep more hospital staffers at the point of care by lessening some of the more mundane tasks, 205-bed Magee-Women's has started using a robot to transport supplies to various parts of the hospital. Meanwhile, in hospital laboratories and pharmacy departments, automated devices also are helping to improve quality by speeding up test results and impeccably dispensing drugs. Robots also are being employed to help improve doctor-patient communication. And computers keep getting smarter-and more robotlike-all the time.
Aiming to reduce errors
Error reduction-an imperative at all hospitals, especially following the landmark 1999 Institute of Medicine report on medical mistakes-is at the core of investment in these technologies. And it's certainly a reason for rising interest in artificial intelligence that is part of decision-support systems designed to aid physicians in treating illness and prescribing medications. The decision-support systems work in conjunction with computerized physician order-entry systems, which have so far been installed at only a small fraction of the nation's hospitals. About 10% of acute-care hospitals have CPOE, according to William Bria, chairman of the Association of Medical Directors of Information Systems. But another organization that tracks the systems, KLAS Enterprises, estimates that only about 4% of hospitals, excluding military and Veterans Health Administration facilities, have operating CPOE systems.
Despite the unimpressive numbers, Bria is a believer in the systems' potential to reduce errors. "There are a lot good products being developed that will be a good extension on what's already out there," he says.
However, he also says many products have been rushed to the market without sufficient research and development, noting that the current systems have experienced limited success. Bria's claim is supported by a article published earlier this month in the Journal of the American Medical Association that says CPOE can actually increase the number of medication errors (March 14, p. 10). And the systems aren't cheap. Bria says the most complex CPOE systems for large academic hospitals can cost as much as $40 million.
One reason Bria isn't enamored with current systems is because they are equipped with what he calls "dumb alerts," which warn physicians when they've nearly completed a prescription order. "We need alerts before decisions are made," he says.
Joel Diamond, a private family-practice physician who works at 185-bed UPMC St. Margaret hospital in Pittsburgh, helped the hospital select its CPOE system. Diamond doesn't have supporting data on the system-in use at St. Margaret since September 2004-but he says there's no doubt care has improved. One way it has helped, Diamond says, is by reducing the number of tasks physicians forget to do, such as placing orders for tests or pharmaceuticals.
Diamond admits that physicians at St. Margaret have been ignoring some alerts-the doctors contend some of the prompts are often false alarms-but he says improved compliance is just a matter of fine-tuning the system. "This technology is advancing like cell phone technology," he says. "The cell phone you have today won't be the same cell phone you have in the future."
He adds that he wasn't too surprised with the JAMA findings because users always make errors when dealing with a new technology.
Delivering results
Also hard at work in more of the nation's hospitals are courier robots, as well as robotic communication devices that facilitate doctor-patient interaction. Courier robots are newer technologies, and it's difficult to pinpoint how much hospitals are investing in them overall. At least three companies-Aethon; Pyxis Corp., a subsidiary of Cardinal Health; and California Computer Research-offer the machines.
The Aethon product, called a Tug, is being used in about six hospitals including Magee-Women's, which has been a testing site for the robot since 2003. The company charges about $1,250 per month for the Tug, but an Aethon cost analysis shows that hospitals on average would pay a person $92.50 per shift to do what a Tug can do for about $18.86.
Robert Brennan, director of materials management at Magee-Women's, says the Tug has been able to help reduce the hospital's overtime costs but it's too early to come up with a firm figure. The hospital uses two Tugs, one with a locked cabinet for transporting pharmaceuticals and another with an attached cart that transports medical equipment, usually from the supply room to the surgical suite.
The machine is about a foot long and about half a foot high and attaches to the bottom of a specially designed cart. It has a built-in sensor, so if someone or something does get in its way, it will stop before a collision occurs. The Tug is also equipped with a camera, which beams images to Aethon's headquarters, where operators monitor the Tugs round the clock. Workers can direct the robots from Aethon's office or the hospital.
A map of the hospital is programmed into the Tug. It usually works like this: When a delivery request is made, a supply-room worker will load the cart and then select the Tug's destination through a touch screen. On the screen, workers can track its progress. As the machine moves about the hospital, it triggers sensors that open doors and summon elevators. As it approaches an elevator, the Tug will announce, "Calling elevator."
Speakers are located inside the rooms where the Tug makes deliveries. Once the robot reaches its destination it sends a message-which is audible through the speakers-alerting workers to unload the cart. After unloading, the Tug then returns to the supply room, where it can be restocked or insert itself into a charger.
Now, many in the hospital would like to have a Tug in their departments-indeed, a hospital lawyer jokes that she wants a paralegal Tug-but Antonelli says departments can add them only if their purchase is budget-neutral.
Cardinal Health purchased HelpMate Robotics, which developed a courier robot in 1999. The HelpMate, which stands 4 feet 6 inches tall, can weigh up to 600 pounds and has a 24-inch-by-26-inch storage capacity. The company has deployed about 108 robots at 78 healthcare facilities, and like the Tug they're used to make deliveries of various supplies and equipment. It differs from the Tug because the entire robot is one unit, while the Tug attaches itself to a cart. Including installation, the HelpMate goes for about $150,000-it can also be rented-and the company says a hospital can see a return on investment in 18 to 24 months.
Unlike the Tug or HelpMate, California Computer Research's RoboCart runs along a fixed path. The RoboCart is mostly used to transport specimens from one end of a clinical lab to the other. The model is being used in about 10 hospitals in the U.S. and in 15 abroad, according to its manufacturer. At a RoboStation, robotic arms attached to a table load and unload the RoboCart. The RoboCart travels along a path marked by special tape, and technicians can operate it with a hand-held device, according to its manufacturer. The RoboCart costs about $1,375 per month to rent or about $25,000 for purchase and installation, according to the company.
Denise Geiger, laboratory director at 248-bed John T. Mather Memorial Hospital in Port Jefferson, N.Y., thought about adding a courier robot to address some of the workforce shortage problems at her hospital, but instead she decided to purchase a lab automation system. The hospital has witnessed a 100% increase in emergency room visits since 1996-attributed to a growing and aging population in its market-and now receives about 40,000 visits per year.
Double the volume
Despite the accompanying increase in lab workload, the hospital hasn't had to add staff, in part thanks to increased automation. "We have the same number of (full-time equivalent staff) and double the volume," Geiger says.
About four years ago, the hospital bought a lab automation system from Beckman Coulter. These systems, which move blood samples like bottles through a brewery, are currently in about 200 hospitals, but that number is expected to reach about 300 hospitals by year-end, according to Diagnostic Testing & Technology Report, an industry newsletter.
At Geiger's hospital, about 60 tests can be performed through the system, and it takes about 45 to 60 minutes for completion. "Before it was unpredictable" when a test might be completed, she says. The results have improved patient flow, which leads to fewer unnecessary admissions and savings of close to $2 million per year, according to the hospital.
The process usually starts in the emergency room. ER staff members label a lab specimen with a bar code that indicates which patient the sample is from and what tests need to be performed. The samples are then put on a conveyor belt that leads into the lab. From there, the sample can be tested and placed into a refrigerated storage bin, all without a lab technician handling it. This process eliminated about 14 steps for technicians, and it's helped the hospital realize a 20% decrease in possible errors, Geiger says.
McKesson Corp.'s Robot-Rx automates a hospital's pharmacy department by using a roughly 7-foot robot that moves along a fixed path in the centralized drug distribution system. Bar-coded medications are stored on shelves and orders are sent to Robot-Rx electronically.
The system pulls the medications off the shelves, labels the proper patients' information and dosage with a bar code and drops the medication into a bin. From there, nurses use a hand-held device to scan the bar code and ensure it's the proper medication before administering it.
Children's Hospital Central California, a 246-bed facility in Madera, has been using Robot-Rx for three years and the $1 million system has helped lower medication error rates to less than 1%, says spokeswoman Micheline Golden. Last fall David Brailer, HHS' health information technology czar, saw the Robot-Rx at work at 1,285-bed UPMC Presbyterian in Pittsburgh, which has been using the system since 2001.
The robot is in
To support another basic task at hospitals-communication between patients and caregivers-InTouch Health has developed a 5-foot-6-inch mobile robot that might stir up images of Number 5 from the movie "Short Circuit." Unlike Number 5, this robot must be operated by a user.
The robot is designed for doctors to communicate with patients, even when doctors are not in the same building, a process that's been dubbed "telerounding." The University of California-Davis Medical Center took part in a six-month study that examined whether telerounding is as safe as performing traditional rounds. "It's basically a remote teleconferencing system," says Charles Casey, a hospital spokesman. Hospitals need a wireless Internet connection to use the robot.
Lars Ellison, a UC-Davis urologist, used the robot, which the hospital nicknamed Rudy, in the study that recently concluded but doesn't yet have the results. When using Rudy, Ellison could sit in his office, located about three blocks from the hospital, and check on patients. A camera pointed at the doctor sends his image to the screen that serves as Rudy's head. Ellison speaks into a microphone and steers Rudy with a joystick.
The hospital leased the robot for about $3,000 per month, and UC-Davis is considering using Rudy as a teaching tool and maybe even a translator. The hospital hasn't identified how Rudy can save money, but Casey says the benefits will be in improved patient satisfaction.
The robot is good for doctors such as Ellison, who work at more than one hospital. It's often more reassuring for patients to speak with a doctor who has been treating them, and the camera on Rudy lets him zoom in close, enabling the doctor to examine an incision.
"There's a chuckle factor involved," Casey says. He adds: "On its surface it's strange, but everyone has liked it."
