Telemedicine has caught on over the past several years as an effective way to bring patients and specialists together via the magic of video conferencing. Unfortunately, most telemedicine setups require the patient to be in a room equipped with a computer, camera, microphone and monitor, so that specialists can remotely assess his or her condition. Could robots be the answer, providing both patient care and a view for specialists checking in from afar?
The William Lehman Injury Research Center (WLIRC) in Miami for a year has been experimenting with a budding type of telemedicine that uses a robot to let videoconferencing go mobile, allowing a specialist working from a remote location to see a patient (and for the patient to see the physician) from the moment he or she checks in for surgery through recovery.
A typical scenario would unfold as such: A patient is brought to the Ryder Trauma Center at the University of Miami's Jackson Memorial Hospital (where the WLIRC doctors work) by ambulance or helicopter. While the patient is en route, the trauma center checks to see if there is a specialist on site who can treat the patient's specific injuries. If there are none available and the specialist on call is unable to make it to Ryder in time, staff at the center wheel out the RP-7, made by InTouch Technologies, Inc., a Santa Barbara, Calif., medical robotics technology company. Once a specialist is located, he or she uses a laptop or PC to remotely connect via wireless broadband with the robot. After the connection is made, the specialist is able to control the robot's movement, possibly even meeting the patient at the door. From there, the specialist can autonomously drive the robot to operating rooms, intensive care units and patients' bedsides so he or she can monitor those patients as well as instruct nurses and residents.
View a slideshow of the RP-7 in action
The WLIRC doctors and physicians from the U.S. Army's Trauma Training Center (working at the Ryder Trauma Center) have been testing the RP-7, to see if the above scenario is realistic. The 200-pound, (90.7-kilogram) 67-inch- (1.7-meter-) tall metal medical man glides along on three spherical balls (rather than wheels) at a top speed of four miles (6.4 kilometers) per hour. As the Army's Web site points out, it "looks vaguely like one of the Daleks [robots] from Doctor Who with a view screen mounted on top."
Ryder is the only "level 1" trauma center in Miami–Dade County, which makes it difficult to find specialists to weigh in on all cases, particularly within the critical first 60 minutes after an injury, says Jeffrey Augenstein, WLIRC's director and the RP-7 project's principal investigator. "There is a shortage of trauma specialists in this country," he says. "You need to have a plan B to bring expertise from the outside to the point of care, where decisions often involve life and death."
Jackson Memorial Hospital sees more than 8,000 emergency patients per year, about half of them at Ryder. Approximately 30 percent of the general admissions result from gunshot wounds, stabbings or falls and the rest are the result of blunt trauma, vehicular accidents and various other causes. "We've got to find a new paradigm," Augenstein says, "where you can take the expertise of one person and cover many, many patients."
The WLIRC had been testing an RP-7 on loan from InTouch, but the doctors were recently given their own RP-7 with help from the Telemedicine and Advanced Technology Research Center (a unit within the U.S. Army Research and Materiel Command at Fort Detrick, Md., that is sponsoring a portion of the research); Qualcomm, Inc., (a San Diego, Calif., provider of wireless technology and services also sponsoring as well as providing technical support); and the American Telemedicine Association (a Washington, D.C., nonprofit organization managing the project). Although the WLIRC would not say how much the project costs, InTouch noted that an RP-7 costs about $250,000.
The RP-7 is a complex tower of technologies designed to be a doctor's proxy when he or she cannot be present. InTouch's panoramic "Virtually There" visualization system integrates digital cameras, microphones and other components to create two-way communication. The robot's Holonomic Drive System is the mechanism that lets the RP-7 roll from place to place while the SenseArray 360 System, a network of infrared proximity sensors and a bumper around the base of the platform, is designed to get the robot where it is going without bumping into walls or running over feet.
The WLIRC's previous RP-7 was tested by doctors connected wirelessly to the robot from within the Ryder Trauma Center, but they're now gearing up to test the ability of doctors to connect to the RP-7 from their homes, offices or anywhere else they can get a wireless signal. The RP-7 can be controlled via desktop PC or laptop at this time, but one of InTouch's goals for its product within the next two years is to make a robot model that is controllable via cell phone.
In the meantime, the doctors are trying to figure out the best way to work with their robotic colleague. Wireless connectivity via radio-frequency waves has always been taboo at hospitals, where staff fear that cell phones and Internet-connected laptops may interfere with sensitive medical equipment. Although some wireless devices do cause interference with some medical equipment, they are no more risky than two-way radios and other wireless communication devices already in use throughout hospitals, says Dan Spacht, regional sales director for InTouch Health.
Another concern is making sure that the robot does not step on anyone's toes—literally—during surgery. Whereas this may happen from time to time, Augenstein says, "If someone needs to do something in the space the robot is in, then the robot gets out of the way—either by being driven remotely or being pushed by one of the people in the room."