Robotic Telepresence
An emerging application of robotic technology which allows medical personnel to provide non-invasive care to distant patients is described here. Another name for this field includes Remote Presence and can be considered a branch of medical robotics.
Contents
Disambiguation
These technologies differ from surgical robotics used locally as an adjunct to perform various procedures such as cardiac or urologic surgery. This application is also different from more traditional telemedicine where the patient is brought to the access point for provider interaction.
Features
The machine can have the ability to be maneuvered remotely by the local provider within the distant institution. Alternatively, the device can be moved to different locations manually by someone located at the remote location. It allows the provider to interact with the patient by “seeing” with a camera and “hearing” with microphone and speakers. The communication in two-way and in real time. No more than a standard broadband internet connection is required on both ends. The machine can allow for specialized input such as a stethoscope or an ultrasound probe. The optics and zoom visual function allow detailed visual interrogation of the patient or other pertinent data such as electrocardiograms or radiologic images.
Some of the uses for this technology include:
Critical Care Coverage
There is a significant shortage of trained Intensivist providers int he critical care units nationwide. These manpower issues may be years or decades to be fully addressed. Telepresence allows the in room consultation with an intensive care specialist in remote locations.
Stroke evaluation
Thrombolytic therapy for an acute central nervous system ischemic event is critically time dependent. A window of only a few hours exists from the onset of symptoms to the time when medication to dissolve blood clots becomes ineffective. However, the use of this medication in patients who are not bonafide candidates for such therapy can result in serious iatrogenic consequences. Robotic telepresence allows for urgent consultation with a neurologist during this critical time period in places and situations where such expertise might not otherwise be immediately available. An example of such a robot in action for this problem may be found on this Youtube video: http://www.youtube.com/watch?v=Io5wZ17W0cQ
Specialty Outreach
Specialty consultation in remote locations where the access to such providers is limited or not existent can be facilitated by telepresence. The ability to see the patient remotely along with performing a robust physical examination (short of palpation/touch) makes this approach clinically meaningful and reimbursable by third party payors.
Training and Mentoring
The use of robotic telepresence as a mentoring tool allows a local provider to glean from the experience of a specialist in his or her field of practice. Examples such as community surgeons being taught recent or improved techniques are possible using such remote presence. Training of ancillary staff with current best practices or new protocols can be facilitated with this technology.
Facility Bed Management
Community hospitals are under enormous economic pressures. Optimizing the bed capacity regarding length of stay and transferring patients when appropriate but keeping them at the local facility if reasonable can make large differences in the smaller hospital’s bottom line. The appropriate minimization of hospital length of stay for selected patients can be enhance with the use of remote presence. Issues regarding the necessity of transfer can be further elucidated with the help of a tertiary care specialist helping to determine need.
References
Vespa, PM, et al Intensive care unit robotic telepresence facilitates rapid physician response to unstable patients and decreased cost in neurointensive care Surgical Neurology 67 (2007) 331–337
Gandsas, A, et al Robotic Telepresence: Profit Analysis in Reducing Length of Stay after Laparoscopic Gastric Bypass j am coll surg.2007(1) 72-80
Agarwal, R et al The RoboConsultant: Telementoring and Remote Presence in the Operating Room During Minimally Invasive Urologic Surgeries Using a Novel Mobile Robotic Interface UROLOGY 70: 970–974, 2007.
Lai, F.,Stroke networks based on robotic telepresence Journal of Telemedicine and Telecare 2009 (15,3) 135-137
Lai, F., Robotic Telestroke Program: Transforming Stroke Care Supplement to Endovascular Today, November 2008 8-11
Submitted by Kevin Kavanaugh
