100 devices, 60 hospitals: More often, doctors visit bedside via robot
■ The machines cut response times for intensivists and surgeons, allowing them to see patients more quickly.
From miles away, Richard D. Fessler, MD, has listened to a patient's thumping heartbeat.
The Michigan neurosurgeon also has pulled over his car, hurried into Starbucks and hooked up his computer to see a patient at a distant hospital.
Both encounters came by way of a robot.
Dr. Fessler is among a growing number of physicians using robots to connect with patients. The devices may look like fancy kin to vacuum cleaners, but their high-tech circuitry lets a stethoscope be attached so a doctor can hear someone's heart from a remote location. With a laptop, joystick and wireless connection, doctors log on to the robot from coffee shops, home or elsewhere and roll it into a hospital room to check on a patient.
"It saves me an hour or so going back to the hospital, and it allows me to be there immediately," said Dr. Fessler, medical director of the Michigan Stroke Network, a group of hospitals that provides stroke care across the state. "It's actually a lifesaver, in a way, for me."
And for patients. Besides making rounds, the machines are dispatched to emergency departments and intensive care units. Specialists in medical centers lend expertise through robots placed in hospitals that have no specialists on hand.
"I don't think this robot can be viewed as a replacement for a human being. However, this may be one more tool we have to extend and improve health care delivery to our patients," said Li-Ming Su, MD, director of laparoscopic and robotic urologic surgery at the Brady Urological Institute at The Johns Hopkins Hospital in Baltimore.
During the past decade, physician use of robotics in surgery has become more common. But for these remote-presence robots, it's still a relatively new day.
In 2003, Johns Hopkins began trying a robot on rounds, enabling a doctor to visit patients and answer questions while away from the hospital. A 2004 study of 30 patient visits found that half of patients preferred seeing their own doctor by robot rather than a different doctor. Physicians who use robots today hear similar remarks.
"They really want to see their own doctor because it's he or she who really knows what's going on with them," said Alex Gandsas, MD, head of bariatric and minimally invasive surgery at Sinai Hospital in Baltimore. He added that about three in four patients are discharged from Sinai the day after gastric bypass surgery using a robot for postoperative visits, compared with two days without the gadget.
Making the rounds
About 100 robots are in use at 60 hospitals nationwide, said Yulan Wang, PhD, chair and CEO of InTouch Health, a Santa Barbara, Calif., company that makes the robots. The typical machine stands about 5½ feet tall and weighs 220 pounds. A computer screen attached as the head shows the face of the physician who operates the rolling robot by joystick via computer from another location.
Digital cameras atop the screen capture real-time video of the patient. Infrared sensors around the gizmo's "waist" and base help doctors avoid bumping into things.
"It's really easy to operate. We just need someone to push the elevator button because the robot doesn't have any arms," said Paul M. Vespa, MD, director of neurocritical care and associate professor of neurosurgery and neurology at the David Geffen School of Medicine at UCLA.
Two years ago, UCLA Medical Center started testing the robot in its neurosurgery intensive care unit. Now the center has three robots. Response times for specialists dropped from a few hours to about 10 minutes, and ICU patient stays have decreased by a day or more, Dr. Vespa said.
He has shown x-rays to patients on the screen where his face usually is. One Saturday night, the family of a patient came to town and wanted to speak to him. Dr. Vespa was at home but soon connected by computer to a robot. "They're very satisfied that they're getting information through a physician," he said.
In November 2006, the Michigan Stroke Network introduced robots that let participating hospitals in the state call stroke specialists at St. Joseph Mercy Oakland hospital in Pontiac, Mich., where doctors connect and send in the robot. Patient Bernadette Delap was recovering from surgery at St. Joseph when the gadget came in late one night.
"I didn't know if I was hallucinating or what. When the robot came into the room, it came beside my bed and said, 'You look great,' " she said. "I'd rather see a robot than nobody at all."
At Houston's Methodist Hospital, neurologist James Ling, MD, uses robots to review stroke patients' progress, judging their ability to speak and repeat words.
Physicians expect this technology to spread to rural settings where specialists are scarce. Meanwhile, they are finding other applications for it. Since December 2006, Johns Hopkins Hospital has turned to a robot for Spanish-speaking patients in its ED late at night and on weekends. Within about 10 minutes, a Spanish interpreter off-site can tap into the device, said Alex Nason, director of telemedicine at Johns Hopkins Medicine.
Dr. Gandsas, of Baltimore's Sinai Hospital, mentored two surgeons in Argentina after sending them software that allowed them to connect their computers to the hospital's robot and watch procedures from its screen. Via robot, he also assists surgeons in the operating room. "In three minutes," he said, "I'm in the operating room."
From just about anywhere.