Hospital Information Systems
Robots expand delivery options with seamless integration
By Aldo Zini, March 2011
A growing number of forward-thinking hospitals in search of greater efficiencies are embracing automated delivery robots.
There has always been a comfortable marriage between healthcare and technology.
The first generation of this union witnessed the impact technology had — and continues to have — on the diagnosis and treatment of patients. Thanks to technological advances of which our forefathers could only have dreamed, people are living longer, healthier lives; diseases that once seemed insurmountable are now being aggressively challenged by modern medicine.
The influence technology has had on the business side of healthcare, primarily over the past decade, comprises the second generation of this marriage. Business offices and IT departments at hospitals, clinics, physicians' offices and insurance carriers are applying smart technology to help make the system operate more efficiently, effectively and sensibly for all. Imagine a hospital's business office before computers, calculators and adding machines.
As 2011 unfolds, we find ourselves on the precipice of the third generation of this evolution — how technology can be used to simultaneously improve both the quality of care and, at the same time, make the healthcare system more efficient and considerably more patient focused.
Perhaps the most dazzling example of this can be found in the growing acceptance of electronic health records. Just a decade ago, the adoption of EHRs and other health information technology (such as computer physician order entry) was minimal in the United States. Fewer than 10 percent of American hospitals had implemented HIT while a mere 16 percent of primary care physicians used any form of EHRs. But that is all changing as provisions and incentives found in the American Recovery and Reinvestment Act are encouraging a movement toward electronic health records as a way to foster improvements in quality, safety, efficiency and access.
But EHRs are just one of many dramatic examples of how technology is changing the way hospitals function. Radio-frequency identification (RFID) tags that track every doctor, nurse and piece of equipment in the hospital in real time, for example, can enable a faster emergency response. Smart beds that automatically transmit patients' breathing and heart rates to their charts can alert nurses to developing problems more quickly. And according to industry analyst Datamonitor, spending on telemedicine, which now entails everything from remotely monitoring patients to analyzing medical images from afar and someday could even include long-distance surgery, will reach $6.1 billion by 2012.
While examples of new technologies and innovation can be found throughout the hospital, one area that seems to have been overlooked is hospital logistics. Moving vital equipment, supplies, medication and more from one place to another is largely being done in the same manner since the invention of the elevator more than 100 years ago: by people pushing carts. This may get the job done, but is not altogether effective and contributes to hospital inefficiencies and even medical errors when critical deliveries are not made on time.
A growing number of forward-thinking hospitals in search of greater efficiencies are embracing automated delivery robots. Now found in nearly 200 hospitals around the country, these robots are being viewed as a sensible logistics solution by CIOs, CEOs and CFOs because they enrich patient care, enhance productivity and provide cost-saving, quality-oriented solutions to everyday challenges. They're also conquering workforce shortages, breaking down delivery silos, making efficient use of shrinking resources, and bringing a new generation of smart technology into the fold.
A different kind of robot
For more than a decade, robots have been making their mark in the operating room at medical centers across the nation. Originally approved for general abdominal procedures such as gallbladder removal, robotic surgery — where the surgeon manipulates computer controls rather than a scalpel — is now used for heart and prostate cancer surgery, gynecologic procedures and bariatric surgery, among others. With the help of a tiny camera inserted through an incision port, a surgeon can see the surgical field onscreen as he or she sits at a console in the operating room, from which he or she guides the robot's instruments, also inserted through ports. Someday, the doctor guiding the robot could be sitting at a console literally around the world from the patient.
As of late, hospitals are adding a decidedly different kind of robot to their corridors. Automated delivery robots safely and courteously travel the hallways of many of America's most progressive institutions. In truth, it should come as no surprise that robots are beginning to take their rightful place in U.S. hospitals. After all, robots have been around for decades, providing usefulness in various forms of manufacturing and assembly line production. But now, thanks to advanced sensors and safety technology, robots are moving beyond factories and into different types of work where they are able to provide measurable value and significant cost savings — and that includes having a momentous impact in healthcare.
For those hospitals that have taken this step, there can be little doubt about the value the robots provide as they touch numerous departments to deliver, track and retrieve goods and supplies. They operate 24/7, don't get sick or injured, don't take breaks or vacations, don't require benefits and don't complain.
Robots provide value hospital wide. Consider:
• Robots support the laboratory by delivering samples, blood and supplies in a secure and confident manner. At the University of California-San Francisco Hospital, for example, the laboratory staff loads its robots with blood products, selects a preprogrammed destination on a computer touch screen and presses the robot's "go" button. The robot is then on its way to a medical wing of the hospital, transporting blood for transfusions. When it reaches its destination, point personnel enter an electronic code to unlock the cart cabinet and access the contents. Staffers sign to confirm the blood products were received; the robot then returns the signed documents to the laboratory.
• Robots support the pharmacy operation by ensuring timely and reliable delivery of medication to nurses' stations throughout the hospital, either scheduled or on demand. The latest models — such as those being used at Geisinger Health System in Pennsylvania and the University of Maryland Medical Center — also have tracking capabilities, which broaden the value proposition beyond just labor savings to aid in regulatory compliance, error reduction and chain-of-custody concerns.
• Robots support food service by delivering meals to patient floors and returning dirty trays back to the kitchen. At Central DuPage Hospital in the Chicago suburb of Winfield, for example, robots are supporting the food service department by providing consistent and dependable delivery of the hospital's room service patient meals. This allows dietary hostesses to spend an increased amount of time at the patient bedside, resulting in dietary patient satisfaction scores that are among the best in class.
• Robots support environmental services by retrieving soiled linens, regulating waste and trash, ensuring a sanitary environment and improving infection control. Last year Kaiser Permanente Los Angeles Medical Center (LAMC) installed a fleet of state-of-the-art robots to transport linens and remove trash throughout the facility. At LAMC robots deliver clean sheets and gowns to patient floors, remove and transport soiled linens and transport trash for disposal. As in other facilities, these robots are viewed as a sensible approach to providing basic supply and transportation needs, performing a function that may be invisible to patients but critical to hospital operations.
In all instances, robots help hospitals streamline internal supply chain operations so that nurses and clinical staff don't get mired down in searching for missing supplies or making the deliveries themselves, and instead can focus more on providing the important human component of patient care for which they were trained. At El Camino Hospital in the Silicon Valley, for example, 19 robots are helping the hospital run more efficiently and cutting costs by $650,000 a year. Moving unassisted around the hospital without the need for any special infrastructure, these robots carry safely through the hospital medical supplies and patient meals, laboratory specimens and prescription drugs, linens and equipment, as well as trash and waste.
Advocating for robots in the hospital
CIOs need not be concerned with what new headaches and challenges the introduction of robots to their hospital may bring. The best robots in the industry are self-sufficient, easy to install and straightforward to operate. Using a three-dimensional map preloaded into the robot, a set of laser rangefinders, and sophisticated odometry algorithms, robots can self-localize within the building in reference to the map. No external references like magnetic strips or beacons need to be installed nor do they burden the hospital's wireless network for navigation. Obstacle avoidance — of walls, people and other robots — is achieved with ultrasonic and infrared sensors in addition to laser rangefinders. Hearing the robots announce what they are about to do — such as "crossing hallway" and "turning around" — alerts those nearby. People often marvel at their independence as they watch them call for an elevator or say "thank you" after completing a delivery.
By seriously considering and advocating for the introduction of automated delivery robots into their facility, CIOs can play a critical role in helping to position their hospital as one of the nation's most technologically advanced. Here's how to get started in that effort:
1. Carefully assess where robots can have the greatest impact in your hospital. Meet with department heads in pharmacy, dietary, lab and materials management to discuss the needs and challenges they face — needs that could be intelligently addressed through the addition of robots to supplement their workforce.
2. Determine how the impact of robots on your hospital operations will be measured. Surely there are savings in FTEs as, on average, one robot can provide the productivity of 2.8 employees yet costs less than a single FTE. But there are other measurements as well. In the pharmacy and lab, for example, robots can speed delivery, potentially leading to reduced lengths of stay. Robots have also proven to increase employee satisfaction, especially among nurses who find themselves able to spend more time on direct patient care.
3. Look for robotic solutions that can be introduced with minimal disruption or extra work from a technical, infrastructure or resource standpoint. The robots making the greatest impact in the industry today require no wires, lines, tracks, rails, landmarks or infrastructure for navigation. They do not need to interface to the HIS and utilize less than 100 Kbps of network bandwidth, yet they support multiple communication options, including pagers and VOIP phones. They are equipped with automatic hands-off recharging, have a simple two-button operation and include sensors for obstacle detection and navigation, including ultrasonic sonar, infrared and laser rangefinders. The best systems even offer complete help-desk support, hardware and software, remotely through a secure VPN connection.
Healthcare's future is continuing to evolve and technology on all levels is leading the way. As hospital CIOs become increasingly challenged to help their institution thrive in an era of shrinking reimbursements and limited resources, automated robots are increasing efficiency, reducing expenses and enhancing patient care. And that's a winning combination that can't be ignored.
Aldo Zini is president
and CEO of Aethon,
a provider of mobile,
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