By K. Richard Douglas
Many clinical engineering and biomedical engineering departments have already changed their name to “healthcare technology management” because it describes the mission; to manage health care technology. It is the “technology” component that has most evolved for biomeds, with networks, firewalls, anti-malware and high-definition monitors commonplace.
The connotation that most people associate with technology today is anything high-tech; smartphones, smart home devices, netbook computers, smartwatches and home networks, to name a few.
It boils down to processing power, storage, the cloud, screen resolution, biometrics and encryption technology. Modern technology has changed the home, the workplace and social interaction. It impacts purchasing, reviewing, communicating and creating.
In the health care environment, whether hospital, clinic or physician’s office, technology now stores patient medical records, facilitates wireless admittance and helps monitor patients.
It also extends to the home, where telemedicine, apps and vitals-monitoring devices allow for remote medicine between patient and physician. Robotic prosthetic and exoskeleton limbs and computer-controlled wheelchairs can offer patients new mobility.
The advent of new 5G technology can turn 2D MRI images into 3D holographic renderings and allow surgeons an immersive experience that wasn’t available to the same degree before. Although virtual reality technology has been in use for years, it is now being more refined for health care with near real-time connectivity and no “lag.”
This technology also has application in telemedicine, where the ability for an immersive collaboration between the physician and the patient can be achieved through augmented reality tools in near real-time exchanges.
Technology in health care is following the trends. Sure, there are delivery robots, surgical robots and sterilization robots in hospitals across the country, but there are also innovations that recognize the move toward more home health care. What used to be simple telemedicine will continue to be a source for new products that let physicians monitor patients while they are at home instead of in the hospital. Devices and apps are being developed all of the time to this end.
One area of home health care that is still in the early research stages is the application of assistive technology robots that can help individuals with profound motor impairments. These humanoid robots could assist with feeding and other routine personal tasks. Through the use of standard assistive computer access technologies, the individual with the impairment could control the robot in the same way they might control a computer.
“I believe a lot of the new technology will take us away from traditional in-house (in-hospital) support of medical equipment and into the homes of patients. You can already take your EKG, pulse-ox, glucose level, etcetera, from your smartphone. We may have to support these devices in the near future,” says David W. Braeutigam, president of Braeutigam Enterprises LLC in Arlington, Texas.
Braeutigam is speaking of biomed’s role in the servicing of remote home-based medical equipment, that is a trend that parallels the aging of baby boomers.
The tech giants are getting into the health care space. They are finding ways to apply their areas of expertise to modernizing health care and launching high-tech innovations to advance the next wave of innovative products.
Virtual reality (VR) and mixed reality (MR) applications allow medical students to learn to treat patients and surgeons to learn complex procedures. It is also used to train engineers to repair diagnostic imaging equipment.
Artificial intelligence (AI) can assist medical diagnosis and help doctors identify pathology on diagnostic scans. Using AI, big data can be parsed and information can be interpreted much faster.
Robots in Health Care
Robots are becoming a more common presence in hospitals. From routine, monotonous deliveries to delicate surgery, robots have staked out a role in the modern health care setting.
Delivery robots can allow nurses to focus on more important tasks. Some of the early iterations of these helper robots can carry heavy weight, deliver medicines, documents and other things necessary for hospital staff. They can eliminate a substantial amount of walking for nurses and other staff also. With built-in GPS, they can navigate the hallways and wings of hospitals without running over anyone’s feet.
These delivery robots offer mobility and have to think about their route, while sterilization robots are less sophisticated and the surgical robots aren’t actually robots but robotic systems, controlled by the surgeon, offering greater acuity.
Robots, of all kinds and purposes, need a brain; right? Depending on the application, a robot needs to think things through and make smart decisions. Just like a computer or a smartphone, the robot depends on an operating system. While robots can employ AI, the argument is that they lack common sense. The basis for AI is a principle called “deep learning” which is based on the original theory of backpropagation. This is now a 30-year-old approach. What engineers would like to do now is give the robot common sense.
With common sense, a robot’s usefulness in a hospital or other setting is improved.
Not only are scientists and engineers concerned about imbuing robots with common sense, they are also working on creating robots that can build a strong relationship with patients going through rehabilitation. The scientists want patients to be able to trust the robot and to feel that the robot shares the same goals.
To this end, those developing socially assistive robots (SARs), are considering philosophical and developmental psychology in the process of improving these devices. The robot must be able to recognize the frustration felt by a patient with compromised language abilities, for instance, from a stroke.
In some sectors, robots that help humans are termed “cobots.” Cobots are segmented into four types of job assignments that include: repetitive, dirty, dangerous and difficult. These tasks could be in construction or demolition, farming, surgery or in military defense. Many of these cobots handle jobs where human employees are scarce or where there are aging populations.
The price of robots has decreased over time as the cost of human labor has increased. Many robots and cobots will replace humans in tasks that the robot is well-suited for.
Surgical and Sterilization Robots
Robotic surgery is not new, but it has become more commonplace and accepted among surgeons. The best known surgical robotic system is the da Vinci Surgical System, which has gained wide acceptance as greater numbers of surgeons have been trained to use it. It is used for minimally invasive surgical procedures.
The newer da Vinci system, introduced in 2018, allows for more precise surgeries in the abdomen area and chest because the arms are smaller in diameter. The new system also includes a high-definition camera and the arms can work with instruments that are easily changed. With a price tag of about $2 million, the dissemination of these robots is still limited to a degree.
Because many of the leased robots come with their own service contracts, HTM does not yet play much of a role in the servicing of this equipment. As the masters of all things electronic and mechanical, that could gradually change in the future.
The sterilization robots have become an accepted method for killing harmful pathogens that may escape traditional cleaning techniques in patient rooms. Healthcare-associated infections (HAIs) impact thousands of patients each year. Deadly, drug-resistant yeast strains like C. auris can cause serious illness or death. Germ-killing robots, such as the XENEX units, use a pulsed Xenon lamp to generate ultraviolet light that can destroy pathogens.
Most biomeds do not work on these robots, but some have.
“I attended the XENEX training on the disinfection robots back in 2015. These devices were always needing the same PM parts like bulbs and the occasional parts like power supplies and lift motor sensors. These were easy devices to work on. XENEX was my only experience with this type of UV disinfection technology,” says Vincent Sumarkoff, BMET II, technology management department at Banner Casa Grande Medical Center.
Disinfection robots can help reduce infection rates, which helps with Medicare reimbursements.
“Let’s not forget that a BMET or CE services equipment for the OEM also. So, an in-house department may not be supporting it but it is being performed by an HTM professional,” Braeutigam says.
One benefit for biomeds is that most robots do not have to store or memorize patient protected health information, so this is one less cybersecurity consideration if, and when, they are serviced in-house.
Creating with 3D
Even in this day of high technology, when nothing is unexpected, the concept of 3D printing still seems futuristic. The technology has come a long way since its first use in 1983, from the rare demonstration to consumer grade units. The technology is catching on in every sector with the 3D printing industry growing by 35.2 percent in 2014 alone.
Will the units ever find widespread use and acceptance in the HTM department?
“So as for 3D printing, or additive manufacturing, yes, HTM plays a larger part in that industry for health care. Not just for the repair and maintenance of the units at larger research hospitals, but we – biomeds – are a perfect type of human to have one of the units in the shop for creative problem solving. By nature, biomeds are looking for ways to innovate and save either time, money or both to support patient care. We have an experimental unit in our department that we have done quite a lot with. From designing and prototyping X-ray sensor positioning tools to repairing our shop fridge shelf bracket,” says Chris Bryant, CBET, an imaging service specialist at the Captain James A. Lovell Federal Health Care Center in Illinois.
Bryant says that it is really impressive to see what happens when you couple creative ideas and the means to make them a reality.
“Some departments are looking to build replacement parts for smaller pieces of equipment. I heard a story about how one company is charging a silly amount to repair an MRI coil because of plastic wire guide. Think of what could happen if we could print out an FDA-approved piece in house and put the item back into service the same day,” Bryant says.
“Not only is it good for the hospital in financial savings; think of the energy and resources spent to ship the coil, build and warehouse the repair parts, heat and cool the repair facility, what long-range environmental impact would we gain by having build-on-demand capabilities,” he adds.
As Bryant mentions, the printed replacement part would have to be FDA-approved or else the approach would present liability issues.
Not only could the technology help with the construction of an approved part, but there are other applications. Using 3D printing technology, customized health products can be created that are tailor-made to a particular patient. These can include prosthetics and implants.
Using stem cells, instead of plastic or metal powders, a new science is emerging for 3D bioprinting that could build tiny organs, or “organoids,” which could grow into a liver or kidney inside of a sick patient.
A related technology is also being developed that uses human plasma and materials taken from skin biopsies, that can print human skin for burn victims. This 3D-printed skin can be created at the rate of about 100 square centimeters in a half hour.
Airway splints, made with 3D printing, can be created for babies at very low cost and can treat a condition called tracheobronchomalacia. This causes the airways around the lungs to collapse. The splints can be designed to grow with the patient.
While technology will continue to be more pervasive throughout our culture, its many applications in the medical field will help improve patient outcomes. The opportunities, for those skilled in mechanics and electronics, to be hands-on with this new technology is something that will grow incrementally. The HTM department has the perfect skill set to adopt and utilize many of these devices while providing service and repair as well.
It’s only a matter of time.
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