In Roseville, Michigan, a man walks into his house and says out loud “Alexa, turn on the lights.” His living room lights instantly illuminate. In Carlsbad, California, a woman heads out to work, but first asks her smartphone, “OK Google, what is the traffic like?” She then asks the voice assistant if it will rain later in the day.
A recent robotics competition at Grand Canyon University in Arizona highlighted the interest and focus on robots among students. The competition pitted alliances of high school student teams against each other.
In Columbus, Georgia, high school students build robots and compete in the Georgia For Inspiration and Recognition of Science and Technology (FIRST) Robotics Competition.Robotics classes and clubs can be found in junior high schools and high schools across the country, continuing a trend that is exploding. A new generation of robotics engineers are being developed from a young age with skills that will lead to even more advanced robots in the future.
In Baton Rouge, Louisiana, a surgical robot performs the intricate steps in a knee replacement operation. A sterilization robot cleans a hospital room in a VA hospital in Grand Island, Nebraska.
The military is developing robotics systems to take on some of the most dangerous missions to reduce the risk to soldiers in the field. The U.S. Army incorporates what they call the Common Robotic System (Individual) program, which is a 25-pound ground robot which can be transported in a backpack. The robot allows soldiers to remain a safe distance from a threat that is being observed.
Robots are finding their way into the fast food industry, handling everything from dish washing to food preparation and serving.
The use of artificial intelligence (AI) and robotics has become integrated into our everyday lifestyles and health care environment. Technology that was more science fiction than reality two decades ago is in everyday use across the country today.
In health care, the list of applications grows yearly as new ways are found to integrate technology into hospital chores, robotic greeters, UV cleaning, patient monitoring and surgery.
In China, robots are being put into nursing homes to act as companions to some of the country’s estimated 230 million senior citizens. And, in Nagoya, Japan, Robear is a bear robot that resembles Yogi the Bear, and can lift a patient out of a bed or from a wheelchair and move the patient to a bed or bath. This can prevent back injuries to caregivers.
Robear’s developers report that there are still kinks to be worked out.
A robotic seal in Japan has been developed to engage in conversation with elderly patients to help prevent dementia.
Some U.S. hospitals use courier robots to carry away garbage and deliver linens. A greeting robot made ECRI Institute’s 2017 Top 10 Hospital C-Suite Watch List. The robot is used to greet guests in two Belgian hospitals. At Kettering Medical Center in Kettering, Ohio, they use four “assistive staff” robots to do yeoman’s work. The robots make deliveries of medical supplies, equipment and food to each of the five floors in the medical center.
“They deliver supplies to clinical areas, making multiple daily trips and covering many miles. We have created names for them such as R2D2, Hal and Rosie,” says Salim Kai, MSPSL, CBET, biomedical engineering manager at Kettering Health Network.
“They save the hospital costs, can work 24/7 and never complain or get tired,” he says.
HTM in a Robotic World
What HTM’s role is in regards to servicing robots is largely yet to be seen. Much of what determines this role going forward is the availability of training and the willingness of the manufacturer to allow in-house service or the dissemination of proprietary information.
According to Intuitive Surgical’s website, a surgeon uses the da Vinci Surgical System every 60 seconds. There are more than five million patients who have undergone daVinci-assisted surgeries and the robotic devices can be found in hospitals on six continents with more than 4,400 da Vinci systems in hospitals. The systems are generally serviced by Intuitive Surgical’s technical support teams.
Outside of surgical robots, disinfection robots are becoming more commonly used. They use a UV-C light source to kill pathogens.
“The cleaning robots we use require basic electronics, controls and mechanical abilities. Training from the OEM is necessary, and due to the nature of the light assembly and software that controls the robots, a contract to cover parts and software,” says Gregory L. Herr BSEE, MBA, CCE, CHTM, director of Healthcare Technology Management (HTM) for The Christ Hospital Health Network in Cincinnati, Ohio.
“A general electronic and biomed background are excellent and the biomedical techs commitment to patient care is an excellent fit. Detail oriented and good deductive thinking is necessary,” he says.
“Supporting these units, we are working with environmental services staff versus our normal clinical staff. However, these units are used to protect the patient care areas, and there is oversight from infection control and other nursing services. The important aspect has been to get the training and tools necessary to understand how the equipment works and support it per the OEM recommendations,” Herr says.
“Since there are a limited number of units, and they are a critical part of the room turnover process, demand for these units is high. Downtime must be kept as low as possible with the ability to respond quickly to needs. We had to train several HTM specialists in order to meet the demand. The lights are the number one item that goes, and the company can monitor when they might fail and alert us to the need to replace,” Herr adds.
He says that the HTM specialist must have this combination of electronics, mechanical and control plus be detail oriented and have the ability to communicate with environmental services and the OEM.
“Not too different from our traditional biomedical requirements,” he says.
The sheer number and variety of robots that could populate hospitals in the years ahead begs the question; who handles what?
“There are those food delivery robots or pharmaceutical delivery robots that can be maintained by facilities staff. Then, these humanoid robots that have a lot of programming for interaction; do they fall to the IT department? Some of these are funded through special grants and so that might be one service methodology. There might be someone in HTM, who has been dabbling in robots for 10 years and they are a great person to maintain the pharmaceutical delivery robot,” says Rob Maliff, director of strategic growth and business development at ECRI Institute.
“With the changes in technology, the skill sets of the HTM technicians/engineers will be invaluable. The troubleshooting and resolution-focused drive that HTM has will assist in ensuring access to technology for patient care,” says Michael McDonald, MS, CCE, chief, biomedical engineer, healthcare technology management for VISN 20.
“They will need training specific to the different models of robots with an overall understanding of networking and network security. The da Vinci robot in particular is a system that we cannot maintain with in-house staff. The vendor does not provide training and the only way to maintain the equipment is through a service contract,” McDonald says. “Most HTM departments manage the service of the robots currently in use by in-house or service contract.”
“There are AI systems that could be coming that would go beyond the traditional robots the HTM will need to support due to the integration of multiple medical devices as well as the patient,” McDonald adds.
“We might get to a time in the near future where a critical amount of robots are in a hospital and the hospital will have to take a step back and say ‘What is the best way for us to service robots?’ We’re not there yet, but we might be there soon because we are going to have a lot of robots,” Maliff says.
Will there be hybrid departments in the future that will take on the servicing of robots?
“A lot of HTM departments now report to the CIO. It’s another good example of medical technology combining with IT to come up with this new platform that both departments should really be involved with,” Maliff says.
Herr describes a number of skills that HTM staff would need to maintain a contingent of robots.
The day may come in the near future when the ability to service robots is part of the skill set that an HTM professional should have.
“Good mechanical/electronic/electrical mind, logical thinking, precision, the ability to deal with software and talk to the OEM/vendor, [someone who] enjoys ongoing training and can function in a high stress environment; the robots tend to become key dependencies on the department’s workflow [and the] ability to communicate at a high level with users, OEM, management and IT,” Herr says.
Another Service Contract
Of course, in many cases, the manufacturer or developer of the robot will continue to service the robot. As is the case in the previously mentioned robots at Kettering Health Network, the robots are leased and the lease includes all service. At Kettering, leasing has proven to be a more fiscally beneficial route than purchase, and service agreements would continue.
As long as the HTM professional receives OEM training, they should have the skill set to take on the maintenance of the standard robots currently found in hospitals.
“I feel any good, seasoned biomed tech should be able to support these with OEM training and support,” says Rodney Nolen, clinical engineering manager at University of Minnesota Health.
“For these devices and systems, the OEM training is a must. There are multiple proprietary software and other items that will need to be communicated and trained by the OEM. Also, networking and IT basic skills would be very helpful,” Nolen says.
He says that his system’s robots have been kept under a service contract and staffing would prevent them from taking on robot servicing at this time.
Herr says that there are other robots used in his facility.
“The OR is the primary user of these robots, and at our hospital, the contracts and management of the da Vinci robots are in the OR. Other robots recently purchased will be under HTM. The issue with these robots is there is no training for support. The OEM wants to support and will not train an in-house or ISO service. HTM is now trying to bridge that gap and working to see where HTM can add value. The robots all run on software and software support and updates are critical or the robots quickly become outdated,” Herr says.
“Other areas are robotic systems in pharmacy to sort and count pills, again under contract, and currently the vendor will not support in-house service,” he adds.
He says that they don’t currently have any robots for telemedicine (e.g. in the emergency department and other clinical areas), but that HTM will be there to try to help support them when that happens.
“The challenge for HTM, as I see it, is the OEMs want to support the equipment and work directly with the clinical departments. Getting service histories and knowing if the equipment is working within specifications is usually hard to obtain,” Herr says.
“The OEMs may have good reasons to limit service and repair, and it will be up to HTM to convince them that there is value in providing some training and not rely on field service entirely,” Herr adds.
Whether or not robots present a cybersecurity risk may depend on the type of robot and its purpose.
“A lot of times, the robots themselves do not have any protected health information. If a greeting robot is programmed to respond to simple questions, but they don’t have any information about the patient or the diagnosis. Then, there is not that threat of hacking the robot to get specific patient information. There’s no patient information stored on the robot generally,” Maliff says, speaking of greeting and delivery robots.
“Right now, they are a low-risk vector from a cybersecurity risk. But, what if a robot gets involved in diagnosis?” Maliff asks. “If you think about it, Watson is a type of robot, so Watson or other deep-learning robots or deep-learning algorithms, in a broader sense, they have a ton of patient information.”
Maliff points out that robots will not likely displace employees as a rule, but the robots will handle more repetitive tasks and employees will simply take on new functions.
He points to a video on YouTube that shows a nurse robot attempting to set up a patient’s meal on an overbed table which takes something like 45 minutes. The video shows a student-developed nurse assistant robot which will eventually be used with telemedicine.
“There are still things that humans do an awful lot better,” he says.
With tens of thousands of robot-focused engineers entering and graduating from colleges and universities, the prevalence of robots in all settings is likely to increase. The health care setting is a prime recipient of many types of robots. Their mechanical-electrical construction begs for HTM involvement. Like so many other pieces of equipment, there will be a point where a service contract is moved to in-house service.
There may be a robot in your future.
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