By Hiep Nguyen
Robotic technology can take many forms. In the Department of Urology at Children’s Hospital Boston, we are evaluating a remotely controlled, videoconferencing robot on wheels to help transition our patients’ care to the home after surgery. This transition is a time of significant anxiety for all. In the hospital, children have around-the-clock care and monitoring; after discharge, families tend to lose contact with their physicians and nurses unless there is a problem or complication.
The robot we’re testing, the VGo, allows us to make virtual house calls. As children recover in familiar and comfortable surroundings, with their families around them, we can talk to them, monitor them, view their home environment, help parents assess their child’s status and answer their questions and concerns. We can sometimes identify errors and avoid complications before they require emergent and costly medical attention.
We’re often asked why we use this mobile robotic system, a relatively new and costly technology, rather than established, less expensive alternatives such as cell phones or computer-based videoconferencing programs like Skype or Facetime. Why don’t we simply pick up a telephone and call our patients? Such questions have been asked of every new technology since the beginning of the industrial age.
From the days of Alexander Graham Bell, the telephone has allowed people to efficiently communicate and exchange information across a distance. But in medicine, we need not only ears but also eyes to get visceral information about our patients and context for their clinical scenarios.
You may say that videoconferencing, using computers already in patients’ homes, can provide these “eyes,” allowing health care providers to see and talk to patients. But that isn’t always enough. In some situations there’s a clinical advantage to moving the device to where the patient is – for us to be “embodied” by the device as if we were actually in the room. An orthopedist or a physical therapist may want to see a patient walk up the stairs. A pulmonologist or a respiratory therapist may want to evaluate a bed-bound patient on a ventilator. A urologist may want to check the toilet see how much blood is in the urine after bladder surgery.
These tasks would not be possible with a desktop device. But skeptics still ask, why not use a video-enabled computer tablet, laptop or smart phone to provide this mobile view? Why do you need a robot on wheels?
The answer lies in the quality of the clinical interaction. Patients and families interact with the mobile robot as if it were an embodiment of their health care provider. They seem to more readily connect intellectually and emotionally with the robot than with a computer, and commonly report feelings of closer communication with their health care provider when using it. Perhaps this is because the device can respond to the patient or family as a human would — physically orienting toward whoever is speaking, or angling the camera to follow someone as they sit and stand.
Interestingly, these simple attributes seem to promote a greater sense of trust, and reinforce the patient’s and family’s perception that their health care providers are paying attention to their concerns and questions. Children in particular seem to bond to the robot (which, at 4’6″ high, is about their height) and communicate better with it than with a computer screen.
Researchers have noted that homebound children, when provided with embodied robotic systems, were able to experience school as if they were there. When given a more traditional telecommunication system such as a program on a desktop computer, they were less engaged and acted as if they were “looking in” rather than being in the classroom. More importantly, when a physical robot was among them, children in the classroom treated the homebound child as if he or she were really there. Learning was more active than with computer-based systems.
Moreover, the current embodied telecommunication device will continue to evolve. Its upgradeable, reusable, dedicated platform will be modified – so that robots like the VGo will have not just “eyes” and “legs,” but also “hands” to measure vital signs, to sense heat and pressure through touch, and to perform simple blood, urine and respiratory evaluations. Eventually, a “brain” will be added that will teach patients about their disease process and help them solve basic health problems independently. For example, the robot could help the family recognize what is expected and not expected after surgery, engaging them in their health care and reassuring them. If an unexpected problem arises, the robotic system could contact the doctor and transmit information to aid the diagnosis.
Finally, the dedicated robotic systems can go home with any patient who has an electrical outlet — no home WiFi, home computer or technical sophistication needed. The systems can operate on a 4G network, making a uniform standard of care available to all patients, regardless of their financial status. While currently these systems can be costly, they’re reusable, and price will become less of a concern as demand and competition increase.
Computers were once large, expensive and of use to just a limited few, but now are an essential and accepted part of our daily lives. Maybe one day, robotic systems will become equally essential in medicine, allowing health care providers to be more time- and cost-efficient while delivering high quality care to patients.
Hiep Nguyen, MD, FAAP is a pediatric urologist, surgeon and director of Robotic Surgery Research and Training at Children’s Hospital Boston. He is a pioneer in developing, testing and implementing robotics techniques to improve minimally invasive surgery.
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