Health News Digest

December 28, 2009

The Tireless Caregiver For The Homebound:  A Robot


By  Michael D. Shaw

Health care is big news—and big money—these days, but most of the discussion seems to be limited to how we are going to pay for it, especially in light of the huge cohort of aging baby boomers threatening to overwhelm the system. When technology is mentioned at all, the focus is usually on innovative surgical techniques or breakthroughs in radiological imaging.

We often forget that there is more to the picture than acute in-patient care. The very improvements in acute care and pharmaceuticals that we celebrate mean that many will be living longer, if less mobile lives. Thus, we are brought to the decidedly non high-tech world of providing care to the homebound.

In some cases, this primary caregiver is faced with a 24 hour, seven day a week responsibility, and, if that were not tough enough, more stress can occur when the patient has to be left alone, during shopping trips and the like. There is the matter of safety, as well as ensuring that medications are taken at the proper time. To be sure, such mundane issues receive scant media coverage, but they are real for untold thousands of caregivers and family members.

What if technology were to enter this environment? How about robotics?

The term “robot” comes to us from Czech playwright Karel Capek’s 1920 work Rossum’s Universal Robots, in which a scientist discovers the secret of creating humanlike machines that are more precise and reliable than human beings. Years later, the machines dominate the human race and threaten it with extinction, though at the last moment it is saved. Capek coined “robot,” deriving it from the Czech word meaning forced labor.

The particular class of machine that would be deployed in the home health care application is called an Autonomous Mobile Service Robot, or simply a Mobile Service Robot (MSR). Such a machine operates in the users’ own environment, performing independent tasks to reach a user’s goals. The interface between the user and machine must be natural and straightforward, and must consider both normal and unexpected situations.

An example of this sort of MSR is the CareBot™ from Gecko Systems. Gecko describes the CareBot as “a new kind of companion that always stays close to the patient, enabling family and friends to care for them from afar.”

This cyber Florence Nightingale can

  • Remind the patient to take meds
  • Play favorite songs
  • Alert the patient to the presence of a visitor—or intruder
  • Notify designated people when a potentially harmful event has occurred
  • Respond to a large variety of voice commands
  • Adjust its “personality” to suit the patient
  • Provide virtual visits, via an on-board webcam and video monitor

By virtue of purpose-designed artificial intelligence software, these robots can do everything from monitoring a patient’s blood pressure and pulse rate, to delivering bedpans. At the same time, they can carry specialized supplies like bandages, IVs, and a defibrillator.

The remote patient monitoring aspect crosses over into how robots can advance the exciting world of telemedicine. Using high quality cameras and data transfer via the Internet, radiological images, sounds, and patient records can be transferred from one site to another. As such, physicians can readily consult with colleagues and specialized experts, despite geographical separation. Clearly this can save time and money, bringing the best of health care consultation to virtually any location.

Remote patient monitoring solutions have demonstrated success for patients with congestive heart failure, chronic obstructive pulmonary disease, and diabetes.

Ironically, though, according to a recent study from the Spyglass Consulting Group, third party health care payers seem to be resistant to providing reimbursement for remote patient monitoring despite evidence of its efficacy. The old model, whereby reimbursement is based on the quantity of procedures performed, rather than the quality of care delivered, is still very much in play.

I have a feeling that based on recent legislation—not to mention the inevitable parade of older, sicker baby boomers—this will be changing.