Space age healthcare as robot heralds telemedicine advance for Bermuda
A robot has joined the staff at King Edward VII Memorial Hospital (KEMH) to assist in difficult cases.
Akin to C-3P0 in 'Star Wars', or Rosie in 'The Jetsons', RP-7 is proof that we've entered a new era in medicine.
Manned by physicians at the Lahey Clinic in Massachusetts, RP-7 can move about hospital floors unassisted, visiting patients at their bedsides or conferencing with medical staff. Assistance is needed in moving between floors but in essence, its operation is y remote.
"RP stands for remote presence," said Scott Pearman, vice president of Physician Relations at KEMH. "The whole concept of remote presence medicine is to allow physicians to be in two places at once. It is a multi-platform system that allows live, two-way audiovisual communication."
The presence of RP-7 ushers in a new era of medicine for the hospital. Historically physicians at KEMH consulted with doctors overseas, most often by telephone.
Thanks to the partnership of KEMH with Lahey Clinic, consultations can now take place between doctors in much the same way that they would if both doctors were in the same room.
"The visual aspect of RP-7 is huge," said KEMH Hospitalists Programme director Arlene Basden. "Ordinarily the physician on the other end will have to depend on the local physician to describe symptoms. Now they can actually see not only the patient, but also any X-rays or CAT scans that may be involved. We can just hang them and the physician on the other end will be able to dial in and actually view the x-rays and CAT scans just as clearly as if they were physically in the room."
The RP-7 technology involves a physical robot and a web-based management console. Consultants at the Lahey Clinic can log into the robot console, consult with a KEMH physician and examine a patient by operating the robot's features. Medical staff and patients at KEMH can see the consultant on the computer screen "face" of the robot.
The machine is able to move about the Emergency Ward, Intensive Care Unit and the Wound Care Clinic, thanks to wireless Internet service in place.
"We are in the process of rolling out the IT infrastructure that will make the whole hospital wireless. From that point in time a physician from Lahey will be able to drive right through the entire hospital," said Mr. Pearman.
According to Tracey Batakis, a nurse in Lahey's telemedicine department, any problems the hospital has seen with its seven robots stem from poor Internet connection.
"The major glitch is if we hit a spot where the wireless connection is a little weak then I can have a slow Internet connection," she said.
But overall, the robots have been a tremendous asset to the hospital. "It is so beneficial for my physicians. They [make rounds] after hours and on weekends, especially on their critical patients, so it has become an extremely valuable tool," said nurse Batakis.
"The robot is in our Intensive Care Unit and they can beam in via a laptop computer from their home or elsewhere," she added.
Bermuda is the first overseas location where Lahey has one of the robots. Here it is used primarily for access to specialists rarely on Island.
Mr. Pearman said it would not replace local doctors making their rounds.
Prior to RP-7 anyone in Bermuda needing a subspecialist would likely have to travel overseas for consultation. This now becomes unnecessary.
"Our relationship with Lahey is that we have a contact number that we call in the event that a doctor on staff or in the community needs a subspecialty consult," said Mr. Pearman.
"They can call Lahey's office and they have a clearing house that will secure one of the sub-specialists. On an emergency basis they can get a consult within 60 minutes or they can arrange appointments in the next 24 or 48 hours."
Mr. Pearman said talks are underway with Lahey which could see RP-7 help KEMH better care for its patients in other ways.
He said use of the robot could greatly reduce health costs as it eliminates the need for overseas travel and thereby airfare and hotel expenses.
And according to Mr. Pearman RP-7 also paves the way for foreign specialists to do their operations at KEMH.
This can have a huge impact on healthcare costs and the wellbeing of patients, many of whom tend to be more relaxed in a familiar setting.
RP-7, the Lahey Clinic robot at King Edward VII Memorial Hospital (KEMH), has already proved valuable in the care of local patients.
Hospitalists Programme director Arlene Basden gave an example that happened a few weeks ago.
She said a patient suffering with recurrent fluid in both lungs was brought into the Intensive Care Unit (ICU) at KEMH. The male patient could not be flown overseas because he was unstable.
Dr. Basden said a pulmonary/respiratory specialist was consulted in two sessions that lasted about an hour each time.
"The specialist was able to review X-rays, CAT scans and all blood results. Additionally, he was able to see the patient and could assess the ventilator and ventilator settings," she said.
"The interaction gave us insight into things that we did not think of and we were able to institute further management in him that otherwise we couldn't," she said.
Dr. Basden said the advice given would not have been possible had the consultation been done by telephone.
"With the robot, he (the pulmonary/respiratory specialist) was able to undertake a live consult. There was constant communication between the specialist, the patient and doctors here in the ICU. The specialist was able to see the patient and communicate to everyone involved at one time."
Scott Pearman, vice president of Physician Relations at KEMH, said RP-7 has also already proved helpful in the Wound Care Clinic where, in many cases, patients have to have a limb amputated because wound healing did not take place.
"We've used the vascular surgeon for patients having difficulty with wound healing where we've looked for the second opinion and have been able to bring the patient into the hospital with their family," he said. "The Lahey surgeon has been able to have an ordinary consultation just as if they were in their office. They were able to talk to the patient, were able to view the wound, and meet directly with the physician and patient and make decisions on care."
And RP-7 has also been used to heal patients emotionally. Mr. Pearman said some local families have been able to visit with a family member who is in long-term care at Lahey through RP-7.
"We've had eight, nine, ten, family members in the office [of the Chief of Staff] talking to their loved ones at Lahey, and giving them a real uplifting experience vis-à-vis the robot," he said.
And according to nurse Tracey Batakis of the Lahey Clinic, families really appreciate the chance to meet with their bedridden relatives.
"It takes them about 30 seconds to get over talking to the screen, but when they are used to it they love it," she said.
Asked if such use of the robot was heartwarming but wasteful, Mr. Pearman said KEMH considered it a part of quality care for its patients.
RP-7 is a new staff member of sorts at KEMH. Although he hails from the Lahey Clinic in Massachusetts, no work permit was required for him.
That's because he's a robot, remotely operated by specialist physicians at Lahey.
RP-7 is actually his nickname, his full name being Remote Presence 7. The number seven was selected because he's the seventh robot that Lahey has.
He is operated via the web and has a computer screen "face" and a real stethoscope attached. Through his face, the specialists at Lahey are able to read medical charts and scans just as clearly as if they were physically in the room.
His height varies because his face can go up and down, but he's in the region of 5 feet 5 inches and slightly rotund.
RP-7 runs on an electrically charged battery that lasts for about 24 hours.
He's been at KEMH since February but began seeing actual patients in May. RP-7 is not owned by KEMH. The robot is here through a lease agreement with the Lahey Clinic. Just how much the hospital pays for that lease is confidential, but he is insured.
"Maintenance is arranged via our local IT department in conjunction with the In-Touch Ltd that manufactures the equipment," said a KEMH spokesperson.
While there are no protocols in place at KEMH on who has to be present when the robot is in use, vice president of Physician Relations Scott Pearman said a new category had to be created in the hospital's by-laws to accommodate physicians giving advice through the robot.
"We have now privileged at least 20 Lahey physicians for remote consultations," he said. "That means they are licenced to provide advice to our physicians remotely. They would have to get additional privileges if they came on-Island."
