Robotics, healthcare and wellness today
Healthcare and social assistance workers may work in designated facilities such as healthcare and residential facilities or within people’s homes. These variable workplace environments, along with the fact that client services staff often work alone, can increase the risk to worker health and safety. Trends indicate that patients are getting older, sicker and heavier while workers are also getting older. More patients will need lift assistance, raising the risk for workers suffering from musculoskeletal disorders caused by the increased demand of hazardous manual tasks. Workers in aged care have a higher than average chance of being seriously injured at work due to hazardous manual tasks or slips, trips and falls [SWA18].
Robotic technologies can be applied to both medical treatment and to the provision of medical services, with benefits to both patients and healthcare workers. Robotics in treatment include medical interventions such as prevention and health promotion, treatment and care, and rehabilitation. Robotics in service provision impacts on resources applied to healthcare and wellness including human resources, logistics, material handling, research, monitoring, surveillance, and technology. Robotics applied to the medical environment provides an opportunity for significant benefits to the safety and well-being of healthcare workers.
The use of robotics technologies in healthcare and wellness has already produced new products and services and created new markets. The impact of medical robotics on clinical practice includes:
- Facilitating medical processes by precisely guiding instruments, diagnostic equipment and tools for diagnosis and therapy
- Improving safety and overall quality of medical treatment, reducing patient recovery times and the number of subsequent treatments
- Enhancing the cost-effectiveness of patient care
- Enabling the delivery of services to remote areas
- Improving the training and education of medical personnel by using simulators
- Promoting the use of information in diagnosis and therapy [IFRSR17].
The healthcare and wellness sector has the potential to benefit from automation of parts of its workflow. However, despite more than 1.7 million robotics procedures worldwide (to 2013), the use of surgical robotics has not delivered on its early promise. Some equipment has been made more expensive and studies are divided on the overall health benefits related to the use of surgical robots. Between January 2000 and December 2013 there were 144 deaths, 1,391 patient injuries, and 8,061 device malfunctions associated with robotic systems used in minimally invasive surgery (MIS) [PLOS16]. Conversely, the use of robots in non-surgical areas is delivering undisputed benefits [IFRSR17]. Following is a description of some of the current common applications of robotics in the healthcare and wellness sector.
Diagnostic robots may come in the form of robot arms/manipulators that guide diagnostic equipment outside the human body or guide the body relative to a diagnostic instrument, or microrobots that carry diagnostic instruments inside the body. The most established procedures in this field are for radiology and biopsy where the robots can operate in potentially dangerous radiological environments [IFRSR17].
Simple mobile robots transport material such as food, pathology samples, linen, and medical equipment around hospitals or between buildings on a hospital campus. This practice is becoming common at new hospitals in Australia, when the robots are planned for as the hospital is being built (see Case Study p. 64). Disinfectant robots are also being trialed [IFRSR17].
Robotic pharmacists can be used in conjunction with electronic health records to dispense medicine and are increasingly used in some pharmacies.
Australia is seen as a follower in the uptake of surgical robots, although the practice is rapidly increasing (see Case Study p. 65). Most common are teleoperated robots that allow surgeons from different locations to advise or operate on patients. The main uses are as surgical assistants (holding tools), tele-surgeons, image-guided surgery, and activation of motions such as drilling [IFRSR17]. The current motivation for using surgical robots is usually to increase precision rather than to increase efficiency (e.g., the use of the Da Vinci robot in urology to remove prostate cancer – robotic prostatectomy). More work needs to be done to improve the accessibility, intelligence and accuracy of operations to reduce individual surgery time, making more treatments possible and reducing surgical waiting lists.
Vital signs monitoring and sample taking
Nurses regularly make and record measurements of vital signs and take samples from patients (mainly blood samples). Automated vital signs monitors have been developed but are not yet common. There are known issues with automatically recording the data that largely relate to IT systems and a lack of electronic health records. Inexpensive, non-contact, computer vision-based vital signs monitors would have significant impact. Automated machines for blood taking have been demonstrated, however they are not yet commercially available.
Remote or teleremote medicine
Current mobile telemedicine is essentially a video chat session on a robot, but there is future potential to have the ability to either point or interact with the remote physical environment [ABC18]. Imagine a National Telemedicine Network (NTeN) in which a surgeon from Perth can help with a trauma case in Brisbane. This represents a good opportunity for Australia due to its significant proportion of rural and remote locations and known issues with the availability of suitable healthcare workers in such areas. The Australian Defence department also has a strong interest in this area, with some systems already used for remote ward rounds.
Rehabilitation and physical therapy robots
Rehabilitation robots assist people with a disability to complete necessary activities or provide therapy with the aim of improving the patient’s physical or cognitive functions. The aim is to increase the training intensity for improved functional rehabilitation compared to using a human therapist’s assistance. Physical therapy robots stimulate body movements, helping the patient to learn control of mobility functions (gait and balance, arm and hand) by controlled repetitive movements for neurological rehabilitation. As physical therapy is labour-intensive and strenuous for therapists, it is well-suited for automation [IFRSR17].
Bionics, exoskeletons and lifting assistants
By definition, these robots are likely to interface directly with humans. The military has been a significant funder of prosthetic limb and exoskeleton development. South Korea and Japan have focused on lifting assistance robots. Open-source bionics is becoming a significant activity world-wide.
Manufacture of medical devices
A significant proportion of medical devices must be custom-made for a patient (e.g., stents to replace heart valves). Consequently, some medical devices that may be presumed to be mass produced are in fact hand-made. The medical device industry has the potential to significantly benefit from the latest manufacturing techniques that utilise robotics (see Chapter 5).
Robot training for medical interventions
There is greater use of simulation in health care education to improve patient safety and quality of care. This includes the adoption of more realistic simulation-based teaching methodologies, which serve as a bridge between the acquisition and application of clinical skills, knowledge, and attributes, and increasing use of robotic simulators [IFRSR17].
Companion robots are becoming more common, particularly for the elderly or people with disabilities. These robots can replace or augment companion animals, providing a level of comfort and care, and increased mobility. Robots can also be used to remind elderly people living independently to take their medication or to help perform regular medical checks, such as taking blood pressure. Such robots have been trialled all over the world, including Japan, where “around 5,000 nursing-care homes across the country [Japan] are testing robots” [EC17]. Companion robots may be in the form of a humanoid or wheeled robot, and tend to resemble something ‘cute’ (e.g., cats, dogs, seals, or other furry creatures). The “Paro” robot provides a good example (see Case Study p. 67).
Social robots are designed to interact with humans. Companion robots are a type of social robot but social robots have broader applications than companionship. Social robots are being trialled for use as concierge robots, delivering information and public health education to reduce the workload of healthcare professionals in these repetitive tasks. Social robots can be used to deliver interventions such as therapy or to monitor patient health and well-being.