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Hospital robots need close oversight and strict governance

Strong governance is vital for finding the right balance between cutting-edge technology and patient care in the clinical setting.

Kaiser Permanente sparked outrage when reports surfaced that its emergency department used a robotic application to deliver sensitive information to a patient in Fremont, Calif.

USA Today was the first media outlet to report the incident, writing that end-of-life news was delivered to a patient with chronic lung disease via a robotic screen that displayed a doctor from a remote location.

Kaiser Permanente disputed the accuracy of reports in a statement and said the organization does not use robots to deliver terminal diagnoses. It went on to say it will use the incident as an opportunity to review how to improve patient experiences when interaction with video capabilities is involved.

Still, the incident raises questions about using hospital robots, especially in patient-facing settings. Healthcare organizations will be challenged with finding the right balance between the ethics of patient care and cutting-edge technology. For John Henderson, vice president and CIO of CHOC Children's, establishing governance is key to achieving that balance.

"If it's the right thing for our patients and their families, we will figure out the best and safest way to implement it," Henderson said.

Balancing patient care and new technology

Hospital robots are a familiar topic at CHOC Children's, a regional pediatric healthcare network that includes a 334-bed main children's hospital in Orange, Calif. For years, the healthcare organization has used 4-foot-tall remote robots to transmit video so CHOC Children's clinicians can consult with Hoag Hospital Newport Beach Emergency Department on young patients about to be transferred to the organization.

Before deploying new technology in the clinical setting, a governance process that consists of guidance from an executive steering committee and project leadership teams helps determine how and when to deploy new technology, Henderson said.

Often, the governance team recommends piloting the technology in small, contained areas, so CHOC Children's can quickly identify and address potential issues and learn what adjustments need to be made to the workflow to support successful deployment and adoption beyond a pilot, he said.

"We do extensive testing and validation in nonproduction environments before releasing any patient-facing technology to production," Henderson said.

When the technology launches broadly, Henderson said CHOC Children's establishes a control center that partners with hospital operations to monitor the technology and evaluate how it's working in the context of patient workflow and experience. The control center will remain in place for roughly 15 to 30 days before the healthcare organization transitions back to normal operations.

After that, CHOC Children's will continue to monitor the technology to ensure quick response to issues that may arise between patients and the technology -- something Henderson said is one of the biggest challenges when it comes to implementing patient-facing technology. Clearly defining the technology's purpose and capabilities, as well as its limitations, is vitally important, he said.  

"We want to continue to provide high-quality care and maintain our patients' and families' confidence in the technology," Henderson said. "Being able to clearly articulate what the technology can and, most importantly, cannot do is critical and is sometimes the most difficult message to convey."

Future of robotics in healthcare

Robotics in healthcare is not a new concept. They've been integrated into telemedicine and surgical settings, but using robots for patient interaction is a challenging one, according to health psychologist and social scientist Kathrin Cresswell.

Indeed, hospital robots that interact with patients and even with healthcare staff are being adopted at a slower pace than in other areas, such as in surgery, according to Cresswell.

But, in surgical settings, patients are somewhat passive during the experience, and the robot is controlled by the surgeon. Introducing hospital robots to the clinical setting brings a host of unpredictable challenges emerging from mixing both human and robotic worlds, Cresswell said.

We do extensive testing and validation in nonproduction environments before releasing any patient-facing technology to production.
John HendersonCIO, CHOC Children's

"The extent of these challenges can only really be discovered by use in context, which then may lead to potentially undesirable consequences," Cresswell said.

For healthcare organizations introducing hospital robots, it's about "trying to avoid the car crash before it happens" by evaluating technological functions in small-scale pilot settings, Creswell said. Pilots should include a limited number of humans, including patients and healthcare staff, in a natural clinical environment over extended periods of time.

"You need good social science to guide these evaluations and a close working relationship between developers and implementers to make adjustments as you go along," she said. "Only when this is done should you start thinking about scaling functionalities. While careful evaluation is likely to help avoid some accidents, there will always be a risk for others, as the real social world is extremely complex and unpredictable."

Ethical concerns also pervade the idea of hospital robots, because patient issues can vary across people and settings. And because technologies are evolving rapidly, ethical and legal frameworks may struggle to keep up, she said.

"One consideration in relation to patient-facing robotic functions is whether we are creating a new two-tier healthcare system where only the privileged can afford care by a human being," Creswell said.

She said she believes it's important healthcare organizations keep in mind that robotic applications are intended to improve patient care. That should mean evaluating local drivers for the technology, as well as determining patient expectations and potential concerns before implementation.

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