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Some fear that hospitals will become “Robots R Us” environments, but that is unlikely. Chatbots, although useful, are poor stand-ins for in-depth, in-person conversation with a health care provider. And if COVID-19 did anything, it put a million faces to the tragedy of what it’s like to die without human contact.
Never has the phrase “necessity is the mother of invention” been truer than in the past year. For beleaguered hospitals, not always known as early adopters of change, the need to cope with an unprecedented pandemic has led to (maybe forced is the better word) an exceptional openness to inventive ways of delivering health care services.
And everything is happening at maximum velocity. Changes that once would have taken months, if not years, are now being deployed while the ink is still wet. “The urgency of decision-making and new ideas…has led to so much change that we now refer to it as ‘COVID time,’” writes Emily C. Webber, MD, chief medical information officer at Riley Children’s Health and Indiana University Health.1
Some of the changes have been sticking-the-finger-in-the-dike–type solutions: Whatever works, do it, and do it fast. This includes nurses wearing garbage bags because they don’t have enough personal protective equipment, for instance.
Some changes will not only have staying power, but spur innovation; say, in technology.
Health care has already realized what technology can do. According to Zebra Technologies’ 2019 Intelligent Enterprise Index survey, health care facilities were among the 17% of businesses that self-identify as fully “intelligent enterprises.” In other words, they have “connected the physical and digital worlds” by, for example, digitizingworkflow and using cloud computing.2
The Atlantic Council GeoTech Center surveyed more than 100 technology experts on the impact of COVID-19 on 5 key fields: the future of work, data and artificial intelligence (AI), trust and supply chains, space commercialization, and health and medicine. Nearly all respondents believe that the coronavirus pandemic will “accelerate invention significantly” in 4 of those fields, with “little impact” on space tech innovation3 (quite a statement, considering we’re now getting weather reports from Mars).
“As the virus imposes heavy demands on health care systems, strains international supply chains, and changes the way we work, it will spur innovation in those areas,” the report says. “Likewise, as cloud infrastructure is forced to cope with increased traffic and public health professionals strive to harness massive data sets to fight the pandemic, developments in the fields of data and AI will accelerate.”
For institutions, initiating change is often like trying to turn an ocean liner around. But in an interview with MedCity News, Bill Cox, director of quality at Hospital Sisters Health System in Springfield, Illinois, said, “Over the past year, we quickly learned that implementing technology during a pandemic required us to be as fluid as possible. We couldn’t be locked into a strict timeline with no flexibility or willingness to shift key milestones. Once lockdown began, we had to rethink our timing and learn to plan for uncertainty.”4
Being constantly in crisis mode has meant maximizing and repurposing existing technology. And the advanced-tech innovations are coming fast and furious from around the world. But what if the appropriate technology isn’t ready yet? Individuals and institutions step up.
Consider Manan Gandhi. In India, where the situation is now so dire that people are dying in hospital parking lots if they aren’t dying at home, Gandhi teamed up with Amit Sarda, an app developer, to tackle the problem of finding COVID-19 essentials such as medicines, oxygen cylinders, and hospital beds. They created a free online app, Covid Resource, that collects all the information into 1 uniform platform. The developers have crowdsourced a user-friendly way to search, with information created from Google Docs shared on social media and regularly updated by a Twitter community.5
The staff at Massachusetts General Hospital also took the initiative. They repurposed nearly 600 iPads from closed outpatient units to create video portals to communicate with patients in isolation rooms.6 First, though, they had to figure out the most efficient way to display the iPads, which turned out to be on poles for intravenous (IV) therapy. “We had to pull together things we had on the shelves, like clamps to secure the iPads to the IV poles, and repurpose and reconfigure that equipment, and it takes a lot of work to take something to go from zero to 100 and implement [it],” said Keith Jennings, chief information officer, in one of the hospital’s publications. The devices reside on bedside tables; patients can initiate a conversation without having to push buttons. The hospital also reprogrammed secure phones and iPads so patients can receive video calls from family and friends.
Video capabilities and telehealth, already in use since 1959, became an even more essential connection between doctors and patients during the pandemic, particularly for patients who did not have COVID-19 but still needed care. With strict isolation, video and “chatbots” have allowed caregivers to keep track of signs and symptoms from a distance. Northwell Health in New York added thousands of Amazon Echo Show smart displays to its facilities, 2-way video-calling devices for providers and patients (and configured the devices to comply with federal telehealth guidelines on privacy and data protection).7
A top priority everywhere has been to ensure that staff and patients are as safe as possible. Hospital Sisters’ 15-hospital system has, for example, implemented SwipeSense electronic hand hygiene monitoring systemwide. “Change is always difficult—and change across 15 hospitals is change magnified times 15,” Cox said. “Since electronic hand hygiene was a new technology, the culture change and education was really about the value of moving from a manual process to an automated process…. We had to get staff [to] buy into the rationale for a new electronic process and emphasize that it’s best for our patients.”
He adds, “With any technology or culture change, there will always be people who don’t like the new process and question everything.” The answer, he believes, is to engage in the conversation and show how the process is valuable and how it changes outcomes. It’s also important, he says, to reward compliance and success.
“COVID-19 actually surfaced a very challenging issue—the dependence on manpower,” said Ng Kian Swan, chief operating officer of the National University Health System (NUHS) in Singapore, in an article for channelnewsasia.com.8 Many hospitals have been “hiring” extra help in the form of robots for years, but the pandemic has pushed robots to the front line of the front line, so to speak. Robots don’t need personal protective equipment (PPE) and they don’t get sick. Nor do they mind endlessly going from room to room doing repetitive tasks such as bringing supplies, so they free up staff to focus on caregiving. They also keep human interactions to a minimum, reducing the chance of virus transmission.
Take Moxi, for instance. Moxi has been working full time at Medical City Heart Hospital and Medical City Spine Hospital in Dallas, Texas, for more than a year now. It delivers PPE, coronavirus and other lab samples, and COVID-19 tests. It picks up and delivers things dropped off for patients. “When you add [everything] up, …it could add maybe 10 to
15 minutes per task,” the hospitals’ chief operating officer, Josh Kemph, told KXAN Austin, an NBC affiliate in Texas. And with Moxi running anywhere from 50 to 75 tasks during a shift, “it’s hours and hours back to the staff.”9 At one of the hospitals, Moxi delivered more than 4000 items of PPE in a month. “[E]very one of those is something that a nurse did not have to run down to another unit to grab,” Andrea Thomaz, CEO and cofounder of Diligent Robotics, which built Moxi, told KXAN.
Robots are used to disinfect patient rooms with equipment using UV light. One type of bot uses UV-C lights to destroy the genetic material of viruses in minutes. Others enforce social-distancing rules. In Belgium, Antwerp University Hospital employs robots that speak more than 53 languages and determine whether face masks are being worn appropriately.10
In a “smart” field hospital in China, robots backed up exhausted staff by flagging patients with fevers, measuring blood oxygen levels via smart bracelets, delivering medications, and cleaning infected areas. They even provided exercise lessons and entertainment for quarantined patients.11 Drones also have been pressed into service, for jobs such as building inspections.
Some fear that hospitals will become “Robots R Us” environments, but that is unlikely. Health care is, at its core, in the business of connecting people to people. Chatbots, although useful, are poor stand-ins for an in-depth, in-person conversation with a health care provider. And if COVID-19 did anything, it put a million faces to the tragedy of what it’s like to die without human contact.
“Quit trying to get robots to replace people,” said Robin Murphy, PhD, Raytheon Professor of Computer Science and Engineering at Texas A&M University, speaking to the Robotics for Infectious Disease consortium last year. Robots should not (and cannot) take the place of skilled workers and should not be used in situations where human empathy is important, she stated. Instead, they should be used to protect human workers and help them by minimizing the time they waste on unskilled tasks.12
The most sensible way to use robots in a pandemic, Murphy advised, is to use the ones that already exist, that people are already comfortable using, and that can scale up to be immediately useful. The middle of a pandemic—or anytime during a pandemic for that matter—isn’t the right time to drop a new bit of technology into the mix. The people needed to operate the robot (most need adult supervision) are already exhausted and stressed. They shouldn’t have to take valuable time to get up to speed on the robot.
John Wall, principal technical adviser at Metro North Hospital and Health Service in Brisbane, Australia, observed that the pandemic has caused a number of changes there too. Leading IT design for redevelopment for hospitals, he has found that with COVID-19 “everyone’s had to learn to adapt and be agile. Normally in health care, staff are too busy, but there’s been a real change in the dynamic over the past 6 months. There has been so much more ownership and interaction, and people are more open to working through the solutions and being a part of them.”13
Here to Stay?
Many tech-driven systems and ways of providing care have proved their worth during the pressurized time of COVID-19 and have a guaranteed future in health. Telemedicine, so crucial, has received a tremendous leg up in the past year. The CARES Act, for example, delivered $200 million to start the COVID-19 Telehealth Program.14 The funding will support broadband connectivity and telemedicine kiosks, among other things.
The pandemic also revealed yawning gaps in infrastructure. Many facilities have been working on becoming more agile, making it possible to switch spaces from purpose to purpose more fluidly. “One of the many lessons of this crisis is that flexibility of space is paramount to enable optimum resilience and provide readiness for the unknown,” said Suzanne MacCormick, global health care business growth lead at WSP, a professional services firm. “Smart” building solutions, such as a system that combines various technologies to monitor power, lighting, patient logistics, and air quality, all in real time, can support that resilience.15
This month, the VA Palo Alto Medical Center began rolling out Bitscopic’s Praedi-
Alert clinical surveillance tool, which includes a dashboard for automatically monitoring patient blood samples for COVID-19 infection. “Many infection control processes in hospitals are still done manually,” said Farshid Sedghi, Bitscopic’s chief operating officer and cofounder, “which means that problems are detected only after they occur and countless hours of manual work is done, which could have happened automatically, 24 hours a day, with the right software system.”16
Then there’s the tech tool that bridges many different health care areas: barcoding. From keeping track of patients throughout their hospital stay to labeling specimens, barcoding can help manage surges in volume, such as when a pandemic arises.
Ng Kian Swan of NUHS says leveraging the new types of technology “helps us to drive efficiency, productivity, safety. Most importantly, it also provides a platform for us to upskill our fellow colleagues…it is actually preparing a future-ready workforce.”
Knowledge is power, and data of all kinds have become a powerful weapon against future crises. Capturing data from this pandemic could mean that the next one is much more easily managed. Health informatics, the clinical application of data and digital technology, is one of the fastest growing fields, according to WSP.
But a STAT news article warns, “Some AI systems could also be susceptible to overfitting, meaning they’ve modeled their training data so well that they have trouble analyzing new data—which is coming constantly.…”17 And according to Wall, “Smart projects fail because they don’t get to the heart of the way that humans do things.”
The pandemic’s impact has been massive, in lives lost, services rendered, and money spent. Now, (hopefully) on the downward slope of the mountain, we can begin to act on lessons learned and incorporate the most useful into the so-called new normal. Identifying at-risk patients, screening staff and patients, distinguishing COVID-19 from other respiratory illnesses, predicting which patients will get worse, and tracking supplies are all things that can be improved and adapted for postpandemic use. They’re not just here for the pandemic, they’re here for the future.
In 1942, Isaac Asimov defined the Three Laws of Robotics, the first being: A robot may not injure a human being or, through inaction, allow a human being to come to harm. Technology at its best serves us well and health care will always be people based. But technology will always have to make room for the individual, like Manan Gandhi, who just wants to help people live.
JAN DYER is a writer and editor specializing in clinical topics. She lives in Suffern, New York.