SANTA CLARA, Calif. — The inaugural Healthcare Robotics Engineering Forum, which was held this week at the Santa Clara Convention Center, continued its examination of the state of technologies to improve the quality of care. Keynotes, panelists, and other speakers also discussed design considerations and the commercial prospects for intelligent systems in healthcare.
Day 1 of the Healthcare Robotics Engineering Forum covered topics including 3D printed anatomies, human factors needs, and what developers should know about U.S. Food and Drug Administration guidelines. The day concluded with the presentation on the expo floor of the Leadership in Engineering Achievement Program or LEAP Awards, with OnRobot winning a Gold Award for industrial automation. About 450 people attended the international event, which was co-located with DeviceTalks West.
The programming on Day 2 delved deeper into healthcare robotics engineering. Here are more insights:
1. Robots aren’t replacing practitioners anytime soon
A recurring theme at the Healthcare Robotics Engineering Forum was that while most roboticists are aware of the opportunities created by automation, the general public and many healthcare practitioners are not. Historically low unemployment has coincided with the growth of robotics in healthcare and other industries, noted Ken Goldberg, professor of engineering at the University of California, Berkeley. Skills shortages and aging populations are contributing to the demand.
In his keynote, which opened Day 2, Goldberg outlined the history of the development of instruments such as steerable needles, interchangeable surgical tools, and a robotic palpation probe. Deep learning is helping healthcare robotics become more autonomous, but it’s still intended to assist rather than replace physicians and specialists, he said.
Goldberg asserted that levels of autonomy could be described in the same way as for autonomous vehicles.
Level 3 should be possible for supervised surgical sub-tasks like suturing and debridement. https://t.co/RxvWOlZppS
— Ken Goldberg (@ken_goldberg) December 10, 2019
Even with emerging technologies such as the Internet of Things (IoT), 5G networks, cloud robotics, and fog robotics, “surgeons won’t be replaced,” he said. “We need their instincts. We want to enhance surgeons and make them more consistent.”
Editor’s note: Goldberg will also be keynoting the “Robots for Good” track at CES 2020 in Las Vegas in January. Robotics Business Review, which is now a sibling site to The Robot Report, will be presenting that track.
Gregory Fischer, professor of mechanical and robotics engineering at Worcester Polytechnic Institute (WPI), described the work done at WPI’s PracticePoint development and testing facility on robotic systems that can work on a patient inside an MRI machine.
“We’re adding cooperative control like that for an autonomous car, with the doctor pushing the gas and the robot steering,” he said. “PracticePoint is working in real time in clinical environments.”
WPI is also working with the open-source community to develop application programming interfaces, simulations, and assistive technologies, Fischer said.
2. Healthcare robotics needs standards to get to market faster
“Standardization can help robotics companies build products that get to market faster,” said Naysahn Saeed, global director of healthcare services, CSA Group, a Canadian standards organization. “Standards can be even more helpful [in healthcare robotics] than in other applications because the process can answer public questions about safety. This helps with adoption, acceptance, and access to regulators.”
He cited fellow speaker Cory Kidd at Catalia Health’s session on Mabu, “an AI-powered, cloud-based, robotic wellness coach,” as well as the session by Gary Mulcahy, chief technology officer at Astrodyne TDI, about power assurance for robotic surgery. Both had said that standards are needed for diverse healthcare applications.
Industrial safety standards are considered “similar consensus standards,” Saeed explained.
In the works are two new safety standards: IEC 80601-2-77, which applies to robotically assisted surgical equipment (RASE), and IEC 80601-2-78, governing systems for rehabilitation, assessment, compensation, and alleviation (RACA) such as exoskeletons but not prosthetics.
While international standards bodies typically take five to 10 years to publish new requirements, technology moves faster, and the RACA and RASE standards moved relatively quickly, Saeed said. There is a transition period of two to three years for adoption and implementation of national rules, followed by a stability date or period of no updates. In this case, that would be from 2022 to 2024.
In addition to safety standards for hardware, healthcare robotics developers are becoming aware of the need for data-sharing standards.
“Industry leaders such as Intuitive Surgical and Auris Health are aware of the potential to share data,” said Goldberg. “They and others could synchronize and learn reliable policies from large enough data sets.”
3. Doctors welcome new tech — as long as it’s designed to truly help them
While physicians and surgeons might use cutting-edge technology in the operating theater, they take a step back to the 1940s to dictate results into a phone, said Carla Pugh, professor of surgery and director of the Technology-Enabled Clinical Improvement Center at Stanford University School of Medicine.
Current procedure reports are imprecise, said Pugh in the closing keynote of the Healthcare Robotics Engineering Forum. She described her work with a team combining wearable technologies, a variety of sensors, and artificial intelligence to record and analyze the maneuvers of surgeons.
“In October, we launched the Surgical Metrics Project at the American College of Surgeons’ Clinical Congress at the Moscone Center in Chicago,” Pugh said. “We are studying how to quantify surgical processes and are collecting data to represent nuances of processes. From that, we can create a baseline that can facilitate training and development of new technologies, but first, we need a baseline.”
“The goal is to bring surgeons into the conversation to understand different data streams and to have a voice in how the data is used and how they can benefit,” Pugh said. “We should think about data for mastery like athletics. Everybody wants to be excellent, and measurement culture is what healthcare needs.”
4. Healthcare robotics, from the battlefield to the OR
As with other robotics applications, much of the initial research and development into healthcare robotics has been supported by the U.S. military. How far a leap is it from the laboratory to the battlefield and back to hospital operating rooms or even ambulances?
The potential for teleoperation hasn’t yet been fully explored, acknowledged Goldberg.
“In a scenario where you have wireless, maybe 5G down the road, you could have some level of control for a device that would be operating under a surgeon’s control,” he replied to a question after his keynote. “It would do specified subtasks, using the perceptual skills of the doctor with the control systems of the remote system for reliability.”
5. View the hospital as an ‘indoor city’
Tony Melanson, vice president of marketing at Aethon, an ST Engineering company, likened a hospital to an “indoor city” in his session on “Applied Mobile Autonomy in Healthcare.”
“In terms of helping nurses with challenges with internal logistics, a hospital is a dynamic environment,” he said. “Healthcare has become the largest employer in the U.S. and is the largest contributor to worker’s compensation claims, costing an average of $40,000.”
Multiple sessions looked at the demands that clinical environments place on robotics, from hygiene and space to power and ease of use. As autonomous mobile robots, mobile manipulators, and robotic-assisted surgical devices grow from dozens to thousands of deployments, reliability and control will be important, said Melanson and others. Much of the emphasis will shift to software and services, they predicted.