Improving Healthcare Outcomes & Reducing Costs Through Medical Automation

AMI, Inc.Improving Healthcare

Through Automation

WPI Venture ForumMay 11, 2010

Improving Healthcare proving Healthcare

Outcomes & Reducing Costs Outcomes & Reducing Costs

through Medical through Medical

Automation & RoboticsAutomation & Robotics

2AMI, Inc.Improving Healthcare

Through Automation

Medical Automation & RoboticsMedical Automation & Robotics

� Past through Present

� Opportunities

� Technologies

� Venues

� Summary

�References

Through Automation

DefinitionsDefinitions

Robot DefinitionsRobot Definitions vary. There is a general consensus of the essential robot vary. There is a general consensus of the essential robot characteristics:characteristics:

�� SensorsSensors —— Robots employ sensing technology to acquire information Robots employ sensing technology to acquire information about their environment. about their environment.

�� IntelligenceIntelligence —— Robots process information captured through sensor Robots process information captured through sensor technology and produce outputs for decision making, coordinationtechnology and produce outputs for decision making, coordination and and control. control.

�� MotionMotion —— Robots automatically follow instructions that are preRobots automatically follow instructions that are pre--programmed, or generated in realprogrammed, or generated in real--time based on sensor input, to perform time based on sensor input, to perform deliberate, controlled, and often repeated, mechatronic actiondeliberate, controlled, and often repeated, mechatronic action

Robotics for Medicine and HealthcareRobotics for Medicine and Healthcare is considered the domain of is considered the domain of systems able to systems able to perform coordinated mechatronic actionsperform coordinated mechatronic actions (force or (force or movement exertions) on the basis of movement exertions) on the basis of processing of information processing of information acquired through sensor technologyacquired through sensor technology, with the , with the aim to support the aim to support the functioning of impaired individuals, medical interventions, carefunctioning of impaired individuals, medical interventions, careand rehabilitation of patientsand rehabilitation of patients and also to support individuals in and also to support individuals in prevention programs.prevention programs.

Through Automation

Robotics: Ancient HistoryRobotics: Ancient History

�� AutomatonsAutomatons

�� Early automated device in antiquity Early automated device in antiquity

�� Ancient Alexandria, EgyptAncient Alexandria, Egypt

�� Herron of Alexandria wrote 5 books Herron of Alexandria wrote 5 books

�� Recent discoveries demonstrated Recent discoveries demonstrated

•• Automated doorsAutomated doors

•• Flying chariotsFlying chariots

•• Entertainment robotic theatresEntertainment robotic theatres

�� Ancient GreeksAncient Greeks

�� Ancient ChineseAncient Chinese

�� Leonardo da VinciLeonardo da Vinci

�� Lion walk across floor and present flowers to the kingLion walk across floor and present flowers to the king

Through Automation

1990s1990s

2000s2000s

1980s1980s

19601960--70s70s

19401940--50s50s

19201920--30s30s “Dumb” machines

Computers developed

1st Industrial Robot GM: Unimate

1st Lap Cholecystectomy

Puma 560: TURP

SRI: Robotics & Telemanipulation

Medical Automation & Robotics: History

da Vinci of Intuitive Surgical

Computer Motion & Intuitive Surgical Merge

ROBODOC from ISS AESOPTM

Fantastic Voyage’Movie

Hansen, Stereotaxis

Through Automation

Medical Automation & Robotics: Medical Automation & Robotics:

OpportunityOpportunity

Minimally invasive procedures for these surgeries in yellow late ’90’s

Through Automation

Growing Unmet Health NeedsGrowing Unmet Health Needs

Through Automation

Growing Clinician NeedsGrowing Clinician Needs

Clinician Shortages:Clinician Shortages:�� Patient Patient -- Nurse RatioNurse Ratio

�� Aging populationAging population

�� population growth population growth

�� average age of nurses average age of nurses

�� changes in opportunities for changes in opportunities for

women women

�� enrollment in nursing schools enrollment in nursing schools

�� high RN turnover ratehigh RN turnover rate

�� restrictions on work visas restrictions on work visas

�� understaffed nursing schools understaffed nursing schools

Potential Solutions:Potential Solutions:

� improving education

� increasing job security

� reverse bidding

� staffing by a free agency

� increasing wages

Through Automation

Social DriversSocial Drivers�� Increasing disabled Increasing disabled

�� Aging Population/Caregiver Aging Population/Caregiver demandsdemands

�� Boomer expectations, demands, Boomer expectations, demands, money and political cloutmoney and political clout

�� Litigious societyLitigious society

Business/Clinical DriversBusiness/Clinical Drivers�� Costs Costs –– Procedure and EconomicProcedure and Economic

�� Reimbursement/PayorsReimbursement/Payors

�� Clinical Labor shortageClinical Labor shortage

�� MIS DemandMIS Demand

�� Quality, Reliability and Safety Quality, Reliability and Safety �� Precision Precision

�� RepeatabilityRepeatability

Technology DriversTechnology Drivers�� Increasing Computer PowerIncreasing Computer Power

�� Imaging Imaging –– 2D and 3D2D and 3D

�� Pattern RecognitionPattern Recognition

�� Haptics Haptics -- PalpationPalpation

�� Advanced MaterialsAdvanced Materials

�� MEMS/NanotechnologyMEMS/Nanotechnology

�� Miniature ActuatorsMiniature Actuators

�� SensorsSensors

�� Human Factors InterfaceHuman Factors Interface

Market DriversMarket Drivers

Through Automation

Barriers to EntryBarriers to Entry

Business/Clinical BarriersBusiness/Clinical Barriers�� Market Need Market Need -- Moving TargetMoving Target

�� Reimbursement/Payors Reimbursement/Payors –– CPT, ICD9, DRGCPT, ICD9, DRG

�� Intellectual Property Intellectual Property

�� Competition Competition

�� Expense of DevelopmentExpense of Development

�� Investors Investors --> ROI> ROI

�� LiabilityLiability

�� User acceptance/easeUser acceptance/ease--ofof--use => data overloaduse => data overload

�� Regulatory ApprovalRegulatory Approval –– FDA, ISO FDA, ISO

�� Clinical TrialsClinical Trials

�� PoliticsPolitics

Through Automation

�� Better Healthcare TogetherBetter Healthcare Together report asserted report asserted

�� BroadbandBroadband--based applications could save the US based applications could save the US

$197 billion over next twenty five years.$197 billion over next twenty five years.

�� Economist Robert Litan based savings on reducing ED Economist Robert Litan based savings on reducing ED

visits, hospitalizations, and length of stay in hospitalsvisits, hospitalizations, and length of stay in hospitals

�� Based on large population chronic diseases: Based on large population chronic diseases: congestive congestive

heart failure, diabetes, COPD, and chronic skin heart failure, diabetes, COPD, and chronic skin

conditionsconditions..

�� Reimbursement issues are a critical issue to solveReimbursement issues are a critical issue to solve

�� Bringing Bringing broadband into more homesbroadband into more homes is a limiting is a limiting

factor factor

Opportunity CostsOpportunity Costs

Through Automation

OpportunityOpportunity

$153.2 billion $197 billion $43.8 billion

$12.5 billion $16.0 billion $3.5 billion

Baseline Savings Policy Savings Gain from

Policy Change

$10.1 billion10.1 million Total:

$0.1 billion 0.1 million Chronic Wound Patients

$3.4 billion 3.4 million COPD Patients

$2.8 billion 2.8 million Diabetes Patients

$3.8 billion 3.8 million Heart Patients

Expense Number of Patients

Through Automation

Major Opportunity AreasMajor Opportunity Areas

�� AmbulatoryAmbulatory

�� Behavior/Social Behavior/Social –– Autism, Elderly Autism, Elderly

�� Clinical Care Clinical Care –– Facilities, Nursing, PointFacilities, Nursing, Point--ofof--CareCare

�� Dental Dental –– CAD, Precision Hardware (Braces)CAD, Precision Hardware (Braces)

�� Emergency Emergency –– ER, Accident, BattlefieldER, Accident, Battlefield

�� High Throughput Screening for New DrugsHigh Throughput Screening for New Drugs

�� Home Home –– Social, Entertainment, ConnectivitySocial, Entertainment, Connectivity

�� Rehabilitation Rehabilitation –– Limb, StrokeLimb, Stroke

�� Surgery Surgery –– CAS, Simulation Training, TelesurgeryCAS, Simulation Training, Telesurgery

�� TelemedicineTelemedicine

Through Automation

Classes of Healthcare RoboticsClasses of Healthcare Robotics

Robotics Technology That Support Doctors, Surgeons, Dentists

Robotic Technology to Support Patients

Robotic Technologies For Temporary Use

Robotic Technologies For Continual Use

Robotic Technology That Supports Infrastructure

Robotic Interventional Systems

Robotic Rehabilitation/ Therapeutic Systems

Robotic Assistive Technology Systems

Robotic Hospital Automation Systems

Robotic Learning/Training Systems

Robotic Support Systems

Robotic Prosthetic and Orthotic Systems

Robotic Smart Living Spaces

Robotic Diagnostic Systems

Robotics Nursing Assistants

Robotics Lifestyle Enhancement Systems

Robotic Laboratory Automation

Robotics Surgical Assistants

Through Automation

Medical Venues: Acute to AmbulatoryMedical Venues: Acute to Ambulatory

�� Accident and Battlefield Accident and Battlefield –– Ambulance, Medic Ambulance, Medic

�� Emergency Room (ER) Emergency Room (ER)

�� Operating Room (OR)Operating Room (OR)

�� Hospital Hospital –– Facilities, Nursing, POCFacilities, Nursing, POC

�� Clinical LaboratoryClinical Laboratory

�� Rehabilitation and LongRehabilitation and Long--Term CareTerm Care

�� Physician Office: PointPhysician Office: Point--ofof--CareCare

�� Home and AmbulatoryHome and Ambulatory

Through Automation

Cost vs. VenueCost vs. Venue

Cost vs. Venue

Battle

Through Automation

Ambulance and EmergencyAmbulance and Emergency

Requirements:

� Locate patients

� Evaluate patients’ injuries/disease

� Stabilize and prepare patients for transfer

� Monitor and transport patient and passengers to ER

� Patient data communication w/physician + facility

Solutions:� Portable Vitals Monitoring Systems

� Automated Dispatch Calling System

� Servo-Controlled ambulance bed

� VECNA Bear Robot for lifting some patients

Through Automation

Diagnostic and Therapeutic Instrument

� Diagnose a battlefield injury based on biomarkers in body fluids

� Automatically releases appropriate drugs

By Clarkson University

Explosion Sensor

� Disposable plastic strip, withembedded sensors

� Measure explosive power

� Strip fits onto a soldier's helmet

� Cost < $1

� Records 1 week’s experience

DARPA funded the Palo Alto Research Center's development

Ambulance Ambulance -- BattlefieldBattlefield

Through Automation

Ambulance Ambulance -- BattlefieldBattlefield

Through Automation

Ambulance Ambulance -- EmergencyEmergency

IntelliVue MP2 Patient Monitor

By Philips

Heartstart Portable Defibrillator

� Life-Saving Technology

� Automated for any user

by Philips

RFID system

� Emergency vehicles inventory control

by ThinkMagic developed

Through Automation

Emergency RoomEmergency Room

ER and Surgical Assistant: Penelope Robotic Nurse

By Robotic Systems & Technologies

Requirements:

� Determine and diagnose

Patients’ injuries/disease

� Stabilize patients

� Treat patients

� Prepare for transfer to OR, room,

home, or step-down facility

Penelope

Solutions:

� RFID Systems to track instruments

� Vitals Monitoring Systems

� Imaging Systems

Through Automation

Surgical ApplicationsSurgical Applications

ApplicationsApplications

�� Abdominal/GYN Abdominal/GYN (AESOP, da Vinci)(AESOP, da Vinci)

�� Cancer Cancer (Cyberknife Radiosurgery)(Cyberknife Radiosurgery)

�� Cardiac/Pulmonary/Thoracic/VascularCardiac/Pulmonary/Thoracic/Vascular

(Hansen, Stereotaxis) (Hansen, Stereotaxis)

�� Neurosurgical Neurosurgical (Neuromate)(Neuromate)

�� NOTES NOTES (NeoGuide)(NeoGuide)

�� Orthopedic, Spine Orthopedic, Spine (RoboDoc, Mako Surgical, (RoboDoc, Mako Surgical,

Mazor)Mazor)

�� Urological Urological

�� Pediatric Pediatric

First unmanned telesurgeryinvolving a robotic surgeon anda robotic scrub technician

Cyberknife

Through Automation

Operating RoomOperating Room

Solutions:Solutions:� RFID Systems to track

instruments� Vitals Monitoring Systems� Imaging Systems� Hi-Res, Large Display

Monitors� Surgical Navigations Systems� Robotic Surgical Systems

OR Surgical RequirementsOR Surgical Requirements::� Avoid injury / do no harm

� Controlled Precise movements� No tremor� No fatigue

� Clear visualization� Provide unambiguous view� Different view perspectives

� Maintain Patient stabilization� Vital signs remain normal� Alter vitals as required

� Reduced surgeon physical strain� Surgical instrument access� Instrument cleaning and

sterilization� Be prepared for unexpected

Through Automation

Operating Room: PastOperating Room: Past

Image Guidance

Optical: BrainLab, Medtronic

Electromagnetic: GE

Intuitive Surgical’s da Vinci Surgical System

Using the da Vinci Surgical System

Armstrong Healthcare’s EndoAssist

Computer Motion’s AESOP

Through Automation

Operating Room: PresentOperating Room: Present

Mako Surgical Robot w/Orthopedic Implant

Stereotaxis Robot Hansen Medicals’ Sensei Robot

Through Automation

Operating Room: FutureOperating Room: Future

SnakeSnake--like robotlike robot�� Features two thin rods Features two thin rods

�� Tipped with tentacleTipped with tentacle--like like

tools tools

�� Six degrees of freedomSix degrees of freedom

SteadySteady--hand Robot hand Robot

SystemSystem�� Surgeons will inject Surgeons will inject

visionvision--saving drugs into saving drugs into

tiny blood vessels in the tiny blood vessels in the

eye in the futureeye in the future

Robot Arm from Carnegie Mellon Institute

by Johns Hopkins Universityby Johns Hopkins University

Through Automation

ePill by Philips Research

� Deliver a drug to a precise location in the GI tract

� Will soon test in animals

Microbot (Credit: Image courtesy of Institute of Physics)

� Analyze vascular wall

� Stop inflammation

� Treat blockages

Through Automation

MIS Mitral valve repair Robotic System

� Minimally Invasive

� Beating Heart

by Harvard and Children's Hospital of Boston

PneuStep Biopsy Robot by Johns Hopkins Urology Robotics Lab

� Can do organ biopsies during MRI scans

Through Automation

Clinical LaboratoryClinical Laboratory

RequirementsRequirements

� Accurate

� Repeatable

� Fast Response

� Sufficient Capacity to meet clinicians’ needs

� Maintenance & Service New Microfluidics Analyzer

� Requires only a drop of blood

� Tests for 35 proteins

� Results in ten minutes

� by Caltech and Institute for Systems Biology

Through Automation

Clinical FacilitiesClinical Facilities

RequirementsRequirements

� Patient Tracking� Entry

� Procedures w/info

� Location

� Health status

� Study participant

� Exit –w/instructions

� Follow-up

� Equipment tracking � Location� Maintenance

� Recall status

� Medicine delivery

� Laundry pickup and delivery

� Food delivery and dish-utensil pickup

� Instrument � Cleaning

� Sterilization

Solutions

� RFID Systems

� Facility Robots

� eHealth Records

� Vitals monitors

Through Automation

HospitalHospital

Roving PhysicianBy InTouch Health

Helpmate - ATLIS (Automated Transport and Logistics Integration Systems) by FMC

Through Automation

Swisslog’s PillPick system

� Bar-code packages

� Stores and dispenses unit dose medications

� Unit doses are automatically placed by Pill Picker

HospitalHospital

Swisslog's BoxPicker

� High-density, automated pharmacy

� Warehouse for the storage and dispensing of medications

� Refrigerated medications, and supplies

Through Automation

WORLD'S LARGEST TELEPHARMACY, THE US NAVY

HospitalHospital

Through Automation

Point Of Care Point Of Care –– DoctorDoctor’’s Offices Office

Signos Personal

Ultrasound Systemby Signostics

Requirements

� Patient Care

� Diagnose

� Therapy

� Refer

� Business and Admin

Solutions

� Discrete Instruments with

� enhanced sensors

� data

� display

� EMR (Health IT, e-Health)

� Business Software

� 21st Century Stethoscope

Accuson P10 handheld ultrasound

By Siemens

Through Automation

RehabilitationRehabilitation

Myomo: Robots empower patient at home

Intelligent Robotic Facilitator

Requirements

� Patient Care

� Therapy

� Feedback, Track Progress

� Back to optimum health

� Onsite and at home

� Business and Admin

Through Automation

RehabilitationRehabilitation

A Manhattan Project for the Prosthetic Arms Race

� Repetitive task practice

� Patient controlled

Through Automation

Home, Ambulatory Home, Ambulatory ––

CARE EVERYWHERECARE EVERYWHERE

ISSUESISSUES�� Healthcare Costs Healthcare Costs

�� 17% GDP 17% GDP

�� 20% by 202020% by 2020

�� Chronic conditionsChronic conditions�� 75% of the nation75% of the nation’’s s

health care costshealth care costs

REQUIREMENTSREQUIREMENTS�� Reduce CostsReduce Costs

�� Improve HealthImprove Health

SOLUTIONSSOLUTIONS

�� Maximize Health outside Maximize Health outside

clinical settingsclinical settings

�� Prevention Prevention

�� Remote Rehab Remote Rehab

�� Remote MonitoringRemote Monitoring�� Health IT, EHR, Telehealth Health IT, EHR, Telehealth

�� ConnectivityConnectivity

�� SecuritySecurity

�� TransparencyTransparency

Through Automation

MEDICATION COMPLIANCEMEDICATION COMPLIANCE

�� > 1/2 the elderly population suffer from one or > 1/2 the elderly population suffer from one or

more chronic illnesses more chronic illnesses

�� they have been prescribed they have been prescribed ≥≥ 3 medications. 3 medications.

�� NonNon--compliance costs over $150 billion per year compliance costs over $150 billion per year

in the U.S. in the U.S.

�� challenge of remembering how to take the challenge of remembering how to take the

medications properlymedications properly

Through Automation

OmniPod Insulin Management System

By Insulet Corporation

"Equivital“

� Wearable vital signs monitor

� Measures and transmits

� Heart rate

� Two lead ECG

� Respiration

� Temperature

� Blood oxygen saturation

� Fall detection

Through Automation

Fitbit

� Small size pedometer

� Clipped on clothes or a wristband

� 24/7 monitoring

� Wireless data upload for analysis

Real TimeLocation System

� Test movement monitoring

� Early indication of dementia

University of South Florida

Corventis - PiiX,

• 15-centimeter patch that applied directly to the patient’s chest.

• It measures real-time heart rate, body temperature, physical activity, body position, respiration rate, and body fluid levels

Through Automation

SENSORED CONTACT LENS DETECTS GLAUCOMA

• High intraocular pressure is a sign of developing glaucoma

• ophthalmologists have means for measuring that pressure, nut not continuous readings.

•Swiss company, Sensimed (Lausanne) has a sensor-embedded .

Courtesy: Medical Automation

Toto's new Intelligence Toilet II monitors weight, blood sugar levels, and other vital signs, transferring data to your computer for analysis via WiFi

Through Automation

FutureFuture

Tissue Engineering + MEMS/NANO + Electronics + Mechanics + Tissue Engineering + MEMS/NANO + Electronics + Mechanics + Biologics + Microbiology => Biologics + Microbiology =>

�� Life Supporting Systems Life Supporting Systems –– Limbs Limbs

�� Life Sustaining Systems Life Sustaining Systems –– OrgansOrgans

�� RoboSapiens or Humobots RoboSapiens or Humobots –– Integration of systems and humansIntegration of systems and humans

RESULTSRESULTS�� Improved QOLImproved QOL

�� Extend LifeExtend Life

�� New lifeNew life

Through Automation

SUMMARY:SUMMARY: Key Steps to SuccessKey Steps to Success

BusinessBusiness

�� Market Need Market Need -- Moving TargetMoving Target

�� Clinical/Client AdoptionClinical/Client Adoption

�� Business Models Business Models –– Who Who Pays?Pays?

�� Reimbursement/Payors Reimbursement/Payors ––CPT, ICD9, DRGCPT, ICD9, DRG

�� Regulatory ApprovalRegulatory Approval –– ISOISO--like Intellectual Property like Intellectual Property

�� Competition / AllianceCompetition / Alliance

�� Expense of DevelopmentExpense of Development

�� Investors Investors --> ROI > ROI

�� LiabilityLiability

CustomerCustomer

�� Level of skill, knowledgeLevel of skill, knowledge

�� User acceptance/easeUser acceptance/ease--ofof--use, Pervasive use, Pervasive

�� DATA DATA –– Fragmented, Fragmented, Overload vs. Overload vs. Understandable, Usable Understandable, Usable

�� Clinical TrialsClinical Trials

Through Automation

Website ReferencesWebsite References

http://medicalautomation.org/index.phphttp://medicalautomation.org/index.phpMedical AutomationMedical Automation

http://www.sages.orghttp://www.sages.orgSociety of American Gastrointestinal and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)Endoscopic Surgeons (SAGES)

http://www.roboticsurgery.comhttp://www.roboticsurgery.comRobotic SurgeryRobotic Surgery

http://www.robotics.orghttp://www.robotics.orgRobotics Association of America (RIA)Robotics Association of America (RIA)

http://www.mira2008.comhttp://www.mira2008.com ; ;

http://www.miraweb.org /http://www.miraweb.org /

Minimally Invasive Robotic Association Minimally Invasive Robotic Association (MIRA)(MIRA)

http://www.mrcas.ri.cmu.edu http://www.mrcas.ri.cmu.edu Medical Robotics and Computer Aided Medical Robotics and Computer Aided

Surgery (MRCAS)Surgery (MRCAS)

http://www.atmeda.orghttp://www.atmeda.orgAmerican Telemedicine Association American Telemedicine Association (ATA)(ATA)

http://www.facs.orghttp://www.facs.orgAmerican College of Surgeons (ACS)American College of Surgeons (ACS)

URLURLOrganizationOrganization

Through Automation

Medical Automation & RoboticsMedical Automation & Robotics

Thank You!Thank You!

Martin SklarMartin Sklar

Automated Medical Instruments, Inc.Automated Medical Instruments, Inc.

781781--248248--68416841

msklar@automedinst.commsklar@automedinst.com

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