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Children's National Turns to Autonomous Robot to Reestablish Human Touch in the ED

Analysis  |  By Scott Mace  
   June 16, 2021

Tech showed caregiver's faces to kids during pandemic, while protecting clinicians and specialists.

As the COVID-19 pandemic raged, a new autonomous robot rolled its way into the favor of providers and patients alike at Children's National Hospital in Washington, D.C.

The robot, acquired with funds made available by the Federal Communications Commission COVID-19 Telehealth Program, also helped solidify the hospital's role as a regional tertiary telemedicine hub for surrounding primary and secondary healthcare institutions.

In the first days of the pandemic, the robot permitted stricter separation of possibly COVID-infected patients in the hospital's emergency department from some hospital staff, and then was able to play a more focused role as patients were treated for any suspicion of infectious disease.

With help from staff engineers, the robot understands the layout of the emergency department. Staff are able to instruct the robot to move from location to location, and while getting there, the robot is able to negotiate getting there under its own control, through autonomous programming, giving people and other objects in its path plenty of room while it makes its way to its destination.

Staff can also control the movements of the robot via a mobile app on their phones when it arrives at each emergency treatment station. For example, not only can they have the robot take the vitals, staff can even make the robot wiggle and wave, amusing children, many of whom seem more at ease with the robot than they are with traditional staff care.

"I would recommend this to be used and to become part of the new standard of care," says Alejandro Jose Lopez-Magallon, MD, medical director of telemedicine at Children's National.

"We had three objectives in mind—to protect patients, protect families, and protect our staff," Lopez-Magallon says.

The robot's supplier, Teladoc Health, Inc., acquired InTouch Health, which originally created the robot (sold under the name Vita), in a company acquisition in early 2020. The robot joins a number of other telemedicine devices at the hospital, including two other autonomous robots, and telemedicine carts that lack autonomous movement, and hence must be moved from location to location by staff. Two of the three Teladoc Vitas there were acquired through the FCC program.

The robots act as eyes, ears, and more for clinicians on the other end of the connection. Clinicians are spared from having to change their personal protective equipment (PPE), which saves time and gives them the ability to move on to the next patient, while nurses and staff continue to provide bedside care.

"I sometimes can hear better than I could in person," referring to the robot's digital stethoscope, especially compared to the disposable plastic stethoscopes required for in-person exams during the pandemic, says Shireen Atabaki, MD, MPH, FAAP, FACEP, associate medical director of telemedicine and emergency medicine physician at Children's National. "It's very good for heart and lung sounds."

In addition to its video camera, the robot's instruments can be wielded by an onsite staff member to reveal to the remote physician or nurse conditions of the ear (otoscope), skin (magnifying dermatoscope), and circulatory system (blood pressure cuff).

"You can't examine the stomach and see if somebody's belly is tender," sums up the type of limits of such a remote examination, Atabaki adds. In that case, a nurse on site can conduct such exams.

And yet, there are other benefits. "Sometimes, the interaction is better," Atabaki says. "You see more of the child. They're moving around, they're not shy, they're talking, complaining to their mother, they're much more comfortable" than if the physician is there in person, particularly when decked out in PPE, she notes.

And to patients, the robot's screen shows them the human face of the clinician—as opposed to an in-person face swathed in PPE. "Showing your face and being able to interact with kids and families makes for a more amenable interaction than just a cold machine," Lopez-Magallon says.

Children's National was also awarded a large grant to create a regional telemedicine consortium across 15 health systems in the D.C. region. "The goal is to provide seamless pediatric specialty care and primary care across the region in light of the COVID pandemic," Atabaki says.

When a pediatric patient presents at a remote hospital, and Children's sends an ambulance to pick the patient up for transport to Children's, a Children's provider can be virtually on board during the trip, Atabaki says.

Children's also has a telemedicine-based COVID-19 follow-up clinic, and the hospital has already scheduled more than 500 visits there, Atabaki says.

"And we can invite a subspecialist, let's say a cardiologist, an endocrinologist, or dermatologists, to join us and provide subspecialty care in the emergency department to a patient," she says.

"Pediatric specialists are a scarce resource in the United States and around the world, even in our own region," Atabaki says. "Telehealth really helps overcome that."

Another area of focus for the regional telemedicine initiative has been providing mental health services between Children's National and its campus in generally underserved Wards 7 and 8 of the District of Columbia, employing telemedicine carts and iPads, Atabaki says.

In addition, a newly deployed family presence program dedicates an iPad and Zoom to each patient room in the hospital, and other hospital resources to allow families lacking Wi-Fi or adequate data plans to be able to communicate with patients from outside the hospital, she adds.

"If you're restricting the number of people that come into an ER with a child, this allows the family member who's out in the car waiting, or at home waiting anxiously to have communication, both with their child who's in the hospital in the ER, and also with the care team," Atabaki says.

Children's National will seek funding to continue the program even as existing funding to run the system sunsets.

"There will be other pandemics," Lopez-Magallon says.

Also, to protect against obsolescence, Children's National leases the Teladoc robot, instead of purchasing it.

"Technology is fluid, and we wanted freedom from having to do a lot of maintenance," he says. "It looks flashy initially, but in three to five years, then it just becomes some funky-looking old [tech]. And it always gets better. And that was a good arrangement."

“Pediatric specialists are a scarce resource in the United States and around the world, even in our own region. Telehealth really helps overcome that.”

Scott Mace is a contributing writer for HealthLeaders.


KEY TAKEAWAYS

COVID-19 FCC telehealth program provided initial funding.

Staff can direct the robot to travel autonomously to different stops in the emergency department.

Robot is part of a larger regional telemedicine program connecting 15 health systems in the Washington, D.C. region.


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