Katherine Thomas doesn't remember much about the 19 days she spent in the intensive care unit at Methodist Hospital in Houston. Recovering from emergency surgery to remove part of her colon, Thomas, 63, drifted in and out of consciousness. But one vision stands out: the 5-foot robot that stopped in for a visit. "I thought it was something from outer space," she recalls. Piloted remotely by her doctor from a command center on another floor, her alien—which looked like an oversize carpet cleaner with a computer monitor stuck on top—allowed her medical team to do their rounds, "seeing" how she was doing and "reading" her vital signs, without unsettling her or the other extremely ill patients in intensive care.
Robots that glide through hospital halls may offer the most visually arresting example of the future of patient care. But they're just one of many dramatic advances changing how hospitals function. Radio-frequency ID tags that track every doctor, nurse, and piece of equipment in the hospital in real time, for example, can enable a faster emergency response. "Smart" beds that automatically transmit patients' breathing and heart rates to their charts can alert nurses to developing problems more quickly. One day in the not-too-distant future, any doctor in the country may have access to the complete medical history of an unconscious trauma patient—perhaps through an identifier implanted under the skin. According to industry analyst Datamonitor, spending on telemedicine, which now entails everything from remotely monitoring patients to analyzing medical images from afar and someday could even include long-distance surgery, will reach $2.4 billion this year and nearly triple to $6.1 billion by 2012.
The investment hospitals are making in change has basically two goals: to improve clinical care and slash error rates, and to reduce patient stress, encouraging healing. Ironically, one of the most anticipated developments is that technology will allow hospitals to do a better job of keeping people out of them. "By 2015, home will be the hub of care," predicts Naomi Fried, vice president of the innovation and advanced technology group at Kaiser Permanente's Sidney R. Garfield Health Care Innovation Center in San Leandro, Calif. Five years ago, when Kevin Reynolds of Corona, Calif., developed congestive heart failure (the No. 1 reason for hospitalization and readmission), he at first was in and out of the ER or urgent care center nearly every month, plagued by shortness of breath and dizziness. Now, doctors at Kaiser Permanente Riverside Medical Center can check his vital signs with the aid of a device the size of a clock radio connected to a scale and other monitoring equipment in his home. He weighs himself each morning and checks his heart rate, blood pressure, and blood oxygen levels; the data are sent in automatically.
If Reynolds's weight is up, indicating he's retaining fluids, he'll get a call from a nurse suggesting a diuretic. Once, when his blood pressure dropped too low, the nurse called him to the hospital immediately, but overall, Reynolds's time at the medical center is way down. "It's helped me with discipline and with taking care of myself," he says.
Remote diagnosis. In rural areas, where specialist coverage is sparse, telemedicine's contribution grows ever more sophisticated. Take ultra-time-sensitive stroke management, for example. In Michigan, 31 hospitals in far-flung locations now use robots identical to the one in Houston to allow a remote specialist to rapidly diagnose stroke and determine, before a patient's very narrow window of opportunity closes, whether he or she is a good candidate for tPA, a drug that dissolves clots. A neurosurgeon at St. Joseph Mercy Oakland Hospital in Pontiac can observe and talk to patients using the robot's video camera, as well as review the CT scan and other lab results. "After one year, 18 hospitals had administered the drug tPA that had never done so before," says Yulun Wang, the chairman and CEO of InTouch Health, which developed the robot.
Robots are increasingly making their mark in the operating room, too. Originally approved for general abdominal procedures like gallbladder removal, robotic surgery—the surgeon manipulates computer controls rather than a scalpel—is now used for heart and prostate cancer surgery, gynecologic procedures, and bariatric surgery, among others. With the help of a tiny camera inserted through an incision "port," a surgeon can see the surgical field onscreen as he sits at a console in the operating room, from which he guides the robot's instruments, also inserted through ports. Someday, the doctor guiding the robot could be sitting at a console literally across the world from the patient. If remote surgery eventually becomes commercially available, many lives might be saved in hard-to-reach locations, from remote islands to battlefields.