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.
Proponents of robotic surgery note that the robot's "hands" are steadier and have a wider range of motion than human hands and that the instruments are more flexible than traditional laparoscopic instruments. This can lead to less pain and blood loss, and potentially better clinical outcomes, they say. But results of studies on outcomes are mixed, says Richard Satava, a professor of surgery at the University of Washington. "If it costs more to do the same operation with the robot, that will slow down the adoption somewhat," he says.
Records reform. Meanwhile, a slow but sure transformation in the way patient records are gathered and stored gained momentum last winter when the economic stimulus package set aside $19 billion for healthcare information technology. Currently, just 1.5 percent of private hospitals can claim a comprehensive electronic medical records system in all clinical units, according to a study published in the New England Journal of Medicine in April. An additional 7.6 percent have a basic system in at least one unit. But putting patient records into digital form and into the massive national database envisioned by President Obama has the potential, assuming it happens, to provide a wealth of information about which treatments work and which don't—and to speed diagnosis and medical care and curtail unnecessary tests and procedures.
A number of institutions offer a hint of what is possible. In the emergency department at Kaiser Permanente's Oakland Medical Center, doctors and nurses carry flat computer tablets about the size of a piece of paper that can access every Kaiser patient's entire medical record. If a patient has previously visited any Kaiser Permanente facility, ER staff can immediately call up his or her medications and any recent test results. They can also sit down next to a bed and show patients an X-ray, say. When Palomar Medical Center West near San Diego opens in 2012, patients will sleep on "LifeBeds" covered in "smart" fabric that records their heart rate, pulse, and respiration and sends the info directly to their medical record.
On a medical/surgical unit at the University of Pittsburgh Medical Center, a flat-screen monitor is mounted on the wall near the foot of every bed. Hospital staffers wear ultrasound ID tags, and as soon as they walk into the room, their name and job title pop up. The system then makes the appropriate chart information available onscreen—a phlebotomist would see what blood draws to do, for example, while a nursing assistant might see what medications are due. The patient has access to the information as well. "Everyone's engaged, sharing the same information," says Tami Minnier, chief quality officer for UPMC. That's important, say experts. Whereas medical practice has traditionally tended to be paternalistic, practitioners now believe that the sense of empowerment that patients get from being engaged in their care can lead to better outcomes. It's the "I think I can" approach.
Besides engaging people in decisions about their own care, hospital administrators are exploring ways that physical structure and environment can ease anxiety and promote wellbeing. "Evidence-based design" is inspired by studies suggesting that patients heal better if they have access to nature, natural light, and artwork, for example. In one oft-cited study, researchers found that surgical patients whose rooms looked out on trees used less heavy medication, suffered fewer minor complications, and went home nearly a day sooner than patients whose rooms looked out on a brick wall. The plans for Palomar Medical Center West call for a plant-filled central atrium and gardens at each end of every floor, and rooms with floor-to-ceiling windows looking out on the mountains, furnished so that family members can stay overnight.
Room change. Palomar's rooms will also be "acuity adaptable," meaning that as the patient's condition changes, the room can, too—becoming an intensive care unit temporarily, say. Studies show that moving patients less frequently results in fewer falls and medication errors. The traditional centralized nursing station will be replaced by stations outside rooms, where a nurse checking in can see the patient.
Some design changes and concepts speak more to hospitality than healthcare: plush furnishings, parking spaces near the door, a self-serve kiosk check-in system that—like a global positioning system—instructs you where to go ("take 10 steps forward and turn right down the corridor labeled 'east wing' "). Such a focus on comfort "creates a healing environment and helps people feel like they have some control," says Bruce Schroffel, CEO of the University of Colorado Hospital. (Skeptics note it may also give facilities a competitive edge in attracting affluent patients with good insurance.) One day soon, patients may be able to order meals, adjust the room temperature and lighting, surf the Internet, and videoconference with family using a remote control in bed.
Or it may take a little bit longer than anticipated. According to an April survey by the American Hospital Association, nearly 8 in 10 hospitals report that they have stopped, postponed, or scaled back facility upgrades or information technology projects because of the economy's recent woes. "The recession is clearly slowing construction projects down," says James Bentley, a senior vice president at the AHA. "How much, we'll see." At whatever pace, though, change is coming.