After repeated surgeries, Riggs began oral chemotherapy, administered by doctors locally, followed when his cancer progressed by a regimen of ipilimumab, a new agent that stimulates the immune system to fight cancer and has shown great promise in a subset of people with advanced melanoma. Now, Doolittle says, scans show no evidence of disease. At first, remote visits were "a little different," Riggs recalls. But the process has "really worked out well."
On hospital floors, robots now bring distant expertise right to the bedside. Chad Miller, an associate professor of neurology and neurosurgery at the Wexner Medical Center at Ohio State University, tells of an intensive care patient he "saw" three years ago when he was working in Los Angeles as a neurointensivist for a provider of telemedical services. The patient had arrived at Fountain Valley Regional Medical Center showing signs of stroke: His language was impaired, and he was slow to respond.
Thanks to a human-size stand-in made jointly by iRobot, manufacturer of the Roomba robotic vacuum, and InTouch Health, a remote health and telepresence company, Miller was able to examine the patient and ask questions. His face appeared on a screen atop the console, and he could zoom in with a camera. He also had access to the patient's scans and history. Miller was able to determine that the man actually was suffering from acute meningitis and quickly prescribed antibiotics.
"Getting the right specialist there can be a life-and-death situation," says Yulun Wang, CEO of InTouch Health, whose latest venture with iRobot, the RP-VITA robot, was announced in May and is now presiding at a handful of hospitals including those at Ohio State and UCLA. For Miller and other doctors operating it remotely, it's a huge improvement. Unlike older versions that had to be rolled in by staff, the RP-VITA can get around by itself, locating itself using sensors, GPS and internal maps, and avoiding obstacles and people. The remote doctor need only tap a patient's location on a laptop or tablet, and the robot will roll to the bedside. Even late at night from home, says Miller, he will be able to see how his patients are progressing. As many as three doctors at once can tap in for a real-time huddle.
Given that there are about 10,000 intensive-care units in the country and only slightly more intensivists – the specialists familiar with multiple systems in the body and how they interrelate during trauma – it should come as no surprise that many health care systems are exploring robots and other variations of the tele-ICU. Sentara has pioneered a central mission-control model, monitoring ICU beds in five of its acute-care hospitals from one place. An intensivist on duty has access to the records and vital signs of patients in more than 100 beds, all of them able to be assessed by a camera in the room if needed. The vital signs and lab results of each patient are fed into a system that processes minute-by-minute data and provides alerts when heart rate or blood pressure, for instance, reaches a threshold or a new trend is emerging as a red flag. "It gives a doctor specially trained to treat critically ill patients the opportunity to see more patients and take care of more critical issues," says Steve Fuhrman, Sentara's eICU medical director.