The Future Isn’t Far
photo courtesy of The Night Hospitalist Co.
Robots and mobile carts offer hospitalists remote access to multiple patients at multiple facilities.
“I think it’s going to explode,” says Yomi Olusanya, MD, a hospitalist in rural Rolla, Mo., and founder of The Night Hospitalist Co., LLC, a startup that is busy developing a business model to provide nighttime hospital coverage via telemedicine. “I think with increased costs and the shortage of physicians, hospitalist groups are not going to have any choice but to find alternative ways of doing business. I really believe that.”
Dr. Olusanya envisions establishing a team of about 10 telehospitalists who would handle cross-coverage calls at multiple hospitals in multiple states. The hospitalists would use a mobile cart fashioned with a high-resolution, dual-focus video screen; a video camera; and diagnostic equipment, such as a digital stethoscope, to aid in physical exams. Hospital clients would be given a toll-free number to call to connect with a telehospitalist between
7 p.m. and 7 a.m., and on-site nurses would simply wheel the mobile cart into a patient’s room to begin the care. All overnight changes in medical management would be transmitted to the correct hospital floors for insertion into patients’ medical records. The Night Hospitalist plans to cover malpractice insurance for its physicians and charge a nightly rate, which would vary depending on the length of the contract.
The mobile cart costs between $20,000 and $30,000, and Dr. Olusanya is contemplating absorbing that expense just to get groups interested. At this point, he’s not promising prospective clients cost savings. Instead, he’s offering them a way to lighten the physician workload in order to increase productivity, job satisfaction and career longevity.
“We’re trying to sell the idea to hospitalists,” he says. “This is so new that I’m trying to figure out the best model.” After originally including hospital admissions in his business model, he ultimately decided to focus exclusively on cross-coverage calls and leave the admissions to an on-site physician. “At this point, I don’t see the telemed machine in the ED doing an admission of a new patient, because it becomes less efficient,” he explains.
Conversely, Eagle Hospital Physicians’ remote-robot program is designed to do hospital admissions. The RP-7 robot is mobile enough to aid in cross-coverage, but hospitals must be careful not to overburden the machine with floor calls because it takes the robot longer to travel around the hospital than it does for an on-site physician, says Betty Abbott, Eagle’s chief operating officer.
—Betty Abbott, COO, Eagle Hospital Physicians, Atlanta
Through the robot, which stands 5 feet 6 inches tall, a remote hospitalist can interact with a patient, the patient’s family, and the physician or nurse through a live, two-way audio and video system. The remote hospitalist can move the robot’s head to view charts and vital signs on monitors, zoom in to look at a patient’s pupils, and use several diagnostic tools with the help of an on-site health provider to conduct a patient exam, Abbott says. The remote hospitalist also can split the robot’s screen to show a patient X-rays, test results, videos, or other multimedia imaging.
“Certainly, using a robot to interact with patients takes some thought,” Abbott says. “Doctors have to be good at using the robot to act like a human being rather than simply a stationary screen in a room.”
The robot received high marks from patients, hospitalists, ED staff, and healthcare providers who participated in the pilot program at St. Joseph’s Hospital, according to the results of Eagle’s unpublished study. The technology is user-friendly enough that all types of healthcare providers can be trained to use it, says Dr. Godamunne. He designed and helped implement the study, and he found patients quickly adapted to the robot once they focused on the physicians’ faces on the screen.