Institute of Medicine

The Institute of Medicine estimates that tens of thousands of Americans die needlessly every year from avoidable medical errors, including infections acquired during surgery. GE and the U.S. Department of Veterans Affairs have now teamed up to change that. They will develop an “intelligent” system using robots, computer vision and automatic identification technologies like RFID tags to fetch, sort, and sterilize surgical tools. The system could save lives, and money.

Some of the technologies behind the system have been helping to automate manufacturing lines for years. But their application in the surgery environment is new. “We believe that in combination with a new level of intelligence, they can help make operating rooms run more efficiently, lead to better patient outcomes, and save millions of dollars in healthcare costs,” says Lynn DeRose, a principal investigator and “auto-ID expert” in the Distributed Intelligent Systems Lab at GE Global Research.

DeRose says that scalpels, clamps and other tools will bear unique IDs that the intelligent robotic system can recognize. The system will be designed to perform a series of tasks, including the sorting of surgical tools, sterilization, and location tracking during transportation to and from the operating room. The goal: deliver the right sterilized tools in the right place, at the right time, and in the right order. DeRose says that perhaps her biggest challenge will be to make the robotic system “intelligent enough” to manipulate a diverse set of surgical implements. “Even maneuvering something as simple as a pair of scissors requires lengthy coded instructions for a robot,” she says.

A system like this is long overdue. Staff in many hospitals still inspect, wash and count tools by hand, a technique that is inefficient and potentially fraught with errors that can lead to delays and patient harm. An automated robotic system could cut surgical infections, streamline surgery scheduling, and improve efficiency. “According to experts in the field, the surgical operation and recovery setting is considered the fastest growing and most resource intensive section of the hospital, accounting for approximately 30 to 50 percent of a hospital’s budget,” DeRose says. “Simply put, the operating theater is the single largest contributor to a facility’s bottom line.”

The designers will evaluate the the two-year, $2.5 million project a VA hospital.

In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers.

Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others.

The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services.

This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments.

This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary (2012). Tracy A. Lustig, Rapporteur; Board on Health Care Services; Institute of Medicine