”Telemedicine is the delivery of healthcare from a distance. Communication technologies are used to bridge distances between patients and healthcare providers. Telemedicine creates the possibility for access to specialized care for patients who may not typically have access to care.”*
Karen Deli, InTouch Health, VP Operations, Physician Services
Historically, we have understood clinical care to be a serious, and sometimes intimate interaction between at least two human actors: the physician with particular medical knowledge and the patient, who bears concerns about the essence of her own mortality. In this way, medical care has been an exchange that involves the idiosyncrasies of human relationships as the patient consults the physician for her specialized clinical expertise. Since medical care involves what it means to be a living being, face-to-face interactions carry significant epistemic and moral import within the human relationships established in clinical encounters. In this project, we aim to unpack the complexities of the telepresent iRobot Vita and its subsequent implications for other meta-elements of healthcare. We do not endorse the Vita as the only telepresent robot for healthcare, but rather we selected this particular device in order to unpack and capture the technical and social complexities that the Vita presents for modern clinical care.
A New Paradigm of Medical Care
Telemedicine challenges our traditional understanding of this relationship between physician and patient, historically understood by the concept of “bed-side manner” and other anthropocentric behaviors demonstrated by body language, tone, and other idiosyncratic communication. Since the physician can actually “see” the patient from a remote location, the patient may not necessarily have a face-to-face interaction with the physician charged with her medical care prior to a telepresent clinical interaction. Why is this significant? Perhaps because the experience of a clinical interaction is especially relevant to how clinicians diagnose patients, and how patients respond to the tenets of those their diagnosis. Nevertheless, telemedicine is empowering patients through the expansion of access and equipping physicians to attend to patients more carefully and expediently.
Through the corporate partnership of iRobot and InTouch Health, the RP-Vita (Remote Presence Virtual + Independent Telemedicine Assistant), telepresence in healthcare is becoming a new standard of care. RP-Vita allows clinical providers to “see” the patient without being physically present, or even in the hospital in which the patient is located. This is so revolutionary because medical care is no longer limited to the context of hospitals or even a primary care clinic. Although RP-Vita’s concrete use cases are highly specified in neurology and acute post-surgical care, the reach of telepresent robots in medicine is actively expanding to more regular use cases, such as primary care.
We organized and designed the above socio-technical diagram in order to reflect on the immense complexities that Vita brings to our healthcare system. Physicians and other clinical providers alike are still bound by ethical codes by the American Medical Association, regulations by the Food and Drug Administration, privacy mandates advanced by the Health Insurance Portability and Accountability Act of 1996 and clinical care standards with healthcare robots outlined by the American Telemedicine Association. These regulations continue to govern patient-provider interaction. Despite the goal to advance patient-centered care, the patient is not the center of the diagram because the Vita acts as a conduit of communicating medical data between physicians and patients. Vita is visually centered in order to illustrate the vitality of Vita’s communicative element in the patient-provider experience.
Using Robots to Better Equip Healthcare Providers
Holding clinical consultations or visits telepresently largely alleviates the conventional burdens that physicians experience in hospitals, namely the lack of consolidated team-based care, competing demands from other clinicians, and distractions of various forms. Relief of physician burnout in areas marked by physician or specialist shortages identifies a major benefit of telepresent healthcare robots to providers themselves. Accordingly, telehealth technologies empowers physicians to focus directly on one patient at a time. Although there are some concerns that care may begin to lose important human elements of traditionally conceived care, provider experience in telemedicine demonstrates the vast opportunities to expand care to underserved areas, increase clinical efficacy, and reduce physician burnout. We consider the benefits of telehealth technologies, namely that of RP-Vita, to outweigh the concerns of the technology use in clinical care. Those concerns are addressed below.
Expanding Geographical Coverage
Furthermore, telemedicine equips physicians to treat patients who otherwise may not have access to particularized medical care. For example, patients in very rural communities do not always have the same treatment options or medical facilities as patients in more urban settings. Specifically, a stroke patient may be able to visit her local clinic and be “seen” by a neurologist physically located 100 miles away. This reduces costs for the patient in terms of travel to access medical care, and enables the physician to more expediently treat patients. In this way, telemedicine expands the gate to new treatment opportunities that are both local and cost-effective for both the clinical care provider and the insurer.
Concerns for Ethics
At present, not all telemedicine visits are insured or fully reimbursable by healthcare companies. This is the current case for iRobot Vita, which raises the question of distributive justice in terms of resources. Further, the use of telepresent robots in healthcare challenges the notion of trust within the traditional physician-patient relationship where the patient in need of clinical evaluation entrusts her care to the physician with expert medical knowledge. Telemedicine offers vast opportunities for the delivery of modern healthcare, however questions of moral import should be evaluated to ensure that basic protections of privacy, confidentiality, and human dignity are maintained in the telepresent mediated experience between physician and patient. We claim that in order to anticipate ethical challenges with telehealth technologies, innovators and healthcare actors concerned with the implications of growing use of telepresence devices in medicine should engage with one another in order to anticipate those moral concerns before ethics has to “catch up.” In this way, attuned awareness for the ethical concerns of telehealth technologies need not hamper innovation, but rather it can serve as a complimentary check on the ways in which those technologies are developed and incorporated into modern clinical care.
*Deli, Karen. “The Essential Elements of a Just In Time Virtual Organization: A Transformation in the Delivery of Healthcare Services – A Case Study: Specialists on Call.” Masters paper presented by Karen M. Deli. Executive Masters in Leadership Degree, McDonough School of Business, Georgetown University. (February 14, 2012): 1. Accessed February 26, 2018.