Children’s Hospitals Today, Winter 2011

An interview on health care telepresence with Dr. Jason Knight, “the robot doctor” at CHOC

Hoag Hospitals in both Newport Beach and Irvine, CA, have an unusual team member helping triage pediatric patients in the emergency departments: the RP-7 is a rolling robot that helps bring the telepresence of a far-off doctor into the room. >Most often, the remote doctor behind the robot is Jason Knight, M.D., medical director of transport services at CHOC. Knight is literally the face of this technology for many of the pediatric patients seen in both Hoag emergency departments. When the robot rolls into a room, the high-resolution display that is the “head” of the robot is usually a live feed of Knight wearing a welcoming smile.

Rationale for remote consulting

“Putting a robot at Hoag started as part of our support and commitment to the children of the nearby Newport Beach area,” Knight says. “The robot can move anywhere in the emergency department. I can use it to talk to patients, their families and emergency department physicians, and most importantly, I can look at the patient, look at the monitors, and check vital signs. I can even listen to the heart and breath sounds with a stethoscope attachment that plugs into the robot. All the data coming into my eyes and ears is something that I never would have had before this system.”

A few years ago, Hoag Hospital Newport Beach, which was primarily seeing adult patients, hired a new chief executive officer who made a business case to close the hospital’s low-census pediatric unit. The decision was made to work with CHOC, approximately 15 miles away, to have it transport and admit any pediatric patients in need of specialized services. As part of his roll with transport services, Knight was the physician leader responsible for putting a robot in the Hoag’s Newport Beach emergency department.

“Hoag created a special status for consulting doctors using the robot; there is now a separate certification for telemedicine privileges just for people like me. My only roll at Hoag is performing telemedicine consults,” Knight says. “On our end at CHOC, we trained all the intensivists and transport team on how to use the robot. A pediatric intensivist is available 24/7 to assist and consult on any pediatric patient that comes into the Hoag emergency department.”

Robot capabilities

The Remote Presence RP-7 robot, made by InTouch Health, can be remotely controlled by a joystick from anywhere with a compatible control station. There are approximately 200 RP-7 units in use at hospitals nationwide. Wheels allow the robots to move around on any flat surface, and a system of high precision video cameras, microphones and a stethoscope make it possible for doctors like Knight to examine patients, talk with families and consult ”in-person” with medical staff to decide on the best course of treatment.

“The clarity of the RP-7 system is fantastic. I have the ability to look 360-degrees and can even zoom in on any detail from the corner of a room and look closely at a patient’s respiratory pattern, examine their perfusion, watch the capillary refill time. I can make it even better with still images if I need to. I can then display the images on the robot’s display and draw on the picture from my remote station to highlight details on X-rays, EKGs,” Knight says. “I can narrate and ‘telestrate’ anything that might help in planning treatment; it’s all highly reliable, and it’s all done in real time.”

Reactions to a robot doctor

The robot has been in place at Hoag Hospital Newport Beach for almost three years, and at Hoag Hospital Irvine since it opened on September 1, 2010, but it is still a novelty and reason for excitement for patients.

“They love it,” Knight says. “I have probably done more telemedicine consults than anyone in our hospital—4 to 6 per month on average. I have the ability to assess a patient, recommend interventions and outline a plan of care for the child. This gives families and caregivers incredible peace of mind. I have yet to have a family say anything negative about it. Usually, they are surprised, impressed and put at ease, knowing a pediatric-trained specialist was involved from the beginning.

“The most fun part of the system is when I get to follow up at CHOC with a patient who first met me through the robot at Hoag. The reaction I get the most is ‘hey, you’re the robot doctor!’” Knight says. “I get to explain that in reality, I’m a real doctor who is here caring for patients, but technology has made it possible for me to meet you, and for you to see my face on the robot, before you ever walk into CHOC.”

Next steps for telepresence

CHOC has a second RP-7 robot in action at the newly opened Hoag Hospital location in Irvine, CA, and Knight sees telepresence functionality growing radically in the next few years.

“My hope for the future is to have a portable RP transport unit that allows me to assess any patient being transported by the CHOC team,” Dr. Knight says. “I’m hopeful that in 2011, I will be able to visualize and start planning treatment for patients from the moment our transport team reaches them. The earlier we can provide pediatric-specific expertise to a patient, the better the care we can provide.”

Hopes for the future

With all the functionality available now, Knight is still looking at how the growth of telepresence technology will continue to change medicine.

“I would like to have the functionality for physicians to monitor patients from home. For instance, the cardiac surgeon operates all day and goes home at night. If he wants to see how his patients are doing in the ICU, he could log into a robot and do night rounds with the nurses before he goes to bed,” Knight says.

“On the other hand, we have patients who are chronic and have lots of medical problems and long term morbidities. Many are in-between; they can’t go home right now because they are too much work for their parents and because they can’t be adequately monitored, but they don’t need the full services of an ICU. If we could use telepresence like the RP-7 to check in daily, look at the patient’s vital signs, and talk with the family and home nurse, it could allow patients to spend more time at home. This would provide a huge cost savings over having a patient spend months in an acute care setting.

“I see some form of telepresence becoming standard practice for medicine in the next five years. And this is true whether we are talking about connecting to the home from the hospital or to the hospital from the home. The applications are endless in both directions.”

Interviewed by Tim Haynes, Assistant Director, Communications, NACHRI