Improving Healthcare Outcomes & Reducing Costs Through Medical Automation

AMI, Inc.
Improving Healthcare
Through Automation

Outcomes & Reducing Costs
through Medical
Automation & Robotics
WPI Venture Forum
May 11, 2010

Medical Automation & Robotics

Past through Present
Opportunities
Technologies
Venues
Summary
References
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AMI, Inc.
Through Automation

Definitions

Robot Definitions vary. There is a general consensus of the essential robot
characteristics:
Sensors — Robots employ sensing technology to acquire information
about their environment.
Intelligence — Robots process information captured through sensor
technology and produce outputs for decision making, coordination and
control.
Motion — Robots automatically follow instructions that are pre-
programmed, or generated in real-time based on sensor input, to perform
deliberate, controlled, and often repeated, mechatronic action
Robotics for Medicine and Healthcare is considered the domain of
systems able to perform coordinated mechatronic actions (force or
movement exertions) on the basis of processing of information
acquired through sensor technology, with the aim to support the
functioning of impaired individuals, medical interventions, care
and rehabilitation of patients and also to support individuals in
prevention programs.
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Through Automation

Robotics: Ancient History

Automatons
Early automated device in antiquity
Ancient Alexandria, Egypt
Herron of Alexandria wrote 5 books
Recent discoveries demonstrated
• Automated doors
• Flying chariots
• Entertainment robotic theatres
Ancient Greeks
Ancient Chinese
Leonardo da Vinci
Lion walk across floor and present flowers to the king

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Through Automation

Medical Automation & Robotics:
History
1920-30s “Dumb” machines

1940-50s Computers developed

1st Industrial Robot Fantastic Voyage’
1960-70s GM: Unimate Movie

1st Lap Puma 560: SRI: Robotics &
1980s Cholecystectomy TURP Telemanipulation

1990s ROBODOC from ISS AESOPTM da Vinci of Intuitive Surgical

2000s Computer Motion & Intuitive Surgical Merge Hansen, Stereotaxis

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Through Automation

Opportunity

Minimally invasive procedures for
these surgeries in yellow late ’90’s

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AMI, Inc.
Through Automation

Growing Unmet Health Needs

Courtesy Robotics Business Review © 2009

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AMI, Inc.
Through Automation

Growing Clinician Needs

Clinician Shortages: Potential Solutions:
Patient - Nurse Ratio
improving education
Aging population
population growth
increasing job security
average age of nurses reverse bidding
changes in opportunities for staffing by a free agency
women
increasing wages
enrollment in nursing schools
high RN turnover rate
restrictions on work visas
understaffed nursing schools

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Through Automation

Market Drivers

Technology Drivers
Social Drivers Increasing Computer Power
Increasing disabled Imaging – 2D and 3D
Aging Population/Caregiver Pattern Recognition
demands Haptics - Palpation
Boomer expectations, demands, Advanced Materials
money and political clout MEMS/Nanotechnology
Litigious society Miniature Actuators
Sensors
Business/Clinical Drivers Human Factors Interface
Costs – Procedure and Economic
Reimbursement/Payors
Clinical Labor shortage
MIS Demand
Quality, Reliability and Safety
Precision
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AMI, Inc.
Repeatability Improving Healthcare
Through Automation

Barriers to Entry

Business/Clinical Barriers
Market Need - Moving Target
Reimbursement/Payors – CPT, ICD9, DRG
Intellectual Property
Competition
Expense of Development
Investors -> ROI
Liability
User acceptance/ease-of-use => data overload
Regulatory Approval – FDA, ISO
Clinical Trials
Politics

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Opportunity Costs
Better Healthcare Together report asserted
Broadband-based applications could save the US
$197 billion over next twenty five years.
Economist Robert Litan based savings on reducing ED
visits, hospitalizations, and length of stay in hospitals
Based on large population chronic diseases: congestive
heart failure, diabetes, COPD, and chronic skin
conditions.
Reimbursement issues are a critical issue to solve
Bringing broadband into more homes is a limiting
factor

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AMI, Inc.
Through Automation

Opportunity
Number of Expense Baseline Savings Policy Savings Gain from
Patients Policy Change

Heart 3.8 million $3.8 billion $79.7 billion $102.5 billion $22.8 billion
Patients
Diabetes 2.8 million $2.8 billion $42.3 billion $54.4 billion $12.1 billion
Patients

COPD 3.4 million $3.4 billion $18.7 billion $24.1 billion $5.4 billion
Patients

Chronic 0.1 million $0.1 billion $12.5 billion $16.0 billion $3.5 billion
Wound
Patients

Total: 10.1 million $10.1 billion $153.2 billion $197 billion $43.8 billion

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AMI, Inc.
Through Automation

Major Opportunity Areas

Ambulatory
Behavior/Social – Autism, Elderly
Clinical Care – Facilities, Nursing, Point-of-Care
Dental – CAD, Precision Hardware (Braces)
Emergency – ER, Accident, Battlefield
High Throughput Screening for New Drugs
Home – Social, Entertainment, Connectivity
Rehabilitation – Limb, Stroke
Surgery – CAS, Simulation Training, Telesurgery
Telemedicine AMI, Inc.
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Through Automation

Classes of Healthcare Robotics

Robotics Robotic Technology to Support Patients
Technology That
Support Doctors,
Surgeons, Dentists

Robotic Robotic Robotic Technology
Technologies For Technologies For That Supports
Temporary Use Continual Use Infrastructure
Robotic Interventional Robotic Robotic Assistive Robotic Hospital
Systems Rehabilitation/ Technology Systems Automation Systems
Therapeutic Systems
Robotic Robotic Support Robotic Prosthetic Robotic Smart Living
Learning/Training Systems and Orthotic Spaces
Systems Systems
Robotic Diagnostic Robotics Nursing Robotics Lifestyle Robotic Laboratory
Systems Assistants Enhancement Automation
Systems
Robotics Surgical
Assistants

Courtesy Robotics Business Review © 2009
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AMI, Inc.
Through Automation

Medical Venues: Acute to Ambulatory

Accident and Battlefield – Ambulance, Medic
Emergency Room (ER)
Operating Room (OR)
Hospital – Facilities, Nursing, POC
Clinical Laboratory
Rehabilitation and Long-Term Care
Physician Office: Point-of-Care
Home and Ambulatory

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AMI, Inc.
Through Automation

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Cost vs. Venue

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Cost vs. Venue

AMI, Inc.
Through Automation

Ambulance and Emergency

Requirements:
Locate patients
Evaluate patients’ injuries/disease
Stabilize and prepare patients for transfer
Monitor and transport patient and passengers to ER
Patient data communication w/physician + facility

Solutions:
Portable Vitals Monitoring Systems
Automated Dispatch Calling System
Servo-Controlled ambulance bed
VECNA Bear Robot for lifting some patients

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AMI, Inc.
Through Automation

Ambulance - Battlefield

Diagnostic and Therapeutic Instrument
Diagnose a battlefield injury based on biomarkers
in body fluids
Automatically releases appropriate drugs
By Clarkson University

Explosion Sensor
Disposable plastic strip, with
embedded sensors
Measure explosive power
Strip fits onto a soldier's helmet
Cost < $1
Records 1 week’s experience
DARPA funded the Palo Alto Research Center's
development

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AMI, Inc.
Through Automation

Ambulance - Battlefield

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AMI, Inc.
Through Automation

Ambulance - Emergency

Heartstart Portable Defibrillator
Life-Saving Technology
Automated for any user RFID system
IntelliVue MP2 Patient Emergency vehicles
by Philips
Monitor inventory control
By Philips by ThinkMagic developed

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AMI, Inc.
Through Automation

Emergency Room

Requirements: Solutions:
Determine and diagnose RFID Systems to track instruments
Patients’ injuries/disease Vitals Monitoring Systems
Stabilize patients Imaging Systems
Treat patients
Penelope
Prepare for transfer to OR, room,
home, or step-down facility

ER and Surgical Assistant: Penelope Robotic
Nurse
By Robotic Systems & Technologies

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AMI, Inc.
Through Automation

Surgical Applications
Cyberknife
Applications
Abdominal/GYN (AESOP, da Vinci)
Cancer (Cyberknife Radiosurgery)
Cardiac/Pulmonary/Thoracic/Vascular
(Hansen, Stereotaxis)
Neurosurgical (Neuromate)
NOTES (NeoGuide)
Orthopedic, Spine (RoboDoc, Mako Surgical,
Mazor)
First unmanned telesurgery
Urological involving a robotic surgeon and
Pediatric a robotic scrub technician

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AMI, Inc.
Through Automation

Operating Room

OR Surgical Requirements: Solutions:
Avoid injury / do no harm RFID Systems to track
Controlled Precise movements instruments
No tremor Vitals Monitoring Systems
No fatigue Imaging Systems
Clear visualization Hi-Res, Large Display
Provide unambiguous view Monitors
Different view perspectives
Surgical Navigations Systems
Maintain Patient stabilization
Vital signs remain normal Robotic Surgical Systems
Alter vitals as required
Reduced surgeon physical strain
Surgical instrument access
Instrument cleaning and
sterilization
Be prepared for unexpected AMI, Inc.
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Through Automation

Operating Room: Past

Intuitive Surgical’s
Using the da Vinci Surgical
da Vinci Surgical System
System

Computer Motion’s
AESOP Image Guidance
Optical: BrainLab,
Medtronic
Armstrong Healthcare’s Electromagnetic: GE
EndoAssist

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AMI, Inc.
Through Automation

Operating Room: Present

Stereotaxis Robot Hansen Medicals’ Sensei Robot

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AMI, Inc.
Mako Surgical Robot Improving Healthcare
w/Orthopedic Implant Through Automation

Operating Room: Future

Robot Arm from
Carnegie Mellon Institute

by Johns Hopkins University

by Johns Hopkins University Steady-hand Robot
System
Snake-like robot Surgeons will inject
Features two thin rods vision-saving drugs into
vision-
Tipped with tentacle-like
tentacle- tiny blood vessels in the
tools eye in the future
Six degrees of freedom
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AMI, Inc.
Through Automation


Microbot (Credit: Image courtesy of
ePill by Philips
Institute of Physics)
Research
Deliver a drug to a Analyze vascular wall
precise location in
Stop inflammation
the GI tract
Will soon test in Treat blockages
animals

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AMI, Inc.
Through Automation


MIS Mitral
valve repair
Robotic
System
Minimally
Invasive
Beating
Heart PneuStep Biopsy Robot by Johns Hopkins
by Harvard and Urology Robotics Lab
Children's Hospital
of Boston
Can do organ biopsies during MRI scans

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AMI, Inc.
Through Automation

Clinical Laboratory

Requirements
Accurate
Repeatable
Fast Response
Sufficient Capacity to meet
clinicians’ needs
New Microfluidics Analyzer
Maintenance & Service
Requires only a drop of blood
Tests for 35 proteins
Results in ten minutes
by Caltech and Institute for Systems Biology

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AMI, Inc.
Through Automation

Clinical Facilities

Requirements Solutions
Patient Tracking Equipment tracking RFID Systems
Entry Location Facility Robots
Procedures w/info Maintenance
eHealth Records
Location Recall status
Vitals monitors
Health status Medicine delivery
Study participant Laundry pickup and
Exit – delivery
w/instructions Food delivery and
Follow-up dish-utensil pickup
Instrument
Cleaning
Sterilization

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AMI, Inc.
Through Automation

Hospital

Helpmate - ATLIS (Automated Roving Physician
Transport and Logistics Integration By InTouch Health
Systems) by FMC

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AMI, Inc.
Through Automation

Hospital

Swisslog’s PillPick system Swisslog's BoxPicker
Bar-code packages High-density, automated
pharmacy
Stores and dispenses unit dose
medications Warehouse for the storage and
dispensing of medications
Unit doses are automatically placed
by Pill Picker Refrigerated medications, and
supplies

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AMI, Inc.
Through Automation

Hospital
WORLD'S LARGEST
TELEPHARMACY, THE US NAVY

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AMI, Inc.
Through Automation

Point Of Care – Doctor’s Office

Requirements Solutions
Patient Care Discrete Instruments with
Diagnose enhanced sensors
Therapy data
Refer display

Business and Admin EMR (Health IT, e-Health)
Business Software
21st Century Stethoscope

Accuson P10
handheld Signos Personal
ultrasound Ultrasound System
by Signostics
By Siemens

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AMI, Inc.
Through Automation


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AMI, Inc.
Through Automation

Rehabilitation

Requirements
Patient Care
Therapy
Feedback, Track Progress
Back to optimum health
Onsite and at home
Business and Admin

Myomo: Robots empower
patient at home

Intelligent Robotic Facilitator
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AMI, Inc.
Through Automation

Rehabilitation

Repetitive task practice
A Manhattan Project for
Patient controlled the Prosthetic Arms Race

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AMI, Inc.
Through Automation

Home, Ambulatory –
CARE EVERYWHERE

ISSUES SOLUTIONS
Healthcare Costs Maximize Health outside
17% GDP
20% by 2020
clinical settings
Prevention
Chronic conditions
75% of the nation’s Remote Rehab
health care costs Remote Monitoring
REQUIREMENTS Health IT, EHR, Telehealth
Connectivity
Reduce Costs Security
Improve Health Transparency
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AMI, Inc.
Through Automation

CARE EVERYWHERE

MEDICATION COMPLIANCE
> 1/2 the elderly population suffer from one or
more chronic illnesses
they have been prescribed ≥ 3 medications.
Non-compliance costs over $150 billion per year
in the U.S.
challenge of remembering how to take the
medications properly

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AMI, Inc.
Through Automation

CARE EVERYWHERE

"Equivital“
Wearable vital signs monitor OmniPod Insulin Management System
By Insulet Corporation
Measures and transmits
Heart rate
Two lead ECG
Respiration
Temperature
Blood oxygen saturation
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AMI, Inc.
Fall detection Improving Healthcare
Through Automation

CARE EVERYWHERE

Fitbit
Small size
pedometer
Clipped on
clothes or a
wristband
University of South Florida
24/7
monitoring Real Time
Wireless data Location System
Corventis - PiiX,
upload for Test movement
analysis • 15-centimeter patch monitoring
that applied directly to Early indication of
the patient’s chest. dementia
• It measures real-time
heart rate, body
temperature, physical
activity, body position,
respiration rate, and
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AMI, Inc.
body fluid levels Through Automation

CARE EVERYWHERE
Courtesy: Medical Automation

SENSORED CONTACT LENS
DETECTS GLAUCOMA
• High intraocular pressure is a sign
of developing glaucoma
Toto's new Intelligence Toilet II monitors weight, blood sugar
• ophthalmologists have means for levels, and other vital signs, transferring data to your computer
measuring that pressure, nut not for analysis via WiFi
continuous readings.
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AMI, Inc.
•Swiss company, Sensimed Improving Healthcare
Through Automation
(Lausanne) has a sensor-embedded
.


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AMI, Inc.
Through Automation

Future

Tissue Engineering + MEMS/NANO + Electronics + Mechanics +
Biologics + Microbiology =>
Life Supporting Systems – Limbs
Life Sustaining Systems – Organs
RoboSapiens or Humobots – Integration of systems and humans

RESULTS
Improved QOL
Extend Life
New life

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AMI, Inc.
Through Automation

SUMMARY: Key Steps to Success

Business Customer
Market Need - Moving Target Level of skill, knowledge
Clinical/Client Adoption User acceptance/ease-of-
use, Pervasive
Business Models – Who
Pays? DATA – Fragmented,
Overload vs.
Reimbursement/Payors – Understandable, Usable
CPT, ICD9, DRG
Clinical Trials
Regulatory Approval – ISO-
like Intellectual Property
Competition / Alliance
Expense of Development
Investors -> ROI
Liability

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AMI, Inc.
Through Automation

Website References

Organization URL
American College of Surgeons (ACS) http://www.facs.org
American Telemedicine Association http://www.atmeda.org
(ATA)
Medical Robotics and Computer Aided http://www.mrcas.ri.cmu.edu
Surgery (MRCAS)
Minimally Invasive Robotic Association http://www.mira2008.com ;
(MIRA) http://www.miraweb.org /
Robotics Association of America (RIA) http://www.robotics.org

Robotic Surgery http://www.roboticsurgery.com
Society of American Gastrointestinal and http://www.sages.org
Endoscopic Surgeons (SAGES)
Medical Automation http://medicalautomation.org/index.php

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AMI, Inc.
Through Automation

Medical Automation & Robotics

Thank You!
Martin Sklar
Automated Medical Instruments, Inc.
781-248-6841
msklar@automedinst.com

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AMI, Inc.
Through Automation

Improving Healthcare Outcomes & Reducing Costs Through Medical Automation

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