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Robots can deliver the goods

Materials Management in Health Care

Max started work at 304-bed Truman Medical Centers , Kansas City, Mo. , in February. His job is delivering medical-surgical supplies from Truman's central supply to its emergency department, operating room and delivery room.

Though Max weighs about 600 pounds, has a limited vocabulary and has no interests outside of work, “the nurses love him,” says his boss, Christopher Harris. “They get their item when they need it.”

That's because Max, who got his name in a hospital-wide contest, is a self-guided HelpMate robot made by San Diego-based Pyxis, a division of Cardinal Health.

“I don't have to go out and look for Max, like I would for an employee,” says Harris, whose title is Pyxis system manager at the hospital. Back at central services, Harris can always spot Max's location in the hospital on a flat-screen computer monitor.

Harris says Max makes 60 trips a day. Traveling at a normal walking pace, this wheeled robot skirts around people and objects and boards elevators to get to other floors.

Max stands on pivoting casters that allow him to rotate 360 degrees. He makes just a few programmed statements, such as "My way is blocked, please move the obstacle." A compartment in his belly, the size of a double-wide kitchen cabinet, carries syringes, linens and other supplies. Harris says the robot has even carried a waffle mattress that was needed in a hurry. The compartment can only be opened with fingerprint identification.

A late bloomer

The word “robot” was coined in 1923, in the play R.U.R. by Karel Capek, but it took decades to create a machine that could more or less fit the description.

A courier robot needs to navigate on its own. HelpMate's creators had to devise a vision system that would calculate direction, determine the distance to objects in the robot's path and generally avoid people and objects, according to the Advanced Technology Program, a U.S. government agency that helped fund HelpMate's development.

“They have to be trainable (programmable),” ATP stated in a brief report on the project. “They must make quasi-intelligent decisions — ‘Go around the gurney with the patient on it.' And they have to be able to report to their human supervisor and ask for help when encountering problems they cannot handle — ‘There is no one here to sign for the parts.' ”

HelpMate, which is especially designed for hospital settings, is technologically more advanced than its chief competitors, which tend to have much smaller groups of clientele. One of them, RoboCart, is manufactured by California Computer Research in Lake Arrowhead , Calif. , and is basically a motorized table for use within a limited area, such a laboratory. Tug, made by Pittsburgh-based Aethon, hauls supply carts around the hospital using wireless signals and sensitive light whiskers that are much like HelpMate's. ATLIS, made by FMC Technologies in Chalfont , Pa. , is a hauling robot like Tug but carries three times the load.

Some futurologists predict that by 2050, more than half the jobs in the United States could be done by robots. But progress toward that goal has been slow for transport robots in healthcare. Twelve years after HelpMate was introduced, Pyxis officials say demand is fairly level. They count more than 100 HelpMate robots at 95 hospitals nationwide. Though these customers represents less than 2 percent of all hospitals nationwide, they include some big names, such as UCSF Medical Center in San Francisco, Barnes-Jewish Hospital in St Louis, Massachusetts General Hospital in Boston and Memorial Sloan-Kettering Cancer Center in New York.

“It takes a certain mindset to be interested in the HelpMate,” says Robert Sobie, vice president for marketing at Pyxis . “You have to say, ‘I'm going to turn this work over to a robot.' You have to be able to trust in technology. That's quite a change for a hospital.”

Sobie says HelpMate's four major uses are in laboratory, radiology, pharmacy and food service. It is also used in central sterile supply for smaller surgical instruments and in materials management to fulfill urgent stock orders, he adds.

Pyxis reports that hospitals with as few as 115 beds have the robot, and the average size of customers is 250 beds. Company officials add that that in most cases, hospitals that buy the robot have recently downsized and are looking for ways to make more efficient use of remaining staff.

The high price can yield savings

Pyxis reports that its robot costs $170,000 to buy -- much higher than the simpler RoboCart, priced at almost $25,000 – but almost all Pyxis customers lease the HelpMate robot.

Don Chase, a product manager at Pyxis, says the lease, which runs for five years, has no standard rate. For example, Truman leases HelpMate as can be part of a package with Cardinal's Pyxis Station, which automates distribution, management and control of medications and supplies. But 139-bed Sentara Williamsburg Community Hospital , in Williamsburg , Va. , which rents only the HelpMate, recently reported that it pays about $2,600 a month.

Chase says the lease rate includes a training session on using the robot and installation of wireless systems and programming on site. This involves installing a map of the hospital into the robot and wiring automatic doors and elevators so that they can be operated using wireless signals from the robot. Sobie adds that the lease price also includes updates of HelpMate software, but not major hardware upgrades, which occur every three years, with the next one scheduled for March 2006.

Pyxis representatives would not quote a return on investment for the robot, saying that savings depend on the cost of people who normally transport material, which vary widely from orderlies to professionals, and salaries within those job categories vary by locality.

Other sources, however, have quoted savings. A 2000 study by Manuel Rosetti, an assistant professor of engineering at the University of Arkansas , predicted that a hospital in Virginia could save as much as $218,000 a year if it replaced 15 human couriers with six HelpMate robots. That comes out to projected savings of $14,500 per robot. But looking at actual savings, APT, the government agency, found somewhat more modest results. It reported that one hospital pharmacy realized net annual savings of around $10,000 per robot per year.

Franklin Square Hospital Center in Baltimore logged better returns from its HelpMate. The 299-bed facility reported in 2002 that the robot saved its food services department about $900 a week when comparing the costs of the robot with the nursing time saved delivering supplies. That comes out to $46,800 a year in savings.

In comparison, Aethon reports that Tug, the hauling robot, saves hospitals as much as $240,000 in its five-year life, or $48,000 a year. The company says Tug costs a hospital as little as a quarter of what employees would cost to do the same task. There were six TUGs in hospitals at last report, but Aethon says it now has a contract with the Department of Veterans Affairs to sell Tugs to VA hospitals.

How robots improve bottom lines

As noted, savings from robots come primarily from freeing up staff time. Savings are high because staffers who transport material in hospitals are often trained people in short supply, such as nurses and technicians.

Transporting supplies when needed can take up a significant amount of time in several hospital departments. In the laboratory, for instance, delivery of specimens and supplies along with documentation tasks can take up 20 percent of the staff's time, according to a report by Robin A. Felder PhD, director of the Medical Automation Research Center at the University of Virginia Hospital in Charlottesville , Va.

Trained medical technologists and medical laboratory technicians who work in labs are desperately needed for more skilled tasks. The American Society for Clinical Pathology recently reported that 46 percent of medical laboratories reported problems in recruiting qualified staff. The society added that at small hospitals, medical technologists deliver 80 percent of lab samples.

Truman's Harris and others report that the robots are particularly valuable on the night shift, when few staffers are available to make deliveries.

Not only can robots fill in for humans, but they are also more efficient and dependable, people who use HelpMates report. They sys these robots operate around the clock, except during battery recharging, and do not take coffee breaks, chat with other personnel or forget and end up in the wrong place. The federal ATP agency reports that the Helpmate makes fewer delivery mistakes than humans and in 1999, the pharmacy at the University of Mississippi Medical Center in Jackson , Miss. , reported that its HelpMate cut delivery times in half.

"People are not reliable for this work," Ellis M. Frohman, director of laboratories at 1,385-bed Barnes-Jewish, told the St Louis Post-Dispatch in a story about its Helpmate several years ago. "They may start out strong at 8 o'clock in the morning, but they will very shortly get tired of going back and forth. And eventually, they will look out the window or go to lunch, or whatever."

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