Robotics- Planning for the Future

by Will Turner and Fred Crans

After the Civil War, the United States was facing a problem. A previously existing technology had begun to spread like lightning, but standards controlling its growth and implementation had not caught up. That technology was the railroad, and two standards of importance required addressing. First- the size of the track. While railroads were proliferating, different size track was used, making it difficult or impossible for different lines to merge. That problem was largely addressed with the Pacific Railroad Act of 1863 was passed, naming “Standard Gauge” the appropriate gauge. While most lines converted, some remained as outliers. On November 18, 1883, the second problem was addressed when Time Zones were implemented across the country. Prior to that time, there were hundreds of individual “time zones,” each controlled locally. The railroads’ need for a standard for measuring time was the impetus for the change. Finally, on June 1, 1886, there was a two-day changeover in which the remaining railroads not using Standard Gauge were forced to convert.

Problems solved- over twenty-three years. Solving the problem cost the outliers a great deal of time and money, and probably drove some out of business.

In today’s healthcare world, technologies such as AI, Machine Learning and Robotics are being implemented at a rapidly-growing pace. Like the railroads of the late 19th Century, Robotics has been around for some time. But in the last few years, its usefulness in areas both clinical and operational has seen its growth explode. The need to perform work with greater accuracy and at lower operating costs has fueled the growth. In many cases, robots can perform tasks more reliably and at lower costs than humans, and since the COVID-19 pandemic, the two greatest problem confronting healthcare organizations are (1) controlling operating costs and (2) recruiting and maintaining a viable workforce.

Robotics, in particular, offers an avenue to address those two concerns. Due to its wide range of possible applications, it can serve the healthcare community on both the direct patient care side, including actual participation in surgical procedures as well as the operational side- moving goods throughout the organization. Virtually every application that can be accomplished by a robot is one that can help address and mitigate the major concerns of today’s healthcare leaders.

What makes robotics even more attractive is the fact that, while a relatively recent addition to healthcare, it is not new technology. Robots have been moving products in industry for years. They represent a proven way of addressing key issues that impact the workforce concerns that sit atop the industry’s list of issues.

Concerns and Considerations: Despite, or perhaps because of the great attractiveness of robots to healthcare organizations, the rush to adopt and implement the use of robots brings with it some real concerns and considerations. Here are a few.

Fools Rush In. When and how to enter the robotics game is a key concern. There are four basic avenues of adoption of any technology:

·?????? Bleeding Edge Adapters. These folks see something, like it and go get it with little or no forethought and planning. While most Healthcare organizations do not have the fiscal luxury of taking such a foolhardy approach, some have done it and most have regretted their decision.

·?????? Cutting Edge Adapters. A couple of steps behind the Bleeding Edgers are the Cutting Edgers. These folks have seen at least some proof of efficacy in the application and are willing to become an early adopter. Their risk, while less than their more eager brethren, is still significant.

·?????? Leading Edge Adapters. This group has waited long enough to be certain of the efficacy of the technology, and fiscally solvent enough to make it work. These are the folks who ultimately prove the value of the technology. This group makes it safe for the last group to open the door.

·?????? Standard Adapters. Last, but not least, this group’s greatest risk is that it took too long to adapt, and that a new technology is on the way

What is the “Right” Robotic Solution? From both a clinical and operational perspective, this is probably the core question organizations have to address when considering the implementation of robots. Historically, the annual Capital Equipment budgeting process has been a Wild West Show where physician after physician lobbies for whatever shiny object they have seen at their discipline’s annual convention. With an average ratio of 5:1 dollars requested as opposed to dollars approved, Healthcare Organizations (HCOs) cannot afford to make mistakes, yet walk into any HCO and you will see hallways littered with dust-gathering, unused dinosaurs that were once “The Next Big Thing.” Today, with margins continuing to shrink, the need for careful, assiduous scrutiny and tough decision-making is more important than ever.

The same is true for the Facilities and Operations arena. Whether it be internal renovations or new construction, decisions about if to implement robots, when to implement robots, where to implement robots or how to implement robots, requires the same scrutiny. A key component of that process is “Horizon Planning”, the idea that something built or renovated today should be viable or at least adaptable to evolving technologies twenty-five to thirty years in the future.

One of the greatest thorns in the sides of HCOs in both the Clinical and Operational sides is the vendor. Vendors are not in business to give organizations what they need. They are in the business of convincing organizations that they need the goods and services that they sell. It is the responsibility of the HCO to make the correct decisions themselves.

Standards. Like the railroads in the late 1800s, HCOs today face standards for use and approval that may be non-existent, nebulous or still emerging. Medical instrumentation standards fall under the auspices of the Association for the Advancement of Medical Instrumentation (AAMI). Non-clinical robotics standards fall under the influence and authority of the American National Standards Institute (ANSI) and “trucks” fall under the recommendations established by the Industrial Truck Standards Development Foundation (ISTDF).

While standards for each type of robots are continually evolving, there are gray areas: An Autonomous Guided Vehicle (AGV) that delivers medical supplies or meals to a patient care floor poses the question: since medical supplies and food are key elements of patient care, do these vehicles fall under AAMI, ANSI, ISTDF or all three?

That is the conundrum all HCOs face and the problem all HCOs need to resolve before moving forward.

They don’t want to be caught in the same situation as those railroads. While adapting to a new time zone meant simply setting the clocks ahead or backwards, adapting to a new track size meant ripping up miles of track and perhaps having to go out of business or sell to a competitor.

Get Help. The considerations and concerns outlined above should tell every HCO that it probably should seek independent, unbiased outside expertise before making decisions regarding the implementation of robots. At St. Onge, we have helped hundreds of clients both within and outside of healthcare make good decisions about the selection and implementation of technologies and operational practices that are right for their current and future needs. Our experts are participants in the organizations responsible for the development and implementation of standards, and can help make certain that what you do is (1) best for you and (2) compliant with existing regulations.

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For more information, contact Will Turner ([email protected] ) or Fred Crans ([email protected] ).

Will Turner is a Senior Engineer at St, Onge. He received both his Bachelor and Masters Degrees in Mechanical Engineering from the University of Vermont.

Fred Crans is a Business Development Executive, Healthcare for St. Onge. In 2020, he was inducted into the Bellwether League, the National Healthcare Supply Chain Hall of Fame.

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