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AMI, Inc.
       Improving Healthcare
       Through Automation



  Improving Healthcare
Outcomes & Reducing Costs
     t...
Medical Automation & Robotics


Past through Present
Opportunities
Technologies
Venues
Summary
References
                ...
Definitions

Robot Definitions vary. There is a general consensus of the essential robot
  characteristics:
  Sensors — Ro...
Robotics: Ancient History

Automatons
Early automated device in antiquity
Ancient Alexandria, Egypt
    Herron of Alexandr...
Medical Automation & Robotics:
        History
1920-30s   “Dumb” machines



1940-50s   Computers developed


           1...
Medical Automation & Robotics:
       Opportunity




Minimally invasive procedures for
these surgeries in yellow late ’90...
Growing Unmet Health Needs




Courtesy Robotics Business Review © 2009

                                           7
    ...
Growing Clinician Needs

Clinician Shortages:                  Potential Solutions:
  Patient - Nurse Ratio
              ...
Market Drivers

                                        Technology Drivers
Social Drivers                            Incre...
Barriers to Entry


Business/Clinical Barriers
 Market Need - Moving Target
 Reimbursement/Payors – CPT, ICD9, DRG
 Intell...
Medical Automation & Robotics:
   Opportunity Costs
Better Healthcare Together report asserted
  Broadband-based applicati...
Medical Automation & Robotics:
           Opportunity
                Number of      Expense           Baseline Savings   ...
Major Opportunity Areas


Ambulatory
Behavior/Social – Autism, Elderly
Clinical Care – Facilities, Nursing, Point-of-Care
...
Classes of Healthcare Robotics

 Robotics                    Robotic Technology to Support Patients
 Technology That
 Supp...
Medical Venues: Acute to Ambulatory



Accident and Battlefield – Ambulance, Medic
Emergency Room (ER)
Operating Room (OR)...
Ba




                                       0
                                           0.2
                           ...
Ambulance and Emergency

Requirements:
  Locate patients
  Evaluate patients’ injuries/disease
  Stabilize and prepare pat...
Ambulance - Battlefield

     Diagnostic and Therapeutic Instrument
        Diagnose a battlefield injury based on biomark...
Ambulance - Battlefield




         19
                      AMI, Inc.
                      Improving Healthcare
       ...
Ambulance - Emergency




Heartstart Portable Defibrillator
     Life-Saving Technology
     Automated for any user       ...
Emergency Room

Requirements:                             Solutions:
  Determine and diagnose                    RFID Syst...
Surgical Applications
                                              Cyberknife
Applications
  Abdominal/GYN (AESOP, da Vin...
Operating Room

OR Surgical Requirements:               Solutions:
  Avoid injury / do no harm               RFID Systems ...
Operating Room: Past




                                             Intuitive Surgical’s
                               ...
Operating Room: Present




Stereotaxis Robot                      Hansen Medicals’ Sensei Robot




                     ...
Operating Room: Future


Robot Arm from
Carnegie Mellon Institute




                                                 by ...
Operating Room: Future




                             Microbot (Credit: Image courtesy of
ePill  by Philips
            ...
Operating Room: Future


MIS Mitral
valve repair
Robotic
System
  Minimally
Invasive
 Beating
Heart                       ...
Clinical Laboratory

Requirements
 Accurate
 Repeatable
 Fast Response
 Sufficient Capacity to meet
 clinicians’ needs
   ...
Clinical Facilities

Requirements                                    Solutions
  Patient Tracking        Equipment trackin...
Hospital




Helpmate - ATLIS (Automated                Roving Physician
Transport and Logistics Integration        By InT...
Hospital




Swisslog’s PillPick system                   Swisslog's BoxPicker
  Bar-code packages                        ...
Hospital
WORLD'S LARGEST
TELEPHARMACY, THE US NAVY




                   33
                            AMI, Inc.
       ...
Point Of Care – Doctor’s Office

Requirements             Solutions
  Patient Care               Discrete Instruments with...
Point Of Care – Doctor’s Office




             35
                          AMI, Inc.
                          Improvin...
Rehabilitation

          Requirements
             Patient Care
                 Therapy
                 Feedback, Track...
Rehabilitation




Repetitive task practice
                                A Manhattan Project for
Patient controlled    ...
Home, Ambulatory –
             CARE EVERYWHERE

ISSUES                   SOLUTIONS
 Healthcare Costs             Maximize...
Home, Ambulatory –
            CARE EVERYWHERE

MEDICATION COMPLIANCE
 > 1/2 the elderly population suffer from one or
 mo...
Home, Ambulatory –
         CARE EVERYWHERE




"Equivital“
 Wearable vital signs monitor        OmniPod Insulin Managemen...
Home, Ambulatory –
 CARE EVERYWHERE

Fitbit
  Small size
  pedometer
  Clipped on
  clothes or a
  wristband
             ...
Home, Ambulatory –
                                       CARE EVERYWHERE
        Courtesy: Medical Automation




SENSORE...
Point Of Care – Doctor’s Office




             43
                          AMI, Inc.
                          Improvin...
Future


Tissue Engineering + MEMS/NANO + Electronics + Mechanics +
   Biologics + Microbiology =>
   Life Supporting Syst...
SUMMARY: Key Steps to Success

Business                         Customer
  Market Need - Moving Target      Level of skill...
Website References

             Organization                                        URL
American College of Surgeons (ACS...
Medical Automation & Robotics



          Thank You!
          Martin Sklar
Automated Medical Instruments, Inc.
         ...
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Improving Healthcare Outcomes & Reducing Costs Through Medical Automation

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Transcript of "Improving Healthcare Outcomes & Reducing Costs Through Medical Automation"

  1. 1. AMI, Inc. Improving Healthcare Through Automation Improving Healthcare Outcomes & Reducing Costs through Medical Automation & Robotics WPI Venture Forum May 11, 2010
  2. 2. Medical Automation & Robotics Past through Present Opportunities Technologies Venues Summary References 2 AMI, Inc. Improving Healthcare Through Automation
  3. 3. 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. 3 AMI, Inc. Improving Healthcare Through Automation
  4. 4. 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 4 AMI, Inc. Improving Healthcare Through Automation
  5. 5. 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 5 AMI, Inc. Improving Healthcare Through Automation
  6. 6. Medical Automation & Robotics: Opportunity Minimally invasive procedures for these surgeries in yellow late ’90’s 6 AMI, Inc. Improving Healthcare Through Automation
  7. 7. Growing Unmet Health Needs Courtesy Robotics Business Review © 2009 7 AMI, Inc. Improving Healthcare Through Automation
  8. 8. 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 8 AMI, Inc. Improving Healthcare Through Automation
  9. 9. 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 9 AMI, Inc. Repeatability Improving Healthcare Through Automation
  10. 10. 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 10 AMI, Inc. Improving Healthcare Through Automation
  11. 11. Medical Automation & Robotics: 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 11 AMI, Inc. Improving Healthcare Through Automation
  12. 12. Medical Automation & Robotics: 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 12 AMI, Inc. Improving Healthcare Through Automation
  13. 13. 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. 13 Improving Healthcare Through Automation
  14. 14. 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 14 AMI, Inc. Improving Healthcare Through Automation
  15. 15. 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 15 AMI, Inc. Improving Healthcare Through Automation
  16. 16. Ba 0 0.2 0.4 0.6 0.8 1 1.2 t tl ef Em ie er Ac ld ge cid en O n cy t pe R ra o tin om Ac g R ut oo Lo e m ng Ho -T spi er ta m l C ar Ph e 16 Cost vs. Venue y s Re ic ha ia b n O ffi ce H Am om bu e la to ry Cost vs. Venue AMI, Inc. Through Automation Improving Healthcare
  17. 17. 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 17 AMI, Inc. Improving Healthcare Through Automation
  18. 18. 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 18 AMI, Inc. Improving Healthcare Through Automation
  19. 19. Ambulance - Battlefield 19 AMI, Inc. Improving Healthcare Through Automation
  20. 20. 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 20 AMI, Inc. Improving Healthcare Through Automation
  21. 21. 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 21 AMI, Inc. Improving Healthcare Through Automation
  22. 22. 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 22 AMI, Inc. Improving Healthcare Through Automation
  23. 23. 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. 23 Improving Healthcare Through Automation
  24. 24. 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 24 AMI, Inc. Improving Healthcare Through Automation
  25. 25. Operating Room: Present Stereotaxis Robot Hansen Medicals’ Sensei Robot 25 AMI, Inc. Mako Surgical Robot Improving Healthcare w/Orthopedic Implant Through Automation
  26. 26. 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 26 AMI, Inc. Improving Healthcare Through Automation
  27. 27. Operating Room: Future 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 27 AMI, Inc. Improving Healthcare Through Automation
  28. 28. Operating Room: Future 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 28 AMI, Inc. Improving Healthcare Through Automation
  29. 29. 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 29 AMI, Inc. Improving Healthcare Through Automation
  30. 30. 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 30 AMI, Inc. Improving Healthcare Through Automation
  31. 31. Hospital Helpmate - ATLIS (Automated Roving Physician Transport and Logistics Integration By InTouch Health Systems) by FMC 31 AMI, Inc. Improving Healthcare Through Automation
  32. 32. 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 32 AMI, Inc. Improving Healthcare Through Automation
  33. 33. Hospital WORLD'S LARGEST TELEPHARMACY, THE US NAVY 33 AMI, Inc. Improving Healthcare Through Automation
  34. 34. 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 34 AMI, Inc. Improving Healthcare Through Automation
  35. 35. Point Of Care – Doctor’s Office 35 AMI, Inc. Improving Healthcare Through Automation
  36. 36. 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 36 AMI, Inc. Improving Healthcare Through Automation
  37. 37. Rehabilitation Repetitive task practice A Manhattan Project for Patient controlled the Prosthetic Arms Race 37 AMI, Inc. Improving Healthcare Through Automation
  38. 38. 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 38 AMI, Inc. Improving Healthcare Through Automation
  39. 39. Home, Ambulatory – 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 39 AMI, Inc. Improving Healthcare Through Automation
  40. 40. Home, Ambulatory – 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 40 AMI, Inc. Fall detection Improving Healthcare Through Automation
  41. 41. Home, Ambulatory – 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 41 AMI, Inc. Improving Healthcare body fluid levels Through Automation
  42. 42. Home, Ambulatory – 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. 42 AMI, Inc. •Swiss company, Sensimed Improving Healthcare Through Automation (Lausanne) has a sensor-embedded .
  43. 43. Point Of Care – Doctor’s Office 43 AMI, Inc. Improving Healthcare Through Automation
  44. 44. 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 44 AMI, Inc. Improving Healthcare Through Automation
  45. 45. 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 45 AMI, Inc. Improving Healthcare Through Automation
  46. 46. 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 46 AMI, Inc. Improving Healthcare Through Automation
  47. 47. Medical Automation & Robotics Thank You! Martin Sklar Automated Medical Instruments, Inc. 781-248-6841 msklar@automedinst.com 47 AMI, Inc. Improving Healthcare Through Automation
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