Innovations in Telerobotics Encourage a Proactive Healthcare Model

“In the absence of appropriate care, life or death could be a matter of a few minutes. That baby would have been dead 10 hours before the plane arrived for sure,” said Dr. Ivar Mendez, professor of Neurosurgery and director of the Virtual Care and Remote Presence Robotics Programs at the University of Saskatchewan, recalling the night when a mother rushed to the Pelican Narrows nursing station with her seizing infant. 

Nestled within the boreal forests of central Saskatchewan you’ll find Pelican Narrows, an isolated hamlet. More than an hour’s drive separates this First Nations community from the nearest hospital in Flin Flon. The Pelican Narrows nursing station is the community’s haven for medical emergencies. Doctors fly in on one- or two-week rotations, but on that fateful night, there were no active physicians available. Thankfully, there was a robot. 

“The baby was assessed, and using one of our robots, the staff at the station communicated with a pediatric intensivist in Saskatoon,” explained Dr. Mendez. Saskatoon is more than 500 km away from Pelican Narrows. The robot effectively eliminated that distance, allowing the nursing station to work with the specialist in Saskatoon, and provide the resuscitative measures to save the child. “You had the expertise of a specialist working with the local medical team, remotely, facilitated by the robot, to save the child,” added Dr. Mendez. 

Remote presence technology made this possible, but it wasn’t a straightforward journey to get there.

Telerobotics—Bridging the distance 

The study of remote presence technologies is a subdiscipline of telerobotics where researchers control semi-autonomous robotic systems from a distance. As a field, telerobotics has been characterized by progress embedded within cycles of technological advancements over many decades and cultural shifts beyond the research landscape. American mechanical engineer Raymond C. Goertz made the first telepresence robot in 1958 to safely handle radioactive materials using electrical systems controlled by on-off switches for axial movements. Therein the foundation was set, and the discourse has grown ever since. Fast-forward to the present, advances in AI have enabled robots to learn, adapt, and become context-aware. Crucial to this progress are the advances in telecommunications and internet connectivity, such as 5G, that have helped facilitate the implementation of remote presence technologies around the world.

The pandemic burst the bubble and ushered a cultural shift in patient-provider interactions.

Remote presence robots are now being utilized across various fields including healthcare, education, business, security and surveillance, space exploration, manufacturing, and industrial maintenance. Robots like VGo allow students with extended illness or disabilities and who cannot attend school physically to participate remotely. Boston Dynamics’ Spot Robot finds its place in industrial applications surrounding remote inspection and equipment maintenance in hazardous environments. Telemedicine robots such as the da Vinci Surgical System enable doctors to remotely monitor their patients and perform complex surgical procedures. Continued development of similar systems has found application in robot-assisted mobility support for the elderly, remote evaluation and rehabilitation, echocardiography, ultrasound imaging, and disinfection.

The telepresence robot at Pelican Narrows is a vestige of time, and emblematic of the rationale behind telemedicine: to reduce social disparities and improve the quality of life. This is especially true in rural and remote communities where access to new knowledge and technology is limited. When the world fell silent with the onset of the COVID-19 pandemic, there was a critical need for robust remote system technologies, with virtual services taking the lead when in-person interactions were impossible. “The pandemic burst the bubble and ushered a cultural shift in patient-provider interactions,” states Dr. Mendez. “Here in Saskatchewan, where I’m based, we went from 60,000 virtual care visits in a year to almost 500,000.” 

Consequently, Dr. Mendez’s research on remote presence technologies has gradually begun to unify around a larger umbrella of efforts to facilitate virtual care for the greater public. As to what this would look like, Dr. Mendez envisions “a virtual hub of sorts, similar to a NASA command center, that centralizes healthcare within a virtual environment and provides services for up to tens of thousands of people.” It is a goal that he believes is not too far out of reach, with preparations already underway for the Virtual Health Hub in Saskatchewan, in what is poised to be an innovative healthcare model that could be recreated across Canada. The Virtual Hub in Saskatchewan will use this technology to enable a virtual care system that would bring together technicians, robotic technologies, medical personnel, and many more to provide centralized healthcare. “The future of healthcare delivery is not building new brick-and-mortar hospitals, but truly harnessing the potential of technology to do what we need for timely and efficient healthcare,” emphasizes Dr. Mendez. 

The adaptive nature of remote presence technology makes this possible. Remote presence technology would capitalize on the robot’s ability to remember the makeup of a hospital floor, navigate the hospital environment that is full of people and equipment, using sensor technology, and go where the physician is needed. “I can call in, let’s say, from somewhere in Europe, and have a robot positioned within the hospital, navigate to the patient’s room, where I can communicate with the patient, access their vitals and related data, from thousands of kilometers away, and provide them the complete service they need,” says Dr. Mendez. In this manner, remote presence technology helps increase point-of-care access to physicians and other healthcare professionals while broadening the range of services available to patients.

Beyond virtual care—Assistive robotics 

Virtual care, facilitated by remote presence technology, has much to offer but it isn’t the only player in the telerobotics arena. Enter physical robots. These systems add another dimension to the use of AI and robotics in healthcare. Also known as assistive robotic systems, they directly interact with and support patients for tasks that require physical assistance. It is a technology that Dr. Mahdi Tavakoli has worked with and continuously developed since 2008, when he founded the Telerobotics and Biorobotics Systems Laboratory at the University of Alberta, for his research on image-guided surgery and post-disability rehabilitation. His lab’s current pursuits include developing robot-assisted autonomous surgical support systems, and AI-driven rehabilitation and assistive robots for people with disabilities.

The development of assistive robots is a confluence of AI, robotics, and human interaction.

“Unlike virtual care, which relies on telecommunication technologies to provide remote consultation and monitoring, physical systems can perform tangible actions, like manipulating objects, providing mobility support, and delivering precise medical intervention,” he explains. As one example, Tavakoli’s lab has developed a handheld surgeon-assist device to improve the accuracy of needle insertions for prostate cancer treatment, or brachytherapy. His team has also built a robotic smart walker, which provides intelligent and personalized assistance to a user while monitoring their health status over time. “This device collects valuable data on the user’s physical condition, mobility patterns, and overall health, which is then used to inform and enhance medical care,” says Dr. Tavakoli. 

The levity with which Dr. Tavakoli speaks of his lab’s robots reflects harshly against the reality of the hours of effort spent designing and building these systems. His lab hosts an interdisciplinary collaboration between engineers, clinicians, and researchers. Working together, they begin by identifying the needs and challenges at hand before conceptualizing the robotic solutions that can help address said issues. A grueling, iterative development process follows where the systems are prototyped, tested, and refined. Data-driven AI helps teach these robots to learn from datasets of patient interactions and medical procedures, helping build adaptability and context awareness that is crucial for real-time success. 

The development of assistive robots is a confluence of AI, robotics, and human interaction. Reflecting on the role this technology could play in modern healthcare, Dr. Tavakoli believes, “Assistive robots enhance the capabilities of medical professionals, help improve patient outcomes by combining human expertise with robotic precision and endurance, and most importantly, bridge the gap between physical assistance and comprehensive healthcare management.”

Two sides of the same coin 

Remote presence systems and physical robots are innovative technologies with the potential to transcend geographical barriers, enhance the quality of life, and foster health equity. Still, there are many challenges to contend with, including the high cost of implementation, regulatory hurdles, safety, and maintenance of these systems in fast-paced healthcare environments. 

While we dream of the possibility of robotic helpers who can make intelligent decisions with minimal human intervention, it is imperative to understand that these technologies also reflect us. As such, their success hinges on effective communication. Amidst all the progress, there is a growing need for continued dialogue that addresses the potential biases surrounding AI-driven systems while respecting individual privacy and autonomy. 

As such, a collaborative approach that brings together engineers, clinicians, policymakers, and the public will be essential to overcoming these challenges and pave the way toward the successful integration of these technologies in our society.