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Robots in Medicine

Posted by michael on Tue Jan 04, 2005 02:48 PM
from the what-could-go-wrong dept.
eberry writes "The Cincinnati Children's Hospital Medical Center will use a robot to mix intravenous medications and prepare its syringes. The robot, about the size of three refrigerators strapped together, can fill 300 syringes an hour, each with a custom dose and a bar-code label routing it to a particular patient. The robot should reduce the potential for errors and improve patient safety. The robot still needs further approval by the Ohio State Board of Pharmacy, but that should come within a month. It should be noted that five Cincinnati hospitals already use computerized pill-dispensing systems." On the other hand, reader Bobbert sends in a cautionary note: "'A group of German patients has filed a lawsuit against financially beleaguered Integrated Surgical Systems Inc., alleging that the Davis company' Robodoc surgical robot is defective and dangerous, according to a company filing with the Securities and Exchange Commission.' So now with robotic surgery, both the doctor and the robot can liable for damages. Next thing you know, telecoms will be liable for medical malpractice if the network connections fail during remote robotic surgery."
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  • by fembots (753724) on Tuesday January 04 2005, @02:49PM (#11256709) Homepage
    Will these robots "sense" possibles error in the prescription though? For instance if the doctor entered the incorrect dose, an experienced nurse might just be able to pick it up, but a robot will just do as told.

    It reminds me a tail strike incident [taic.org.nz] where the pilot entered the incorrect weight and the system didn't pick it up. The incident report stated that the weight/speed combination should not have been allowed by the system at all, but nobody wrote that checking code at the beginning.
    • Will these robots "sense" possibles error in the prescription though?


      I'm sorry, your question does not compute. Shall we play a game of chess?

    • by Nurseman (161297) <<moc.liamg> <ta> <namesrun>> on Tuesday January 04 2005, @03:00PM (#11256859) Homepage Journal
      For instance if the doctor entered the incorrect dose

      I've worked with these types of machines for years, they WILL pick up these kinds of errors, but they will also give alot of false positves. Many times the doctors will order more than the maximum dose, in emergencies, in cases where the person is very sick etc. The machine will not dispense "more" than it is programed to. In these instances, I just opened it with a key, and took what I needed. Drove supervisors crazy :-). The nice things is they pick up on interactions that me, the nurse, or the MD may not even know about.

    • by paranode (671698) on Tuesday January 04 2005, @03:01PM (#11256878)
      People just don't like to trust machines. Some of this is for good reason, but all faults in machines lead back to human error. If humans incorrectly filled, say for example, 200 prescriptions a year and ended up killing 10 people it would be bad and maybe some people would get sued and some folks would lose their licenses. If a machine made one mistake in the course of years that resulted in a death, we'd have everyone up in arms talking about how this could have been prevented and that we're letting people die at the hands of evil machines and then we'd have a battery of laws passed against machines. Unfortunately this sense of losing control takes over people and fear kicks in, even if the machine is 100 times more accurate than a human at the same task.
      • There is a good reason to be leary of machines: automated fuckups.

        The blessing and curse of machines is that they can do the same thing a thousand times over precisely and very quickly. If it's the right thing, they're great. If it's the wrong thing, you're really screwed. To manipulate your example, if 100 people stupidly forwarded a virus-laden email to all their friends, that would be bad. When someone invents an email client that can do the forwarding automatically without the human doing anything
    • by drmike0099 (625308) on Tuesday January 04 2005, @03:07PM (#11256951)
      All prescriptions in a hospital are reviewed by a pharmacist before being entered into the computer system. If the hospital has computerized physician order entry, they additionally go through checking as the order is placed. Nurses still take the drug in their hand and review it before they administer it. Humans still review everything.

      This replaces the very error-prone menial task of filling up vials with the appropriate dose and concentration of medicines. Assuming the system works as intended, there is absolutely nothing being lost here, only gained.
      • My father has worked for years in a robotic prescription-filling department. He visually checks each pill bottle the robot fills against a computer database photo showing what that particular pill is supposed to look like. His department only handles refills: a human has to fill the initial prescription. He says there are far fewer errors in this system than the old manual system, and it eliminates many sources of human error. Of course, a human still has to fill all the hoppers with the right pills, so the
    • It would help to the extent that a calculator prevents errors in math. If the input is wrong or if the answer is 'low battery' a person would have to be there to figure it out.
    • by xenocide2 (231786) on Tuesday January 04 2005, @03:16PM (#11257040) Homepage
      In theory, pharmacists are indespensable human elements that go over these prescriptions, ensuring that bad combinations of drugs aren't administered (some combinations of drugs have a habit of reacting in the blood stream and forming a precipitate that clogs veins and arteries, among other things). In theory, doctors are supposed to be superhumans as well, and not prescribe these combinations.

      In reality, there are no super humans. Its not something the medical profession enjoys admitting. New studies of drug interactions come out regularly, and few can really keep up with the pace. If you were to test a pharmacist and a robot during a month long study, I'd expect that either the robot wins, or the pharmacist winds up being extra dilligent on behalf of the study and ties it for perfection.

      You act like its impossible to program in failsafes, like nobody knows exactly how much is too much, let alone poor helpless software engineers. Certainly, lives are put at risk in both avionics and medical computing. In this case, however, one of the core duties is to check exactly for these things, which places extra emphasis on an already important task.
    • I would be more worried that the hospital will hire some untrained minimum wage slave to refill the robot instead of a more expensive nurse. Somehow I doubt the robot would know it is dispensing medication that has been loaded in the wrong place.
  • by Anonymous Coward on Tuesday January 04 2005, @02:50PM (#11256723)

    The governments of Vancover, Canada and Amsterdam, Netherlands have placed orders of 10 of these machines each presumably to placed on street corners.

    • You know, putting powerful painkillers in vending machines could mean the end of income taxes, if done properly. Not to mention taking out the bottom levels of society as well ...
  • by drsmack1 (698392) * on Tuesday January 04 2005, @02:52PM (#11256746)
    I hate frivilous lawsuits, but at least with a human doing the filling of drugs there is some common sense that can be a fail-safe. With a machine all it takes is a bug to have 300 vials of poison dealt to unsuspecting patients. Won't there still need to be human oversight?
    • To the best of my knowledge, it's human oversight that causes most drug administration accidents...
    • > I hate frivilous lawsuits, but at least with a human doing the filling of drugs there is some common sense that can be a fail-safe. With a machine all it takes is a bug to have 300 vials of poison dealt to unsuspecting patients. Won't there still need to be human oversight?

      Take a look at your doctor's handwriting the next time you get a prescription. If you can't figure it out, your pharmacist probably can't either.

      Human oversight is having sufficient presence of mind to ask your doctor "What drug

      • No kidding, there was recently a case [newstarget.com] at Virginia Mason Medical Center in Seattle where a woman who was admitted for a routine procedure was killed when she was injected with the chlorhexidine solution used to prep the skin prior to catheterization instead of the contrast dye. So much for human oversight.

      • I'll take my chances with the robot.

        Nice line. It'd make a good sig, me thinks.
    • but at least with a human doing the filling of drugs there is some common sense that can be a fail-safe. With a machine all it takes is a bug to have 300 vials of poison dealt to unsuspecting patients. Won't there still need to be human oversight?

      Kinda frightening isn't it? For comparison:

      Robot Bartender. Error = client is drunk. [packworld.com]

      Robot Pharmacist. Error = client is dead.

    • I dont think a computer bug is likely to be the cause of vials of poison being accidently sent to patients. Human error might strike first in the form of someone refilling the machine with the incorrect drugs. Instead of replacing a canister of Drug A with a new canister of A, an orderly accidently hooks up Drug G. Result could be a dead patient who needed Drug A and got G instead.

      As an analogy - stores like Loews have a machine that mixes paint to the customer's desired color. The machine starts with
  • by Icarus1919 (802533) on Tuesday January 04 2005, @02:53PM (#11256774)
    Until the system is fixed so doctors and nurses don't have a constant case of jet lag from being up for different shifts every day, introducing new ways to prevent careless errors is the best way to save lives.
  • This analogy is unfair...

    ' So now with robotic surgery, both the doctor and the robot can liable for damages. Next thing you know, telecoms will be liable for medical malpractice if the network connections fail during remote robotic surgery."

    When you build a product, there is (at least) an implied warranty that it is fit for a specific use. A surgical robot, *should* be able to conduct an operation. We aren't talking an apples and oranges thing here. I think the auther is trying to place a back end c

  • by tygerstripes (832644) on Tuesday January 04 2005, @02:54PM (#11256789)
    Boop...

    Boop...

    Brrz!
    "Benzadrine. Price check on Benzadrine."

    *shudders*
  • by bwcarty (660606) on Tuesday January 04 2005, @02:56PM (#11256808)
    From what I read, the robots don't administer the injections.

    Having been through chemo, I know that the first thing the nurse did each time was show me each of the syringes that were to be injected into my IV. Each was labelled with the medicine name and dosage.

    I never saw the syringes being filled, but since I'm still alive, I trust that there's some degree of verification before I even saw the bag that contained all my chemo meds. For all I know, a robot could've mixed the meds, and I'd be none the wiser.
    • Having been through chemo, I know that the first thing the nurse did each time was show me each of the syringes that were to be injected into my IV. Each was labelled with the medicine name and dosage.

      Its called the "Five Rights" it is how you are supposed to verify the patient : Right Drug ?
      Right Dose ?
      Right Route ?
      Right Patient ?
      Right Time ?

      I dont care if it's Tylenol, the nurse should ask you this each time he/she gives you anything.

  • A group of German patients has filed a lawsuit...

    Whew, for a second there I thought the EU patent system had screwed up.

  • Telecom liability (Score:3, Insightful)

    by GoofyBoy (44399) on Tuesday January 04 2005, @03:00PM (#11256858) Journal
    "Next thing you know, telecoms will be liable for medical malpractice if the network connections fail during remote robotic surgery."

    Telecoms usually have a clause for any business loss due network disruptions. I think that would apply here.
  • by Message Board (695681) on Tuesday January 04 2005, @03:04PM (#11256902) Journal
    blue screen of death
  • by painehope (580569) on Tuesday January 04 2005, @03:05PM (#11256925)
    Next thing you know, telecoms will be liable for medical malpractice if the network connections fail during remote robotic surgery

    Yeah, and engineers might be held responsible if the bridges they design and build fail under normal/expected operating conditions.

    Oh, that's right, I believe they are.

    If the country gets hit with a tactical nuke, I think it's understood that shit happens. If some underpaid joe in Bumfuck, Idaho drives a piece of heavy machinery through the fiber conduit, I expect you to have a near-transparent failover. That's what engineering is about. It's about having the knowledge and experience to design and test well. That's why some people have objections to MCSE or RHCE certs using the word "engineer".

    If you're providing the network service for my remote robotic surgery, you goddamn well better have a fault-tolerant re-routable network in place. And an on-call heart surgeon who can be there in minutes. Because if your negligence messes me up, you better believe that myself or my children will pay you a visit personally. We'll have a little chat and it will involve a butane torch and a ball peen hammer. That's a personal message from me to you, mister golden-parachute budget-cutting book-cooking CEO.
    • The problem comes when you can either have a lifesaving proceedure performed by a robot over a fallable link, or go without and die. People get enraged over the failed link, even if without it they had certainty of death instead of X chance of death.
  • My boss uses a robot for performing Robotic-Assisted Laparoscopic Prostatectomies. I've got an 8 minute video at www.DrSlawin.com [drslawin.com] so you can see how they place the ports--they screw the robotic manipulators right to the anesthetised patient's abdominal wall. Then the doc sits down at the console and operates away.

    BTM
  • Oh my! (Score:3, Funny)

    by HarveyBirdman (627248) on Tuesday January 04 2005, @03:08PM (#11256962) Journal
    The robot, about the size of three refrigerators strapped together...

    Well, I hope it's not for internal use. Can you imagine that thing crawing up your colon?

    Oddly, I think some of you could. :-)

    Aw, man, here comes another Troll/Offtopic mod. :(

  • ...Next thing you know, telecoms will be liable for medical malpractice if the network connections fail during remote robotic surgery."...

    I like lawyer bashing as much as the next human but buy just about any grade of service from any telco and you have signed an agreement which, in some obscure paragraph, says more or less "provider will not be held liable for consequential damages that may result from interrupted service". The Disruption of Service [cablevision.com] clause for Cablevision is typical.
  • The Pusher and Shover robots [jonathonrobinson.com] must not do what they do best in a hospital! Unless of course the remedy is to shove bread down somebody's throat.
  • Paging Doctor FUD... (Score:3, Informative)

    by Shoten (260439) on Tuesday January 04 2005, @03:14PM (#11257019)
    Next thing you know, telecoms will be liable for medical malpractice if the network connections fail during remote robotic surgery.

    Actually, no. Medical malpractice isn't even remotely like what a telecom would be liable for, no matter how badly they screwed up, unless they were actually practicing medicine. What they could be liable for in the above-stated situation is negligence, and frankly I don't have a problem with that. There's nothing exotic about high availablility networking these days.

    This scenario also fails to take into account the fact that the link failing wouldn't be the end of the world. It's not like they just wheel the patient into the operating room and leave them there so the robot can go at it, and it's not like the robot will start wildly flailing about with scalpels and other sharp instruments just because it's no longer being told what to do. And lest we forget, the patient whose robot-surgeon has just stopped working is still all set up in an operating room, on an IV with people monitoring their vitals, in the midst of a well-equipped hospital. Not the end of the world at all.
  • the rx robot develops a morphine habit and starts skimming off shots of pain killers to feed its own habit?

    but seriously, is our nation's medical staff so incompetent/overworked that they can't even load a syringe properly? if so, removing this particular responsibility from their job will only give them more chances to cause potentially fatal blunders in other areas. i've heard so many horror stories about doctors and nurses collapsing patients' veins trying to administer IV medication that I'd almost tru
    • Loading a syringe properly is no problem.

      RTFA, and see that the pharmacy at this hospital fills 380,000 syringes per year, that's an average of over a thousand syringes per day. That will take a few staff, and coordination about what goes where, and be an incredibly boring job.

      Automating repetitive jobs is a way to see that they get done reliably. And you can automate checks that the dosage is within the allowed range of mg/patient kgs.

      Of course, there is still the potential that the medicine that the
  • The robot, about the size of three refrigerators strapped together...

    That sounds large, how many Burning Libraries Of Congress is that?
  • by The I Shing (700142) * on Tuesday January 04 2005, @03:16PM (#11257042) Journal
    Who better than to defend the robot surgeon than the RoboMouth 3000, the finest robot lawyer in production today? Why, the RoboMouth 3000 can file motions 63.7 times faster than the fastest human lawyer, and can should "Objection!" at 135db before opposing counsel finishes the offending remark!
  • This is a deliberate setup.

    They eat old people's medicine for fuel. And when they grab you in their metal claws, you can't escape because they're made of metal.
  • Depression (Score:3, Funny)

    by the_twisted_pair (741815) on Tuesday January 04 2005, @03:20PM (#11257080)
    The electron ram stabbed out another searing blaze of light and took
    out the appendix.

    "How do you think I feel?" said Marvin bitterly.

    "Just ran off and left you, did they?" the machine thundered.

    "Yes," said Marvin.

    "I think I'll shoot down their bloody ceiling as well!" raged the tank.

    It took out the ceiling of the theatre.

    "That's very impressive," murmured Marvin.

    "You ain't seeing nothing yet," promised the machine, "I can take out
    this floor too, no trouble!"

    It took out the floor, too.

    "Hell's bells!" the machine roared as it plummeted fifteen storeys and
    smashed itself to bits on the ground below.

    "What a depressingly stupid machine," said Marvin and trudged away.

    (with apologies to Douglas...)
  • If the telco sells the doctor bandwidth for telemedicine, then violates the uptime guarantees, they're liable. Maybe not for malpractice, but neither is "the robot" (really its makers, in another confused accusation). When lives are at stake, tech suppliers are liable for failures they hide to sell unreliable products.
  • by Mr. Cancelled (572486) on Tuesday January 04 2005, @03:30PM (#11257205)
    Anyone remember the episode wherein a teenage hacker hacks into a medial facility and changes their medical software so that people are given overdoses of insulin?

    In the episode, the hacker was a teenager who was under the impression that the medical facility had blinded his father, and made the changes as a form of revenge.

    In the real life version, I'm going to guess that we'll have people threatening to do something similar unless they're paid off.

    Not that I'm against such changes. I just lost my Grandmother to a similar situation (someone gave her the wrong medicine as near as we can tell at this point), so any technology that can eliminate such errors, or help to reduce them, is welcomed by me and my family. I just think the Law & Order episode illustrates that no automated system's 100% foolproof. We still have to protect them from the script kiddies and such, but this is a huge step towards eliminating human errors, at least.
  • Are you serious? One coding error could affect HUNDREDS of patients. Does nobody read RISKS Digest anymore? Coding failures in medical equipment has been under continual discussion on RISKS for many years.
    All you're doing here is trading one risk for another, a risk that more people are taking on faith, since everyone KNOWS that computers are infallible. Yeah right.
  • A group of German patients has filed a lawsuit against financially beleaguered Integrated Surgical Systems Inc., alleging that the Davis company' Robodoc surgical robot is defective and dangerous

    Because in a little known incident one of their surgical robots went on a rampage, careening wildly down the hospital corridors wielding a variety of surgical scalpels while shouting, "YOU WANT A PIECE OF ME, MEAT SACK?!"

  • good (Score:3, Funny)

    by jeif1k (809151) on Tuesday January 04 2005, @04:51PM (#11258138)
    So now with robotic surgery, both the doctor and the robot can liable for damages. Next thing you know, telecoms will be liable for medical malpractice if the network connections fail during remote robotic surgery.

    Yes, and that's as it should be: if you bring a product or service to market and it causes harm because it doesn't work as promised, you should be responsible for the damages.

    So, if your robot causes unnecessary harm to patients or if your high-availability comlink goes down too much, then you should have to pay.
    • To bring back sanity to the medical system, we need to keep patients from being able to sue doctors or hospitals for malpractice. We need to make sure that those who are trusted with our health have all the tools necessary to get their difficult job done, so we need to end the insanity that is medical malpractice lawsuits.

      And before we can get to that point, we need to insure that doctors don't actually perform malpractice [apsf.org]