Robots in Medicine 135
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."
Human Error and Logic (Score:5, Insightful)
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.
Re:Human Error and Logic (Score:3, Funny)
I'm sorry, your question does not compute. Shall we play a game of chess?
Re:Human Error and Logic (Score:5, Informative)
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.
Fear is part of the problem (Score:5, Insightful)
Re:Fear is part of the problem (Score:1)
Re:Fear is part of the problem (Score:1)
Well, Instead of a rebuttal, apparently I just agree with you.
Re:Fear is part of the problem (Score:1)
I basically agree with your post. But you seem to have left out both error-multiplying nature of machines and their general inablilty to detect errors.
-Peter
Re:Fear is part of the problem (Score:1, Insightful)
Most of these crossings are "blind" because of trees, curves, etc...
I've never once in my life checked to be _sure_ that there was no train coming when the warning lights weren't flashing.
And I've never thought about this fact until now.
How many times have I trusted my very life to what must amount to nothing more than a simple relay circuit?!
I say bring on the bot.
Re:Fear is part of the problem (Score:2)
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
A little perspective... (Score:1)
I would say its more 'People just don't trust things they have no knowledge of' rather than machines per se. I certainly wouldn't blindly trust something programmed by myself or any of my colleagues without being able to verify the results independently myself.
In our case the systems we produce analyse the patient's blood or tissue and then provide prescription reports based on the results. The main selling point of our systems (or so I am told) is our abilit
Re:Human Error and Logic (Score:5, Informative)
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.
Re:Human Error and Logic (Score:2)
Re:Human Error and Logic (Score:2)
This particular hospital does have a computer order entry system that was built largly in house specifically for pediatrics. As a doctor at CCHMC, I can say its pretty good for the most part. The screening is, if anything, is too sensitive, but overall it is very effective at catching my errors. Fortunately, the environment there is such that feedback is very much welcomed and taken ve
Re:Human Error and Logic (Score:2)
Re:Human Error and Logic (Score:4, Insightful)
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.
Re:Human Error and Logic (Score:1, Interesting)
Think about where the 'robot' is getting the prescriptions - what if someone puts the wrong medication in the wrong storage area of the machine? (I presume the machine's got a number of different med's to deal with) It'd be the same if the nurse somehow grabbed the wrong
Re:Human Error and Logic (Score:2)
Re:Human Error and Logic (Score:2)
Do people? (Score:1)
The classic text on this (if an article from 2000 can be considered classic), is To Err Is Human: Building a Safer Health System [nap.edu]
In other news... (Score:4, Funny)
The governments of Vancover, Canada and Amsterdam, Netherlands have placed orders of 10 of these machines each presumably to placed on street corners.
Re:In other news... (Score:2)
Re:In other news... (Score:2)
Just someone else to get sued (Score:3, Insightful)
Re:Just someone else to get sued (Score:2, Insightful)
Prescribing errors. (Score:3, Interesting)
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
Re:Prescribing errors. (Score:2)
Re:Prescribing errors. (Score:2)
Nice line. It'd make a good sig, me thinks.
Re:Just someone else to get sued (Score:2, Funny)
Kinda frightening isn't it? For comparison:
Robot Bartender. Error = client is drunk. [packworld.com]
Robot Pharmacist. Error = client is dead.
Re:Just someone else to get sued (Score:2)
As an analogy - stores like Loews have a machine that mixes paint to the customer's desired color. The machine starts with
Re:Just someone else to get sued (Score:2)
Hacker practical joke (Score:1, Funny)
Robots in the hospital (Score:5, Insightful)
Re:Robots in the hospital (Score:1)
The schedules that nurses and doctors work at hospitals are just bizarre to me as a guy with a regular schedule. I don't work a job where people's lives are in my hands on a regular basis, but I have a regular schedule. It's not odd to see my girlfriend work 7AM-3PM on monday, 1
Re:Robots in the hospital (Score:2)
Poor analogy... (Score:2, Insightful)
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
Re:Poor analogy... (Score:2)
Nice try. In Florida where I used to practice, our malpractice insurance premiums increased 50% in the last two years. Medical costs aren't rising at anything like that fast. Sure we make a comfortable living, but nobody likes to be paid a lot less for a lot more work. Keep that up for a few years, and it really starts to get old.
Eep! Imagine the barcode scenario... (Score:3, Funny)
Boop...
Brrz!
"Benzadrine. Price check on Benzadrine."
*shudders*
There's still a level of human interaction (Score:4, Interesting)
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.
Re:There's still a level of human interaction (Score:3, Insightful)
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.
Remote robotic surgery... (Score:1, Funny)
Patients, not patents. (Score:2)
Whew, for a second there I thought the EU patent system had screwed up.
Re:Patients, not patents. (Score:3, Funny)
Telecom liability (Score:3, Insightful)
Telecoms usually have a clause for any business loss due network disruptions. I think that would apply here.
Re:Telecom liability (Score:2)
Re:Telecom liability (Score:2)
911 calls is one example.
Re:Telecom liability (Score:2)
Similiar to the OS "life / death" clause (Score:2)
Brings a whole new meaning to... (Score:4, Funny)
Re:Brings a whole new meaning to... (Score:2)
Step into the light...
Re:Brings a whole new meaning to... (Score:2)
and there is no such thing as software without
any coding errors. If the robot pharmacist
makes a mistake filling prescriptions, there
will not be one dead patient, but perhaps 300.
Oops! There goes the medical malpractice
insurance premiums, through the roof, as
well as the demise of the robot manufacturer.
Anyone willing to start a pool? The long term
odds are in favor of a catastrophe.
Interesting Thoughts about Telecoms (Score:1)
use your common sense (Score:3, Interesting)
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.
Re:use your common sense (Score:2)
Re:use your common sense (Score:2)
Shit, if we can keep porn sites up, we can keep a link that someone's life depends on up - in most cases. And you can most definitely have an on-staff physician ready to step in. That's the ultimate fail-over procedure.
And as far as people getting enraged, if you tell me that I
RALP (Score:2)
BTM
Oh my! (Score:3, Funny)
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. :(
read the fine print (Score:2)
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.
Thats not the right fine print (Score:2)
You are reading the wrong fine print. The fine print on your contract is not the same as what is on their contract. Their contract specifies that at all time where will be at least 2 redundant links in operations that never travel in the same trench. Their contract specifies that their traffic will always have the highest priority for transfer, and has some traverse time (lag) and bandwidth requirements.
They also pay for that level of service.
robots suing robots (Score:1)
Time to start coding again... (Score:1)
Kenny P.
Visualize Whirled P.'s
At least don't have these robots perform surgery (Score:2)
Paging Doctor FUD... (Score:3, Informative)
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.
Re:Paging Doctor FUD... (Score:1)
It happens. Your right, its not the end of the world.
but because its robots, and because its technology, the infrastructure will take the fall. Just look at the excuses in the counter strike world.
"Poor larry with his 17 bullet wounds through every major organ would be alive today if it wasn't for the high lag."
Re:Paging Doctor FUD... (Score:2)
Re:Paging Doctor FUD... (Score:1)
I was merely pointing out the way technology is blamed.
The person responsible for setting up a remote reobotic surgeon had better use connection models that don't depend upon insecure/unstable pathways, or HE will be the only one purely to blame for any cockups.
how long until... (Score:2, Interesting)
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
Re:how long until... (Score:2)
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
Oh, the units... (Score:2)
That sounds large, how many Burning Libraries Of Congress is that?
Re:Oh, the units... (Score:2)
"Refrigerators" in this context is a measure of volume. BLOC is a measure of energy. There is no obvious conversion from energy to a volume unit. e =mc2 doesn't help without specifying a density.
A typical refrigerator is about 60x30x36 cubic inches. The transportation industry is interested in the volume, and in the largest dimension (or the largest dimension of a rectangular box that can contain the
Robot Lawyer! (Score:3, Funny)
Re:Robot Lawyer! (Score:1)
I don't know why the scientists keep building them (Score:3, Funny)
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)
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...)
Sounds like a good use for robots... (Score:1)
Sounds like a good use for robots, as long as they don't hire the Red Robot [explodingdog.com].
I doubt that this gets state board approval. (Score:1, Informative)
Malfeasance (Score:2)
Law & Order episode comes to mind (Score:3, Insightful)
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.
Re:Law & Order episode comes to mind (Score:2)
Re:Law & Order episode comes to mind (Score:1)
Reduce errors? (Score:2)
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.
Dangerous hospital robots (Score:2)
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?!"
RoboPhobia (Score:1)
it slices, it dices,,,
http://www.google.com/search?hl=en&q=RoboPhobia&b
QA (Score:1)
Error checking in humans (Score:1)
> medical malpractice if the network connections
> fail during remote robotic surgery
As they bloody well should be!
If they undertake to provide a *guaranteed* connection, which they should be, given that's it SURGURY, if the connection fails, the patient is going to be in serious trouble.
The problem with automation of medical work like this is that it removes a level of error checking - the human who fills in the needles or prescriptions.
Humans p
Do you have any brains? (Score:1)
Buddy, if I create a product specifically to do job A, and as a corollary, it can also do B,C,D (unintended uses), the customer cannot blame me if the product fails to work for B,C,D. However, they can blame me if the product is deficient wrt doing job A.
Checks and balances (Score:2)
Re:Checks and balances (Score:2)
Veterans Administration is a leader in this area (Score:2)
Right patient
Right medication
Right route
Right time
and Right dose
The facility in Houston, TX also uses
I was once replaced by a robot at a hospital... (Score:2)
My job was to type up and apply labels to blood, urine and stool specimens when they arrived in the labs and then send them off to the appropriate lab for processing.
There was very little activity so I practiced sleeping sitting up at a computer terminal. Things went well at first but my laziness and irresponsibility started catching up with me. B
AI (Score:1)
good (Score:3, Funny)
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.
Assumption of Liability (Score:1)
This would never fly... It would be akin to a hospital trying to sue the city if an ambulance encounters roadwork delays while trying to transport a patient. Assumption of risk lies with the user of the system.
Re:Tort reform urgently needed! (Score:1)
Re:Tort reform urgently needed! (Score:2)
Doctors are human beings, capable of all the range of human deed and misdeed that everyone else is subject to.
Should they be given carte blanche in their actions? No consequences?
I would agree that it is a bit too easy to sue, and that there are some people who take advantage of that. I dont think that eliminating the ability to take a doctor to court is the answer. That would put us in the position of the doctor being able to do anything with impuny.
Where in the pa
Re:Tort reform urgently needed! (Score:2)
Re:Tort reform urgently needed! (Score:2)
And before we can get to that point, we need to insure that doctors don't actually perform malpractice [apsf.org]
Re:Tort reform urgently needed! (Score:1)
in the example you cite
1,000,000 procedures annually:
20 cases - Wrong Patient, Wrong Site - Surgical
103 cases - Incorrect Procedure - Invasive
90 cases - Retained Foreign Body
incidence of error
( i.e. the probability that an error might occur )
or
99.99979 of procedures had no errors
that's a low incidence by any standard.
Tell me when did doctors stand up and pronounce that they were perfect ?
In fact that's higher performance then almost every system you come in contact with every
Re:Tort reform urgently needed! (Score:2)
However...completely removing the possibility of doctors being held responsible for their actions is not only wrong, but insane. "Wrong site, wrong patient" is exactly what malpractice is supposed to be for.
I agree that it is far too easy, nowadays. Let's change it, not eliminate it.
Re:Tort reform urgently needed! (Score:1)
Thats
While i agree that at face value " wrong site/ wrong pt " should be malpractice let's not jump to conclusions.
While "wrong pt" is harder ( but not impossible) to justify , i can think of quite a few reasons why one might operate on the wrong site.
After all the problem with assessing malpractice is that it always
Re:Cool Possible Acronym Name (Score:2)