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Will droids take over at hospitals?


The high-tech hospital using robotic resources has arrived?here's how security and safety are affected

Will droids take over at hospitals?

The high-tech hospital using robotic resources has arrived?here's how security and safety are affected

In a world increasingly populated by autonomous vacuum cleaners, package-delivering drones, and soon-to-be self-driving cars, it's no surprise that more hospitals are going high-tech and employing automated resources such as robots to help handle the workload. Everywhere you look, healthcare organizations seem to be relying more on automatons, automated systems, and digital technology to free up human resources to provide better patient care and cut costs.

At the brand new, state-of-the-art UCSF Medical Center at Mission Bay in San Francisco, for example, a fleet of 27 "TUG" robots shuttle compartments and carts around the huge complex, which include soiled sheets and medical waste. The new Humber River Hospital in Toronto, meanwhile, boasts of being North America's first "fully digital" medical facility, featuring robots that mix drugs, deliver goods to a patient's bedside and administer medication, automated kiosks and touchpads for patients, and a digital management system that oversees on-site pharmaceuticals.

And in other medical centers, phlebotomist robots like Veebot draw blood from patients, the da Vinci Surgical System uses robotic technology to aid surgeons in performing complex surgeries, and automated systems handle hospital laundry, HVAC controls, lighting operations, and security access controls.

These are all handy advances in technology, but at the same time, they take humans out of the equation. While it's unlikely we will ever see the day when the nurse, physician, phlebotomist, or pharmacist will be replaced completely by robots, one has to wonder how safe the advancements are. Who is making sure that the robots are doing the right thing? What if they malfunction? Can they be hacked?

Some hospital security experts are encouraged by the robotic and digital amenities in facilities like Humber River Hospital. But, they say, only time will tell if this technology is worth the investment and potential risks.

"If capital investment can free up human equivalent employees who can be reassigned to other activities, that could improve patient care and reduce costs," says Bruce Binder, MPH, CEM, CEO of Rochester, Washington?based Global Vision Consortium, an emergency management consulting firm specializing in healthcare.

Similar robotic technologies have been applied in other industries for years?including at Santa Rita Jail in Oakland, California, which uses automated guided vehicles (AGV) to deliver food and supplies throughout the prison. Earlier versions of robot transporters were used in several large hospitals in the 1980s and 1990s, Binder adds, although the technology was less robust and didn't have some of the newer safety features, such as the ability to stop when it detects something blocking its path.

"Everything looks nice and, in theory, sounds fascinating," says Dan Birbeck, captain of the Dallas County Hospital District Police Department in Dallas, who also lauds the automated innovations, but suggests there could be potential problems. "But if the hardware crashes, which happens in many systems, what kind of resources are pulled away from patient care to manage the issue? And what is the alternate method to continue operations without the functioning hardware? What happens during a disaster and electrical utility failure?"


Guarding against digital dangers

Indeed, operating on the cutting edge of technology can be a double-edged sword, say the experts?especially when it comes to maintaining security and safety in a hospital, where peoples' lives are at stake.

"When automation is working, it can be a joy to behold. But when it craps out, particularly if the implementation of automation has resulted in a reduction of staff, the gap is potentially that much greater," says Steven MacArthur, senior consultant and safety expert for The Greeley Company in Danvers, Massachusetts. He adds that the biggest security implication of increasing automation is what happens when the machines malfunction.

MacArthur says he vividly recalls encountering a pharmaceutical delivery robot that politely asked him to move out of its way when the two crossed paths in a corridor a few years ago at a Boston-area hospital.

Aside from such awkward encounters with machines that might have a hard time with manners, consider the nightmare scenario of a system crash immediately following an automated lockdown of all hospital perimeter doors as a result of an active shooter incident.

"At that point, you've got a million things going on and probably don't have enough bodies to post at each of the perimeter doors. So you prioritize based on what resources you can muster and what are the most likely routes of entry, but that's not necessarily going to be enough," says MacArthur. "Technology does not always fail at opportune times."

Then there's the fear of a robot or the contents it's carrying being stolen or tampered with.

"Imagine that an unsupervised robot transporter enters an elevator and the door closes. The person in the elevator disarms any alarm system, opens the locked cabinet on the robot and removes the expensive supplies, pharmaceuticals, equipment, or important patient records," Binder says. "Alternately, the person adulterates the food, pharmaceuticals, or other material used in direct patient care. After reclosing the container, the door opens and the robot continues on its rounds. The person gets off the elevator on a different floor and disappears."

Even if the devices have a tamper alarm, "it would still require human intervention," Birbeck says.

Hospitals spend a great deal of time and money into ensuring security, as well as backup systems, so consider another worrisome scenario: What if the wireless technology employed by robots and other automated systems interferes with the digitally controlled door locks or the security alarm system? Even nuisance false alarms can reap chaos and costly downtime in a busy healthcare facility.

"As our airwaves become more crowded, there's certainly a potential for disruptions and technical problems caused by systems sending wireless signals that confuse and conflict with each other," says Paul Penn, MS, HEM, CHEP, CHSP, president of EnMagine, Inc., a Diamond Springs, California?based consulting firm that provides planning, training, and exercising for healthcare clients. "At a hospital where I formerly worked, the fire alarm system was so sensitive that using a cell phone directly below one of the fire alarms could set it off."


Unique challenges, sobering ramifications

Automated and robotic resources present several complications for healthcare organizations, including concerns over loss prevention and the potential for sabotage.

"Security staff will remain busy with other activities as these automated units go about their activities 24 hours a day, seven days a week," Binder says. "This puts security staff in a similar reactive role similar to what they do when the hospital experiences a theft or a tampering of patient care equipment or consumables."

Additionally, if humans are being disenfranchised by machines, "there can be a tendency to lash out at the change agents. I think most folks can appreciate the desire or need to attain operational efficiencies, but generally not at the expense of their livelihood," says MacArthur.

Binder agrees. "If the staff sees these units as a threat, they can subvert or destroy the ability of the system to function."

While responsibility for repair and maintenance of automated resources will vary, depending on the facility and if these services are outsourced to a contracted provider, Binder says hospital engineers will likely be charged with ensuring that the units and systems are safe and secure, adding to their already considerable workload.

Birbeck, on the other hand, believes that the department responsible for whatever service the robot is providing would probably manage that device or system.

"They would have to work closely in partnership with IT and product support," says Birbeck. "In our police communication centers, where everything is moving into the virtual and cloud-based world, anytime our department has an issue [with technology], we have to call the IT support center to assist."

The key takeaway here? "In essence, we lose control over our systems and become dependent on outside influences to keep the systems up and running smoothly," Birbeck adds.

To reduce risks, MacArthur suggests that failsafe devices should be built into any automated technology, "along with a means of communicating with a parent device that can provide alerts about any delays or issues."

While all of the aforementioned security scenarios have solutions, "the truth is that all machines can break or be tampered with," says Binder. "The biggest security issue of them all is actually complacency. People become comfortable that nothing can happen, because it has not. Then Murphy's Law happens."


Humans trump machines

For these and other reasons, the human element will always be essential to hospital security, says Binder.

"Hospitals deal with people who are experiencing stressful situations, and patients and families can and do act out," says Binder. "Having uniformed hospital security personnel, who are well trained to defuse behavioral emergency situations, will always require the human factor. Digital or robotic aids?such as cameras, radiation and gas detectors, as well as digital door entry systems?reduce some of the need for humans, but they do not replace the need for a well-trained officer to help patients and families while keeping hospital staff, equipment, and activities safe."

MacArthur believes healthcare security going forward will likely adopt a hybrid approach that employs human beings and technology working together?not exclusively one or the other.

"Certainly digital monitoring, access controls, and other automated technologies have been used successfully throughout healthcare for years, with varying degrees of sophistication. But I'm not sure that digital interaction would be as consistently successful as human interaction," says MacArthur. "I suppose you could scare the bejeezus out of someone with a RoboCop-like security presence in a hospital, but I don't think we are there yet."

Birbeck isn't so sure. He hears talk of a near future where security robots?such as Knightscope's K5 security bots, already being used to guard office buildings and malls?are deployed to patrol hospital campuses.

"The problem is, even if a security robot detects something, how do they respond? How does the robot chase a fleeing suspect? A robot isn't going to know how to deal with a patient in crisis or experiencing a psychiatric emergency," says Birbeck.

"If a robot were to respond to an assault in progress, what level of force would they be able or allowed to deploy to stop the attack? Would a robot know who the aggressor was and who was the victim? How do cameras or analytics actually stop anything?"

The answer is they won't, says Birbeck. "They will primarily be just forensic tools for human officers to review after the fact or notification when something occurs. Machines will never fully replace humans on the ground dealing with other humans."

Nevertheless, Birbeck envisions a future where robots could supplement human security by providing an additional layer of protection and be a force multiplier if capable of performing basic detection, deterrence, and reporting.


Moral to the story

As with any technology, when you introduce something new, expect fits and starts as well as greater oversight from management, says Penn.

"The higher the level of technology, the greater the chance it may not work when you really need it. With increased technological complexity, any break in the system has the capacity to shut the whole system down," he says. "We have to always remember that technology is only a tool?it's necessary for skilled people to be present in order to properly implement these tools."

There's also the danger of increased overreliance on automation and increased lack of training by humans to solve the problem when the machines break down.

"In the future, they may not have the skill sets or knowledge resources to fill in for the malfunctioning robot or system. This can lead to inefficiency and perhaps a compromise in safety or security because they've been pulled away from their regular jobs to compensate for an automated resource that doesn't currently work," says Penn.

To decrease these risks, it's important for hospital security leaders to conduct comprehensive risk assessments and vulnerability analyses before choosing to advise hospital leaders about or implement the automation of any security systems, Birbeck recommends.

"Smarter, more advanced technology is coming. But it needs to be well thought through and closely monitored for the possibility of negative consequences," Penn says. "And the bottom line is that you can never take people completely out of the equation."


Healthcare robots at a glance

Robotics and autonomous machines are expected to become more commonplace in the hospitals of the future.

Some companies, such as Aetheon, are developing robots that can complete tasks that once were only able to be carried out by human assistants. According to the company's website, the TUG robot, for instance, boasts the ability to do the following:

Deliver clean linen using detachable multi-shelf racks and return dirty linen using detachable tall bins

Securely deliver medications and provide control through a biometrically secured drawer cart, and free up staff to focus on clinical care activities rather than the transport of medications

Deliver blood or tissue specimens from remote collection points to a main lab using a biometrically secured door cart

Deliver trays of food from the kitchen and return dirty trays using detachable meal tray carts

Transport trash or regulated waste in detachable covered bins

With a maximum towing capacity of 1,000 pounds and more than 10 hours of battery time, the robots can be assigned tasks by computer. By using an onboard map of the hospital stored in its memory as well as scanning laser and infrared and ultrasonic sensors, it can wirelessly go about its tasks and then return to its charging dock to recharge when finished.


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