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Robots in Medicine
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."
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 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.
Rock that crushes, Paper & Scissors that don't matter.
The governments of Vancover, Canada and Amsterdam, Netherlands have placed orders of 10 of these machines each presumably to placed on street corners.
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?
Humor from a Genetically Molested Mind
All you need is a hacker with a sense of humor and that circumcison can turn into a sex change.
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.
oh, yea, Malpractice is up 25% in 10 years (but medical costs have risen much higher...).
The force that blew the Big Bang continues to accelerate.
Boop...
Boop...
Brrz!
"Benzadrine. Price check on Benzadrine."
*shudders*
Meta will eat itself
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.
I hope the PunkBuster folks are hard at work on an update, or I see nothing but problems ahead for this technology.
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 am I being prescribed? At what dosage? In what form?", remembering the answer, and comparing what your doc told you with what's on your prescription... and with your pharmacist gives you after reading your prescription. In at least one recent study, around 6% of prescriptions result in errors.
In the absence of that oversight, I'll take my chances with the robot.
Whew, for a second there I thought the EU patent system had screwed up.
The simple truth is that interstellar distances will not fit into the human imagination
- Douglas Adams
"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.
The surprise isn't how often we make bad choices; the surprise is how seldom they defeat us.
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.
blue screen of death
A curious thought struck me about the submitters comments. Telecoms would almost certainly have heavy contractual stipulations about their degree of liability, if they were the providers for remote surgical connectivity service. IANAL, of course, but it would seem to me that there would have to be very specific events described where the telecom would be at fault (their own operator cuts the power/line, for example) while most other occurances (freak storms, non-related contractors) would be excluded. Has anyone had any personal experience with this out there? It would be interesting to hear how they set up a liability structure for such a critical thing. Also, during remote operations is there a qualified in-person backup handy?
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.
PC moderators can suck my White pierced, tattooed dick. If you think pride == hate, s/dick/Aryan meat mallet/g.
My boss uses a robot for performing Robotic-Assisted Laparoscopic Prostatectomies. I've got an 8 minute video at www.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
That was the turning point of my life--I went from negative zero to positive zero.
So the doctor who mis-diagnosed 2 of my grandfather's three heart attacks should be totally protected from all consequences of his actions? I think you need to clear up the above statement, otherwise it seems extremely stupid right now.
And before we can get to that point, we need to insure that doctors don't actually perform malpractice
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. :(
--- Ban humanity.
...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 clause for Cablevision is typical.
SLASHDOT: news for people who can't concentrate on work or have no life at all and got tired of yelling back at the TV.
Next thing you know, telecoms will be liable for medical malpractice if the network connections fail during remote robotic surgery. Raises an interesting point. Is it ridiculous to hold an ISP accountable for a reasonable service standard in such a case? Should telecoms be necessarily immune to lawsuit for failing to provide a reasonable level of service for a critical care applications? What if the company boasted 99.999% uptime as part of their sales pitch, but failed to deliver that level, and some of the outages cost innocent patients their lives or wellbeing? The client service agreement the doctor signed to get internet service specifically disclaims any liability for losses the doctor might suffer, so it may be up to the patient to hold the ISP accountable. Or would it be more sensical to make ISP's immune to such liability altogether?
That way when I go to the hospital and need drugs, I'll get 'em!!!
Kenny P.
Visualize Whirled P.'s
The Pusher and Shover robots must not do what they do best in a hospital! Unless of course the remedy is to shove bread down somebody's throat.
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.
For your security, this post has been encrypted with ROT-13, twice.
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 trust myself more with a syringe than hospital staff. Maybe instead of paying for this $640k robot, they ought to invest more in better training for hospital staff.
The robot, about the size of three refrigerators strapped together...
That sounds large, how many Burning Libraries Of Congress is that?
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!
You are in error. No-one is screaming. Thank you for your cooperation.
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.
I don't need no instructions to know how to rock!!!!
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...)
Sounds like a good use for robots, as long as they don't hire the Red Robot.
The state of Ohio pharmacy board might approve this robot but I highly doubt it. The rules for Rx dispensing in Ohio are not very flexible or accomadating when it comes to technology. I doubt they would approve non-human supervised dispensing regardless of the accuracy.
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.
--
make install -not war
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.
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?!"
That's our life, the big wheel of shit. - The Fat Man, Blue Tango Salvage
Fear of Surgical Robot with 'Made by RonCo' label,t nG=Google+Search
it slices, it dices,,,
http://www.google.com/search?hl=en&q=RoboPhobia&b
I had a temp job working for this company as QA tech a few years ago and I can tell you right now that I would not want to be worked on by a machine that was QA'd by a $12/hr temp. The machine was pretty amazing, what was more amazing was the bunch of incompetents that engineered it.
> Next thing you know, telecoms will be liable for
> 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 pick up a good idea of what's normal and what's not pretty quickly, and do a good job of routine error checking.
Robots don't, not even a bit. And software, as we all know, is not reliable.
So, you get quicker service, and it's cheaper, but you eliminate a level of error checking.
--
Toby
"Next thing you know, telecoms will be liable for medical malpractice if the network connections fail during remote robotic surgery."
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.
I was under the impression that one of the main functions of a pharmacist is to know most of the various drugs by appearance. That's why drugs come in all different shapes and colors. So the pharmacist doesn't accidentally give you the little blue diamond pill (Viagra) when you're supposed to be getting the big yellow pill, even if the pills are in incorrectly marked containers. (I appreciate the fact that Walgreen's now puts a label on your presicription bottle describing the pill, so you can verify.) Somehow I doubt that automated systems are able to do this yet. Although with injected medicines, I'd supposed they almost all look alike (clear fluid). I'd be willing to bet that the machine has a much lower error rate, but it'd still be nice to have a visual check.
Software sucks. Open Source sucks less.
Right patient
Right medication
Right route
Right time
and Right dose
The facility in Houston, TX also uses robots designed to ferry prescriptions to the various floors of the medical center. Which is being studied for possible use at other facilities.
Many of the VA centers also work with national Mail Order centers that use "extreme" automation to fill tens of thousands of prescriptions daily when a Veteran or other eligible person needs a refill.
Just another case study to consider if you're looking at the use of robotics and electronic records to improve health care and patient safety.
---
More of my personal stuff here
Doctors are not Gods, that is true.
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 parent ( to your post ) do you see someone looking to make a quick buck?
In every other industry, if you make a mistake in your product or service that harms people, you are liable for that harm. In what way is this different?
emt 377 emt 4
Dose Effecting And Labeling Robot.
emt 377 emt 4
It's similar to the standard Windows / Mac OS clause of "This OS is not designed for life / death or mission critical operations"...as if you'd actually want to run Windows in one of those areas :)
Back when I was in college I scored an awesome job working at a hospital. The job paid really good and I worked the graveyard shift so there wasn't much work.
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. Being a college student I soon discovered the joys of binge drinking. This resulted in me going to work with a hangover on several occasions. As you can imagine hangovers + regular sleep deprivation = diminished quality control.
I was there for about a year before being replaced by a machine that could scan the forms, label the specimens and send them off without yours truly.
So what did I do? I took on a new position as a pizza distribution engineer for a multinational firm named Pizza Hut. Gotta love progress.
The Surgery machine that is mention is a simulated neural network, a learning computer of sorts. Most of the pervious mention errors were programming errors. A neural network is not programmed. It has to learn by practice and observing. A computer will not make mistake due to being tired in a several hour surgery. It even state in the article that it can be more precise. It can also learn to stop. People on the other hand can be stubborn and carry on. The reason it take longer is arm articulation is very difficult to do for a computer. People are born with this knowledge to start with.
The only draw back is the neural network has to have consistent human anatomy. The human body is very uniform for the most part.
As for the medicine dispenser, it can be simply given a set of governing rules. It can be told not to mix to specific compounds because they are lethal, or have drug interaction. Your right it is a bit of a nuisance in extreme emergency case but on a day to day consistent bases it just quicker. If it handing out pain medication and other long term treatment it just plain quicker.
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.
.. from someone who programs something similar.
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 ability to reduce or remove doctor/nurse/lab technician's transcription errors from what turn out to be rather complex clinical or medical processes.
Instead of automating the process entirely, our customers generally end up employing a more junior nurse/technician to 'watch' our instruments in case something appears to go wrong. Of course whilst mechincal failures and data corruptions rarely occur, labs and hospitals are wise enough to have their own validation (unit testing, if you will) and calibration methods in place for when they do.
- This and all my posts are public domain. I am a Physicist. I am not your Physicist. This is not Physically advice
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.
"Yes, I have a Disaster Recovery Plan. It's called my Resume"
Oh please...
.00021%
.
..YES
..YES
.00021% error rate guilty of malpractice ?
..thus the expectation of 100% certainty is absolutely unobtainable and unrealistic . Furthermore the cost of this level of reliability is more than anyone but the richest of the rich can afford.
.
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 day
To put this in perspective your incidence of auto accident in the US with injury is 1.68%...8000 times more likely !
Should doctors and hospitals try to avoid mistakes
Should doctors who make too many mistakes face consequences
BUT your comment just shows common unrealistic perspective about reality.
Is a mistake malpractice ? Even if that mistake can be fixed ? Even if that mistake has little or no effect on the outcome ? Is a surgeon or hospital that has a
Do you want to pay a medical bill where 60% of the bill is coverage for insurance ? Even if the doctor in question has never had case of malpractice?
Medicine at the most basic level involves TWO people
No one want to have a mistake made on them , everyone wants medicine to be perfect but outside of the "bill gates" of the world no one can afford it
Robots in medicine can help lower the incidence of mistakes . however mistakes will still exist and a mistake does not equal malpractice.
If we want to improve the medical system them we all need to have a realistic view of the possibilities.
Doctors should feel lucky, a bus drivers kills his passengers because he is too tired to drive, gets charged with homicide and thrown in JAIL. Doctors who have been up for 24 hours and prescribe medicine which kills a person, runs the risk of getting sued, damn that quite a racket.
The force that blew the Big Bang continues to accelerate.
The robots most certainly will (probably more often then you'd like), it's the people you have to worry about-- somewhere betwen 40,000 and 100,000 people die every year due to medical errors.
The classic text on this (if an article from 2000 can be considered classic), is To Err Is Human: Building a Safer Health System
Cache Rules Everything Around Me
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.
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.
Ok 20 cases out of 1,000,000
.00002 % incidence of "wrong site/wrong pt" not exactly an epidemic , nor do we know that any of those cases involved the same doctor or even the same hospital.
... doctors in countries with socialized medcine have vast immunity.
...until people realize that suing a HMO or it's doctors is almost impossible.
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 involves the use of 100% diagnosticly accurate HINDSIGHT.
The benifit of 100% diagnostic accuracy is something that doctors almost never have.
Completely removing doctors from responsibilty is something many propose..."lets model england or canada" they say
" we need a nationwide HMO"
As someone who has attended and testified in many medical malpractice trials i can say that the current method for dealing with medical mistakes and malpractice is dreadfully broken.
This issue i was trying to make with the earlier post was one of context . The common person hears "medical mistake" and leaps to "malpractice". That very leap is the first thing we need to change.
I would like to think that the slashdot crowd is above such base assumptions. While this may be a silly position, my last shred of optimism tells me that the best place for rational change to begin is the smarter then average crowd here.
"Yeah, I got your meds right here - you lumpy bag of mush..." - Bender
My God...it's full of stars!