The future of patient education: Robots!
You’ve heard of robots performing surgeries and dispensing meds, but did you ever think they would take over your teaching? Yes, robots are starting to fill in for us, from pre-op to discharge teaching.
Pre-op teaching by robot
Back in 2003 Healthbot.net developed a natural speaking robot to do patient education before catheter ablation, to free up the surgeon’s time. If the robot did not know the answer to a question, it would look it up on the Internet. The researchers found that patients asked the robot 4.6 questions, while those taught without the robot asked 3.2 questions. It is not clear whether they asked more questions because the robot left out some information, if learners were more comfortable asking a robot than a person, or if they just wanted to interact more with the robot. The study concluded patients in both groups were equally informed about the surgery.
But how did the patient who was about to have a catheter ablation feel about the physician who turfed his pre-op conversation to a robot? How would you feel if your surgeon used this service?
Interactive discharge teaching by touch screen computer
Now, Northeastern University has developed a Virtual Discharge Advocate named a trademarked “Louise.” She is an animated character that appears on the touch screen display mounted on an articulated arm connected to a mobile cart brought to the patient’s bedside. The virtual nurse uses synthetic speech and synchronized animation, and patients “talk” by touching what they want to say on the touch screen. Louise displays a copy of the discharge instructions, while the patient holds a hard-copy. The language used by the virtual nurse is dynamically composed based on each patient’s medical data and questions asked. Louise answers questions, and tests patients’ understanding of key facts. Following the interaction, a report is produced of the patient’s issues and list of questions Louise could not address, so a human nurse could follow up.
The researchers calculated Louise saved the hospital $145 per patient. This is because physicians who perform discharge education using Louise can bill at the higher level (CPT Code 99239), which allows them to bill about $32 more per discharge. In a pilot study of the automated virtual nurse system, 74% of hospital patients said they preferred receiving their discharge instructions from the virtual nurse, rather than their human doctors or nurses. They reported that a nurse or doctor would just hand over a piece of paper, or assume you understand. The virtual nurse took the time to discuss each prescription in detail, and to repeat unclear information, and evaluate understanding.
The future of patient education
Nurses are busy. That’s how a 71-year old man in Oregon who went to the emergency room for abdominal pain went home with printed discharge instructions for pain in pregnancy. The nurse did not take the time to review the instructions with the patient before discharge.
But it is an essential part of our jobs to make sure the patient knows how to continue care at home. The transition from hospital (where one is watched and taken care of) to home (where one is alone) can be stressful for the patient. Robots take the time to teach, answer questions, and evaluate understanding. Why can’t we?
Are you looking forward to a robot taking over your teaching? Did you come to nursing to change dressings or to form therapeutic relationships with patients? Where do you want the future of patient education to go? What are you going to do about it?
Sources:
Elsner, C. H., Berger, T., Wolf, A., Hindricks, G., & Mazzi, C. (2003). Healthbot.net: Patient education with a natural speaking robot before catheter ablation: results from 47 patients. Computers in Cardiology, 669- 672.
Jack, B. W., Chetty, V. K., Anthony, D., Greenwald, J. L., Sanchez, G. M., Johnson, A. E., et al. (2009). A reengineered hospital discharge program to decrease rehospitalization: A randomized trial. Ann Intern Med, 150(3), 178-187.
Muldoon, K. (2008) A hospital’s discharge instructions tell a Gold Beach man he’s pregnant. http://www.oregonlive.com/living/oregonian/index.ssf?/base/living/122239772264110.xml&coll=7
4 Responses to “The future of patient education: Robots!”
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Thanks for the article Fran, it prompts one to really think about technology/robotics and education.
My thoughts:
1. If we (nurses) keep abandoning the task of patient education, will it eventually be taken from us – because we would at one point lack the skills and knowledge necessary to teach? Scary I know, but just putting that thought out there.
2. Do you know of studies that tie nurse-provided patient education to reducing costs? We should probably keep tracking this data so we can keep it relevant to all healthcare stakeholders.
Thanks again, for your very helpful blog. Keep them coming : )
jesy
Jesy, there are many studies that demonstrate that patient education reduces costs and improves outcomes. One of the most powerful:
Koelling, T. M., Johnson, M. L., Cody, R. J., & Aaronson, K. D. (2005). Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation, 111(2), 179-185.
In a randomized study, they compared “the standard discharge process” teaching with 1-hour with a nurse, and found, “The addition of a 1-hour, nurse educator-delivered teaching session at the time of hospital discharge resulted in improved clinical outcomes, increased self-care measure adherence, and reduced cost of care in patients with systolic heart failure.” and “Costs of care, including the cost of the intervention, were lower in patients receiving the education intervention than in control subjects by 2823 dollars per patient.”
Also, “Patients receiving the education intervention had a lower risk of rehospitalization or death.” Patient education saves lives, as well as money!
Teaching patients to take care of themselves is good business and good practice.
It would be interesting to see the retention of information by patients following instructions given by a robot vs. by a trained professional.
I am a proponent of the use of technology in health care, but there needs to be a recognition of its limitations.
My firm, Vivacare (www.vivacare.com), provides health professionals with a free Web-based patient education service to support clinical care and patient satisfaction, but there are no assumptions that it will replace the need for clear instructions to be given first in person. Patient Education Websites, mobile devices, robots…etc. need to be shaped to SUPPORT the health professionalsf. Aiming to replace people with technology will certainly lead to unexpected challenges.
Great post, I bet a lot of work and research went into this article.