By

Joseph H. Guth, Ph.D.

It is estimated by the Office of Management and Budget that there will be a 20% shortfall in the total number of health care workers in the medical profession by 2030.  In the decades between now and then, the Baby Boomers will become the senior citizens in need of additional medical and nursing home care.  All this is framed in terms of a decreasing federal budget and shrinking Social Security/Medicare funding.  With all of these forces acting in concert to reduce the level, quality, dependability and availability of adequate health-related services, what will become of hospitals, medical facilities, nursing and convalescent homes in the United States for the foreseeable future?  And more important, what will become of the patients and residents who will be forced to populate them?

It is not going to get better since the generations following the Baby Boomers born in the 1940s are fewer and less affluent than the Boomers themselves.  They are paying less into the kitty to take care of the Boomers as they reach the age at which they need to draw money and services from the system.  The only viable solution this scientist sees is through the potential development of personal and healthcare robotic and automated systems to add the extra hands needed to care for the ill, injured, elderly or infirmed.  Where low paying nurses aids need to give hands-on care to patients, some of the tasks may become automated or capable of being carried out through robotic systems.  Over-taxed middle and upper level nurses and physicians will have to be able to take care of more patients and do it more quickly, efficiently, with less error and at a lower cost.  Take the following tasks and envision systems that can partially or completely replace the human in dealing with them.

1. Cleaning and bathing a hospital patient or nursing home resident.
2. Delivering food, assisting in feeding and providing beverages.
3. Cleaning of resident and changing diapers in cases of incontinence.
4. Changing bed linens and bathroom supplies (includes linens, blankets, towels, toilet paper, tissues, personal hygiene kits in hospitals)
5. Taking nursing home residents to the bathroom and assisting them.
6. Personal care assisting robots (for shaving, face washing, tooth brushing and applying makeup).
7. Personal care assisting robots (for assisting in dressing and clothes retrieval).
8. Robots to ferry patients in and out of hospitals and nursing homes, and from one location to another within the facility.
9. Monitoring of the movement and activities of patients with dementia and Alzheimers to keep them from wandering away from the facility.
10. Personal security for patients that may be prone to falling or hurting themselves in other ways.
11. Securing and dispensing of medications to the nurse charged with their administration on a patient by patient basis.  This would be interfaceable with a voice-based system through with a prescribing physician could dictate his new treatment orders and prescriptions into the main computer of the facility from any telephone or computer, and the system would notify the pharmacy, verify the prescription, issue pharmacist orders, and then when delivered to the facility, the drugs would be placed in the dispensing robotic system that would present the medicines at the appropriate times for each patient to the charge nurse.  Of course the billing would be built into any such system.
12. Robots that could provide the means to transfer patients from beds to wheelchairs and gurneys if needed.
13. Expert systems that could act as a diagnostic and treatment resource for the physicians, nursing staff and pharmacists.
14. Additional robotic systems in the laboratories to administer tests and perform various analyses.
15. Surgical assisting robots for microsurgery of the most delicate nature as well as routine surgical or orthopedic procedures that must be performed remotely at a distance.
16. Automated hospital beds with pressure-relieving features built into them that effectively prevent bedsore formation.
17. Inexpensive vital sign and specialized diagnostic monitoring modules that can be installed on any existing bed to monitor patients and alert staff more quickly to distressed patients.
18. Physical therapy administrating robots and automated equipment.
19. Janitorial robots (floor, furniture and general cleaning tasks).

Many of these items have already been successfully addressed through robotics and computerized systems.  Work has to be done for several of these issues to provide even a modest offering of products to accomplish them.  As the number of individuals enter the healthcare profession slowly declines over the next four decades, it will become even more critical to utilize those remaining and do it in the most useful and cost-effective fashions.  The cost of many of these systems is high at present, but with the increased need for them, the costs should begin to drop.  As this happens, the labor costs will drop too in terms of total hours and total staff salaries and this savings can begin to fund these replacement strategies.  If a facility can see that the normal lifespan for such devices is typically many years then the savings per year that is realized continues to enhance the profitability.  This long term savings can even lead to additional equipment being purchased to continue replacement of human staffing as it declines.

The total replacement of humans is not contemplated in this article.  Many tasks will need all the skills, knowledge and faculties of a well-trained and caring healthcare professional.  What is being advocated here is the enhanced use of robotic and computerized systems to replace those leaving the healthcare profession and causing the anticipated shortages, as well as to decrease the overall level of medical errors and response time that many of these errors are caused by.  After a few short years of seeing these systems routinely operating in facilities of all types, their full acceptance by all should be assured.  For robotics manufacturers, their long range business and research planning will miss a major opportunity if they dont begin to start research in the development of systems to provide the needed relief.

Dr. Joseph H. Guth, a chemist, is president of Scientific and Forensic Services, Inc. of Norfolk, VA.  He has been in medical and gerontological research and teaching and is now a consultant.  His interest in robotics, computers, artificial intelligence and expert systems goes back to the 1950s when he witnessed one of the earliest fully mechanical engineering computers in operation.