InTouch Health lets doctors be in two places at once

Dr. Yulun Wang calls it an epiphany.

In 2001, while Dr. Wang was running Computer Motion, his ZEUS robotic surgical system played a pivotal role in the Lindbergh Operation, the world’s first transatlantic surgery, as surgeons in New York controlled the arms of the robot as it removed a gallbladder from a patient in Strasbourg, France, via a high-speed fiber optic supplied by France Telecom.

“We combined robotics with telecommunications to enable the projection of human dexterity and perception to another location,” Dr. Wang says in an exclusive interview with BioTuesdays.com. “Just like in the movie Avatar, a person in one location can be projected to another location and interact in another environment as if they were really there.”

In 2003, Dr. Wang merged Computer Motion with Intuitive Surgical (NASDAQ:IRSG) after forming his closely held InTouch Health in 2002. A robot fanatic for decades, Dr. Wang was the principal architect and inventor of the voice-controlled robotic arm called AESOP, the first FDA-cleared surgical robot.

Today, InTouch Health is a global leader in comprehensive telemedicine, providing a full suite of state-of-the-art medical robots and network services for all types of physician-patient consults. At the heart of the application is the wireless and mobile Remote Presence (RP) robot that lets physicians effectively be in two places at once.

The RP system consists of one or more ControlStations and RP-7 robots, which are connected through a combination of secure internet and wireless technologies.  A physician seated at a ControlStation in one location can control the RP-7 in another location to perform key medical activities when it isn’t possible to be physically at the patient’s bedside.

Through the ControlStation, for example, a physician can discuss a patient’s status at the nurses’ station, drive the robot into a patient’s room, observe patient behavior, check bedside monitors and ventilator settings, discuss care with the patient and family members, and return to the nurses’ station to give instructions or discuss next steps.

In addition, whenever access to medical expertise is limited such as in a rural or community hospital— something Dr. Wang calls an “underserved location”—the RP system can improve quality of care and patient safety, decreasing complications for patients in areas of high acuity like the critical care unit, as well as aid in time-sensitive treatment decisions for emergencies such as stroke care.

“We believe that this technology can and will improve the way health care is delivered worldwide,” Dr. Wang says.

Dr. Miles Ellenby, a pediatric intersivist at the Oregon Health & Science University Telemedicine Network, agrees. In a corporate video, he says telemedicine allows a specialist consultation in real time and allows the consultant to see what’s really happening, as opposed to depending on the physician to assess the patient on site and then communicate that assessment over the telephone.

“We now have a camera there to see what’s happening. It helps the physician get the neurologist or the pediatric intensive care doctor when they need them right away,” he adds.

Dr. R.D. Jones, a pediatrician at Rouge Valley Medical Center in Medford, Oregon, contends there are not enough pediatric specialists in the state. “We only have two pediatric intensive care units, and both of them are located in Portland. So this helps with one of the crises we have in health care, which is the distribution of limited personnel; those personnel are going to be located in the bigger cities where they have more of the population to see.”

Dr. Ellenby adds that telemedicine can improve both the immediate care that a child gets by helping a physician on site, which can reduce costs by not having to transport a patient unnecessarily. “A lot of these children can be cared for in the community safely; it’s just a matter of improving the comfort level on both ends of the call to know that things are being done correctly.”

In the acute care situation, such as a stroke, Dr. Ellenby says that it’s critical to have a neurologist make a decision pretty quickly whether or not to deliver what can be a brain-saving medication called tPA (tissue plasminogen activator). “Neurologists aren’t readily available around the state, but they are here in Portland, and they can provide a consultation with telemedicine.”

InTouch Health has more than 400 hospitals on six continents, including North and South America, Western Europe, Asia, Africa and Australia, enrolled in its RP network for the delivery of telemedicine services, such as for stroke, critical care, cardiology, trauma, pediatrics, neonatology, psychiatry, language translation, and clinical education and surgical/procedure mentoring.

“The reason we have a system in Africa is that the royal family in Gabon wanted to get care from Cedars-Sinai in Los Angeles. In Europe, systems are being placed to be used within Europe, but once they have them, they realize that can interact with people in the U.S. as well,” Dr. Wang says.

There are 5,000 hospitals in the U.S., and Dr. Wang figures that in five years, InTouch Health can get to the vast majority of them.

InTouch Health doesn’t disclose financial results, but Dr. Wang says that many customers don’t buy the RP devices but, rather, rent them and then layer in the networking services for one monthly cost. “Our RP endpoints range from under $1,000 a month to over $5,000 a month, depending on what the product is, the quantity and the number of months the customer wants to sign up for.” The company also manages issues around IT, firewalls and bandwidth, so services are seamless for users.

Besides the flagship RP-7, the company’s other FDA-cleared robotics systems include the RP-7i, RP-Lite, RP-Vantage and RP-Xpress. All of these RP end points allow direct connection to Class 2 medical devices. Devices such as electronic stethoscopes, otoscopes and ultrasound can be connected to the expansion bay of the RP end point, to transmit medical data to the remote physician.

The RP-Vantage enables surgical telementoring and remote collaboration in operating and procedure rooms, while the recently released RP-Xpress is a handheld portable unit cleared for connection to diagnostic medical devices.

“There are more refinements coming to the RP line to make core issues of video, audio and mobility better, and [improve] functionality to enable the remote clinician to have more capabilities to do everything remotely,” Dr. Wang points out.

Asked whether robot doctors can solve the health care crisis, he says health care reform has to happen because of cost constraints on the system and trends with the life expectancy and physician shortage.

“Under the Health Care Reform Bill, there are a bunch of concepts being thrown out in terms of pay-for-performance, bundling and transparency, for example.” he says. “But the point is that we have to innovate our way out of this problem. One of the innovations is a robotic doctor. And the future of health care delivery has to become incorporated with telemedicine as one of the key solutions to the health care crisis we have.”