Remote Presence Robots Penetrating Healthcare - A Conversation with Dr. Yulun Wang
By Robotics Trends Staff - Filed Dec 06, 2007
Founded in 2002 and headquartered in Santa Barbara, Calif., InTouch Health is a leader in the design and manufacture of remote presence robots for the healthcare industry. The company today sells its RP-7 robot primarily to hospitals for use in intensive care units, emergency rooms and patient wards. The key components of the RP-7 Robot include:

Virtually There Technology – Integrates digital cameras, audio microphones, amplification circuitry and customer software to create two-way, audio-video communications between doctor and patient. The RP-7 features a pan-tilt-zoom head, mobile base, real-time video monitor allowing the doctor to be seen by the patient and the doctor to view and examine the patient and to capture images.

Holonomic Drive System
– The patented system enables the RP-7 to achieve omnidirectional or human-like mobility, rolling on three spherical balls rather than wheel, the robot can be maneuvered throughout the hospital environment by the remote physician.

SenseArray System 360
- This array of collision avoidance sensors is positioned around the robot’s waist and base to help the physician-drive “detect” when the robot is nearing an object. The infrared sensors provide the physician with additional “vision” and can help slow or stop the robot’s motion to avoid obstacles. The Control Station provides the operator with a graphical picture of the robot’s position in relation to nearby objects.

Expansion Bay – Permits the connection of devices such as handheld cameras, digital stethoscopes and a printer.

Laptop ControlStation
– A portable, laptop based control system offered in addition to the Desktop ControlStation.

RP-System Core – The robot platform is customizable, expandable and can be monitored using a multi-level watchdog system to ensure safe operation of the robot.

InTouch Health CEO and Founder Dr. Yulun Wang recently took some time to answer some questions about the company from John Desmond, Robotics Trends contributing editor. ()

Robotics Trends (RT): Can you tell me a little about the formation and evolution of InTouch Health as a company?  What is your background and how did the company get its start?

Yulun Wang YW: I started the company in January of 2002 with the head of engineering, Steve Jordan. Michael Chan started shortly after as head of sales and marketing. Previously, I had founded Computer Motion, which did surgical robots. We saw an opportunity to do something new, so we started InTouch Health. I had a PhD in electrical engineering specializing in robotics from the University of California at Santa Barbara. I taught there for a couple of years then co-founded Computer Motion, which went public and later merged with Intuitive Surgical. 

RT: How would you describe your company to someone who has no idea what InTouch Health does?  What is your ‘elevator pitch’?

YW: The elevator pitch is that InTouch has developed a communication modality which we call remote presence. It’s the closest we are going to get to the Star Trek “beam me up Scotty” concept in our lifetimes. We combine robotics, the Internet and wireless communications to project a person from one location into another environment and have them be able to move about and interact in that environment as if they are there. We apply this in the area of health care because health care has significant challenges with regards to caring for our aging population and the fact that we have shortages of health care workers, specifically certain types of nurses and physicians. So our technology is used predominantly by physicians today to “beam” into their patient’s bedside to be able to provide care for them anywhere and anytime.

RT: How well penetrated is your product line versus the total market potential?

YW: We have not even scratched the surface.

RT: Who is the typical InTouch Health customer?  Do you have a ‘typical customer’?

YW: Typically today it’s the hospitals, generally in the neuroscience and critical care areas, but also neonatology and pediatric specialists, as well as general surgeons and other types of surgeons. We cover a broad number of clinical backgrounds.

RT: What about ‘premier accounts’, companies with name and brand recognition that are using your products? Can you name some of them?

YW: We are in UCLA, Johns Hopkins, the Trinity Healthcare System, Sutter Health Care System, the Detroit Medical Center and Hackensack University Medical Center. Those are but a few. 

RT: How do you win new business?

YW: We have a direct sales force and we go to a number of trade shows. Many of the people at the company are quite steeped in the healthcare field, so we have a number of historical contacts who we continue to work with.

RT: Have you found any resistance or fear of this product?

YW: Not really.  There is an education process involved our product as with any new idea. Usually people find the idea very intriguing and thought-provoking, but often they have to go through an educational process before they are willing to lay out dollars to acquire the technology.

RT: What kind of price points are you offering?

YW: It’s in the area of $4,000 to $7,000/month for the robot, depending on the duration of the commitment and the volume of units.

RT: Are there other vertical market segments where you feel InTouch products and services would add real value?

YW: Yes, we also think the robots can add value outside of health care such as in offshore manufacturing, corporate communications, in the presentation and trade show industry and in education. Remote presence is really just a new modality of communication which can be applied to a host of applications.

RT: It appears that your RP-7 Remote Presence Robotic System technology is central to many of your platform products.  Can you describe what RP-7 is, its advantages and how it operates?

YW: RP-7 is the name of our robot. It stands about 5.5 feet tall, has a head built with a flat screen monitor and a body with the contour of a human like figure. It rolls on balls rather than legs, which is more energy efficient and simpler in terms of cost structure. The user is generally located somewhere else, such as at home or at a scientific meeting which could be halfway around the world. The user beams into the robot by sitting in front of a laptop computer with an integrated camera, joystick and microphone-speaker system. The user connects to the robot via the public Internet, which facilitates connections and optimizes bandwidth. So the remote physician connects to the robot, which would usually be in a hospital emergency department of and Intensive care Unit (ICU), and it allows the physician to interact and move about in that environment as if they were there.  We use broadband to get up and down off the Internet, and we are using Wi-Fi or 802.11 a, b or g to enable mobility for the robot. And now we are also using cellular broadband so that the remote clinician can be truly mobile and does not have to be located in a particular Internet hotspot or a location where they have direct Internet access.

RT: How do patients typically react to the robot?

YW: That’s a good question. It is also usually one of the first question people ask. The short answer is that patients really love it. It’s an exciting interaction, when their doctor rolls up to them as a robot. Usually the first five minutes is just about the technology, but with a lot smiles and a lot of laughs thrown. This is especially true when we are in a children’s hospital, like in Los Angeles, Orange County and Detroit. When you are rolling down the hall, you are like the pied piper. The children follow the robot and they hug the robot.

Johns Hopkins did a multi-center study about patient reactions to telepresence robots.  They found that patients prefer seeing their own doctor via the robot than another attending physician in person. You can understand why.  Patients simply want to see their own doctor. Their doctor understands what’s going on with them, and the robot enables that to happen.

RT: What gave you the idea for RP-7?

YW:
Well my entire professional history has been in the health care area, so I’m very aware of the trends going on. You have the trend that the number of people graduating from medical schools and nursing schools is flat, yet the population is aging and growing larger. That places exponential demand on health care services. Then you’ve got the increasing specialization in medicine. Given those trends lines, the question becomes how to best use the resources that we have.

A couple of hundred years ago, it took over 90% of the world’s population to grow the food for all of us. Today it takes probably about 2% of the population to do that, because of improving technologies which allow better leveraging of fewer people to create the food for us.  Healthcare has to go through a similar type of transformation. As everybody knows, health care costs are going up and becoming prohibitively expensive. So if we can use technologies which better leverage the resources we have, it can be a real win-win. It can be a win for society in that it can help keep a lid on health care costs, and it can be a win for patients because they can see the right physician at the right time without having to wait forever. Oftentimes, waiting becomes real problematic from a clinical perspective. So there is a safety aspect involved as well. It also increases the efficiency of physicians and clinicians. These groups can actually do more using less of their time.

I use the system to give presentations quite often. This week alone from Santa Barbara, I gave two presentations in Kentucky, one in Louisville and one in Elizabethtown, and I gave a presentation in Palo Alto, one in Irvine, and one in Kansas City. I never left Santa Barbara. So it’s a real efficiency driver.

RT: Can you describe the software that powers the InTouch Health robots? What are the challenges and potential in this area?

YW: On the software side, it’s pretty complex. We have spent many years with many very skilled people working on it. There is the video and audio aspect, which presents unique problems relative to a video conferencing system for instance. Since we have a mobile platform, the dynamics range of the visual field coupled with the latency are big challenges. Additionally with the microphone, when you are moving, you need to accommodate the changing acoustical environment. Then take the control aspects.  We must be able to keep control at a low latency, making it very responsive, yet safe.  This is a real challenge. And then we have a lot of software developed to facilitate connectivity, because typically the robots are behind firewalls, the control stations are behind firewalls, and to make us seem more seamless while traversing firewalls is a big deal. We also have developed a great deal of software to manage and monitor the fleet of systems we have out there.

RT: What lessons have you learned since you have been fielding these robots?

YW: There have been so many of them, it is difficult to articulate them all. Every time we are working with new customers, we are learning new lessons.  The environments, too, is continually changing. The introduction of cellular broadband has brought a new dimension where we can add additional flexibility in our system. We are adding new diagnostic devices onto the robot, such as printers or the ability to plug in a stethoscope. These new capabilities result in a more complete solution to help patients. We also have learned a great deal about electronic medical records and how remote presence can couple with medical records so that a remote physician can not only interact with patients and staff on site, but also have access to all the different information they need to make decisions on how to advance care.

RT: Is there any particular reason the market is not more penetrated? Is it simply awareness?

YW: Yes it’s simply awareness and education

RT: Is there any technology advance that has made your robot reliable enough to be commercially viable today?

YW: The reliability is due to good, solid engineering design. We have had a lot of iterations with regards to our different joints, mechanisms and software to make it rock solid.

RT: Who do you view as your direct competitors?

YW: We really don’t have direct competitors today. Our competition comes in the form of other ways to solve the same problem. For example, the two primary forms are hospitals that just put a camera beside every bedside and monitor it, or hospitals will take a video conferencing system, put it on a cart, and push it around.

RT: What is the InTouch Health business plan?  Do you intend to go public?  How will you continue to differentiate yourself from your competitors?
YW: We aspire to become a public company someday.

RT: Any sense of the timing?

YW: I’d rather not say.

RT: How did you come to locate your company in Santa Barbara, California.? Why is it a good location for InTouch Health?

YW: It’s a beautiful place to live. There is a higher cost of living for the area, but the people who live here really enjoy the environment tremendously. That’s why I’m here. And the university is a great resource for us. Many of our employees went to school at University of California, Santa Barbara.

RT: What can you tell us about the future of InTouch Health?  Can you comment on InTouch products that we might see in the future?

YW: If you use the vision created by Star Trek, the beam me up Scotty vision, we are just going to continue to move and drive things into that dimension, to enable that remote person to be as capable as possible in the remote location.

RT: Do you watch Star Trek?

YW: I haven’t lately, but I used to watch it a lot.

RT: Thank you very much for your time.

Contact
InTouch Health
90 Castilian Drive, Suite 200
Santa Barbara, CA 93117
P: 805-562-8686
F: 805-562-8663
http://www.InTouch-Health.com

RT: Are there other vertical market segments where you feel InTouch products and services would add real value?

YW: Yes, we also think the robots can add value outside of health care such as in offshore manufacturing, corporate communications, in the presentation and trade show industry and in education. Remote presence is really just a new modality of communication which can be applied to a host of applications.

RT: It appears that your RP-7 Remote Presence Robotic System technology is central to many of your platform products.  Can you describe what RP-7 is, its advantages and how it operates?

YW: RP-7 is the name of our robot. It stands about 5.5 feet tall, has a head built with a flat screen monitor and a body with the contour of a human like figure. It rolls on balls rather than legs, which is more energy efficient and simpler in terms of cost structure. The user is generally located somewhere else, such as at home or at a scientific meeting which could be halfway around the world. The user beams into the robot by sitting in front of a laptop computer with an integrated camera, joystick and microphone-speaker system. The user connects to the robot via the public Internet, which facilitates connections and optimizes bandwidth. So the remote physician connects to the robot, which would usually be in a hospital emergency department of and Intensive care Unit (ICU), and it allows the physician to interact and move about in that environment as if they were there.  We use broadband to get up and down off the Internet, and we are using Wi-Fi or 802.11 a, b or g to enable mobility for the robot. And now we are also using cellular broadband so that the remote clinician can be truly mobile and does not have to be located in a particular Internet hotspot or a location where they have direct Internet access.

RT: How do patients typically react to the robot?

YW: That’s a good question. It is also usually one of the first question people ask. The short answer is that patients really love it. It’s an exciting interaction, when their doctor rolls up to them as a robot. Usually the first five minutes is just about the technology, but with a lot smiles and a lot of laughs thrown. This is especially true when we are in a children’s hospital, like in Los Angeles, Orange County and Detroit. When you are rolling down the hall, you are like the pied piper. The children follow the robot and they hug the robot.

Johns Hopkins did a multi-center study about patient reactions to telepresence robots.  They found that patients prefer seeing their own doctor via the robot than another attending physician in person. You can understand why.  Patients simply want to see their own doctor. Their doctor understands what’s going on with them, and the robot enables that to happen.

RT: What gave you the idea for RP-7?

YW:
Well my entire professional history has been in the health care area, so I’m very aware of the trends going on. You have the trend that the number of people graduating from medical schools and nursing schools is flat, yet the population is aging and growing larger. That places exponential demand on health care services. Then you’ve got the increasing specialization in medicine. Given those trends lines, the question becomes how to best use the resources that we have.

A couple of hundred years ago, it took over 90% of the world’s population to grow the food for all of us. Today it takes probably about 2% of the population to do that, because of improving technologies which allow better leveraging of fewer people to create the food for us.  Healthcare has to go through a similar type of transformation. As everybody knows, health care costs are going up and becoming prohibitively expensive. So if we can use technologies which better leverage the resources we have, it can be a real win-win. It can be a win for society in that it can help keep a lid on health care costs, and it can be a win for patients because they can see the right physician at the right time without having to wait forever. Oftentimes, waiting becomes real problematic from a clinical perspective. So there is a safety aspect involved as well. It also increases the efficiency of physicians and clinicians. These groups can actually do more using less of their time.

I use the system to give presentations quite often. This week alone from Santa Barbara, I gave two presentations in Kentucky, one in Louisville and one in Elizabethtown, and I gave a presentation in Palo Alto, one in Irvine, and one in Kansas City. I never left Santa Barbara. So it’s a real efficiency driver.

RT: Can you describe the software that powers the InTouch Health robots? What are the challenges and potential in this area?

YW: On the software side, it’s pretty complex. We have spent many years with many very skilled people working on it. There is the video and audio aspect, which presents unique problems relative to a video conferencing system for instance. Since we have a mobile platform, the dynamics range of the visual field coupled with the latency are big challenges. Additionally with the microphone, when you are moving, you need to accommodate the changing acoustical environment. Then take the control aspects.  We must be able to keep control at a low latency, making it very responsive, yet safe.  This is a real challenge. And then we have a lot of software developed to facilitate connectivity, because typically the robots are behind firewalls, the control stations are behind firewalls, and to make us seem more seamless while traversing firewalls is a big deal. We also have developed a great deal of software to manage and monitor the fleet of systems we have out there.

RT: What lessons have you learned since you have been fielding these robots?

YW: There have been so many of them, it is difficult to articulate them all. Every time we are working with new customers, we are learning new lessons.  The environments, too, is continually changing. The introduction of cellular broadband has brought a new dimension where we can add additional flexibility in our system. We are adding new diagnostic devices onto the robot, such as printers or the ability to plug in a stethoscope. These new capabilities result in a more complete solution to help patients. We also have learned a great deal about electronic medical records and how remote presence can couple with medical records so that a remote physician can not only interact with patients and staff on site, but also have access to all the different information they need to make decisions on how to advance care.

RT: Is there any particular reason the market is not more penetrated? Is it simply awareness?

YW: Yes it’s simply awareness and education

RT: Is there any technology advance that has made your robot reliable enough to be commercially viable today?

YW: The reliability is due to good, solid engineering design. We have had a lot of iterations with regards to our different joints, mechanisms and software to make it rock solid.

RT: Who do you view as your direct competitors?

YW: We really don’t have direct competitors today. Our competition comes in the form of other ways to solve the same problem. For example, the two primary forms are hospitals that just put a camera beside every bedside and monitor it, or hospitals will take a video conferencing system, put it on a cart, and push it around.

RT: What is the InTouch Health business plan?  Do you intend to go public?  How will you continue to differentiate yourself from your competitors?
YW: We aspire to become a public company someday.

RT: Any sense of the timing?

YW: I’d rather not say.

RT: How did you come to locate your company in Santa Barbara, California.? Why is it a good location for InTouch Health?

YW: It’s a beautiful place to live. There is a higher cost of living for the area, but the people who live here really enjoy the environment tremendously. That’s why I’m here. And the university is a great resource for us. Many of our employees went to school at University of California, Santa Barbara.

RT: What can you tell us about the future of InTouch Health?  Can you comment on InTouch products that we might see in the future?

YW: If you use the vision created by Star Trek, the beam me up Scotty vision, we are just going to continue to move and drive things into that dimension, to enable that remote person to be as capable as possible in the remote location.

RT: Do you watch Star Trek?

YW: I haven’t lately, but I used to watch it a lot.

RT: Thank you very much for your time.

Contact
InTouch Health
90 Castilian Drive, Suite 200
Santa Barbara, CA 93117
P: 805-562-8686
F: 805-562-8663
http://www.InTouch-Health.com

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