Health care is becoming increasingly digitalized, starting with online medical records and now moving toward replacing human health care providers with robots. Writing in JAMA Network Open, a team of doctors and researchers from MIT and Brigham and Womenâ€™s Hospital, Boston, cited the COVID-19 pandemic as being instrumental in the expansion of telehealth offerings at many health care systems.1
The goal of telehealth is to limit human contact to lower the risk of infectious disease transmission, but removing the human element of care dramatically changes the doctor-patient relationship. While most existing telehealth systems involve the patient controlling a tablet or smartphone, the researchers suggested that a mobile robotic telehealth system controlled by clinicians would offer a more dynamic experience.
However, before implementing robots to engage with patients in emergency rooms across the U.S., they wanted to find out if robots would be accepted â€” and they were surprisingly well received.
Americans Open to Robotic Care
In the early days of the COVID-19 pandemic, the researchers began to look for ways to minimize interactions between patients coming into emergency rooms and health care providers. In cooperation with Boston Dynamics, they created mobile robots that can measure vital signs like temperature, breathing rate, pulse rate and blood oxygen saturation.
The dog-like robots have four legs and carry an iPad that allows for video communication with a health care provider.2
“Often as engineers, we think about different solutions, but sometimes they may not be adopted because people are not fully accepting of them,” study author Giovanni Traverso said in a news release. “So, in this study we were trying to tease that out and understand if the population is receptive to a solution like this one.”3
First, they conducted a U.S. survey of 1,000 people to gauge attitudes about using robotic systems in hospital settings. In addition to questions about their usefulness in carrying out specific health care tasks, the participants were asked to consider their usefulness â€œwith an emphasis on using robotic systems to limit direct human contact and conserve personal protective equipmentâ€� during the pandemic.4
The results revealed that most people were open to robotic health care services, including not only initial interviews and reading of vital signs but also somewhat more complex procedures, like testing for COVID-19 using a nasal or oral swab, placing an intravenous catheter, drawing blood and moving critically ill patients into a prone position.5
“Surprisingly, people were pretty accepting of the idea of having a robot do a nasal swab, which suggests that potential engineering efforts could go into thinking about building some of these systems,” the studyâ€™s lead author, Peter Chai, said.6
Most Said Robot Care Was Similar to In-Person Care
The next phase of the study took place in Brigham and Womenâ€™s Hospitalâ€™s emergency department. Fifty-one patients were approached about taking part in the robot study, and 41 agreed to participate (one did not get to complete the experiment because of a signaling malfunction with the robot).
The robot, controlled by a clinician, was then navigated to the patient and a video triage interview was conducted via the robotâ€™s tablet computer.
Patients were then asked to evaluate the experience. Out of the 40 patients, 37 (92.5%) said the experience was satisfactory, and 33 (82.5%) said that being interviewed by the robotic system was as satisfactory as being interviewed in-person by a clinician. “For the purposes of gathering quick triage information, the patients found the experience to be similar to what they would have experienced talking to a person,” Chai said.7
The team is now working on smaller robots that would be able to interact with patients outside of a typical hospital setting, such as in an ambulance or field hospital, as well as developing sensors that could take vital signs remotely.8
Another piece of the puzzle, however, before the widespread rollout of robotic health care can take place, is ensuring that people will accept this impersonal technology. As such, they stress, â€œFuture work may consider approaches to maximize acceptance of robotic systems among patients, especially those who declined to participate in the present study.â€�9
Health Passports: Another Form of Digital Health Care
Itâ€™s likely only a matter of time before youâ€™ll be asked to prove your vaccination status in order to carry on with your daily life. â€œThe government seems to be developing vaccine passports by stealth, making sure the technology is in place for anyone who needs it,â€� wrote Lara Prendergast, The Spectatorâ€™s assistant editor.10
Sheâ€™s referring to the U.K. government, which has given sizable grants to a number of private companies developing such technology, however vaccine passports are also being implemented around the world. Denmark, Sweden, Spain, Italy, Cyprus and Malta are among the countries that have expressed positivity toward vaccine passports to revive tourism, while in the U.S., plans for vaccine IDs are under evaluation.11
The app allows users to upload medical data such as a COVID-19 test result or proof of vaccination, which then generates a QR code that you will show to authorities as your health passport.12 The proposed common framework â€œfor safe border reopeningâ€� around the world involves the following:13
- Every nation must publish their health screening criteria for entry into the country using a standard format on a common framework
- Each country must register trusted facilities that conduct COVID-19 lab testing for foreign travel and administer vaccines listed in the CommonPass registry
- Each country will accept health screening status from foreign visitors through apps and services built on the CommonPass framework
- Patient identification is to be collected at the time of sample collection and/or vaccination using an international standard
- The CommonPass framework will be integrated into flight and hotel reservation check-in processes
Eventually, the CommonPass framework will be integrated with already existing personal health apps such as Apple Health and CommonHealth. If you want to travel, your personal health record will be evaluated and compared to a countryâ€™s entry requirements, and if you donâ€™t meet them, youâ€™ll be directed to an approved testing and vaccination location.
Significant Human Rights Concerns
Airline JetBlue announced that passengers flying to Aruba from Bostonâ€™s Logan International Airport could use the CommonPass digital health pass to enter the country.14 The plan is to quickly expand the program to other cities in JetBlueâ€™s network â€” and this is only the beginning.
But, while being positioned as a way to regain a sense of normalcy and travel with ease, itâ€™s actually a restriction of freedom â€” one in which you must â€œpresent your papersâ€� before you can cross a border. The â€œeasyâ€� steps to enter Aruba, which prior to the pandemic would have consisted of showing your passport, now include:
- Download the CommonPass app
- Get tested for COVID-19 by COVID testing companies Vault and XpresCheck, either at home or at the airport
- Prior to your flight, enter your â€œinvitation codeâ€� into the CommonPass app and upload your COVID-19 test results into CommonPass
- Fill out an online embarkation-disembarkation card, which includes your negative PCR molecular COVID-19 test; you can add your CommonPass ID in order to pre-verify with Aruba that you are â€œcleared to travelâ€�
- Upon arrival in Aruba, proceed through the â€œdedicated CommonPass immigration lanes to start â€¦ vacation soonerâ€�
Already, this is creating two â€œclassesâ€� of people â€” those who have the CommonPass and those who donâ€™t. This is just one of the significant human rights and civil liberty concerns being created by the implementation of digital health passports.
As noted by Rosalind Comyn, policy and campaigns manager at the National Council for Civil Liberties in the U.K., â€œIn essence, what vaccine passports are trying to do is create a system whereby some people can access freedoms, services or other kind of spaces and places and other people are excluded from them.â€�15
Big Tech Striving To Be a Digital Health Power Player
From robotics to artificial intelligence (AI), the future of health care is digital, and technology companies like Google are investing heavily in this area. In November 2018, for instance, Google hired the former CEO of Geisinger Health, David Feinberg, to run its Google Health initiative and soon after acquired DeepMind Health, which is part of an AI company creating AI assistances for health care providers.16
Google is working on developing voice recognition technologies to support doctors in their paperwork along with an image library that trains AI models to detect diseases. Itâ€™s also involved in electronic health records, developing a model that uses machine learning to make predictions about patient outcomes, like the likelihood of readmission or death.17
Itâ€™s a concerning trend, considering the â€œfrighteningâ€�18 amount of data Google and other technology companies collect. WebMD dominates health searches done through Google and shares user information with Googleâ€™s advertising arm and other third-party firms â€” a practice that is illegal in Europe.
Google, Amazon and Microsoft collect data entered into health and diagnostic sites, which is then shared with hundreds of third parties â€” and this data is not anonymized, meaning itâ€™s tied to specifically to you, without your knowledge or consent.19
What this means is DoubleClick, Googleâ€™s ad service, knows which prescriptions youâ€™ve searched for on the site, thus providing you with personalized drug ads, and Facebook knows what youâ€™ve searched for in WebMDâ€™s symptom checker, as well as any medical diagnoses you received.
This, along with many other behind-the-scenes partnerships, adds up to large-scale generation of health-related data points that could be used for targeted advertising, insurance premium decisions and much more.
Protecting Your Privacy From Technology
Iâ€™ve been talking about the privacy risks associated with online health records since 2008. The risks, and privacy-encroaching technologies, have only increased since then. The use of robots to replace in-person meetings with your doctor are only the beginning, as are the health passports starting out with the COVID-19 vaccine or a negative COVID test for international travel.
Itâ€™s setting a precedent for expansion that can be extended to other vaccines and medical information, and then to domestic travel and even leaving your house, as the passports will be carried on your phone that has location-tracking abilities. The creation of a decentralized web is part of the answer to protecting your freedom but you can also consider safeguarding your own online privacy if you havenâ€™t done so already.
To encrypt your text messages and keep them from becoming data mining fodder, download the Signal or Telegram app and/or use a virtual private network (VPN) on your desktop, laptop and mobile devices. As far as robotic doctors go, youâ€™re likely going to see more of them, to the point that one day they may play a larger role in health care than people.20