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Arthur wants to have a word with Jack. Jack looks a bit wary about talking to Arthur. That's because Arthur's not a real human being and, technically, Jack's not really talking to Arthur, but rather through Arthur. Jack's communicating with a man some 1,500 miles away in California who helps run Silverado. And Arthur is a wireless, mobile "remote presence robot" that's been roaming the hallways of Cypresswood for three months now.
About five feet tall, Arthur looks like the bastard progeny created if Johnny Five from Short Circuit impregnated an industrial vacuum cleaner. A video camera, LCD screen and microphone are outfitted to a motorized platform on rollerballs. Arthur's head (the screen) can swivel in any direction. The remote operator in California controls these functions with a computer and a joystick. And via a separate camera and microphone, this operator's image and voice registers on Arthur, using a broadband Internet connection and a wireless local network. InTouch Health, the company that developed Arthur, calls the robot the Companion.
"We nicknamed him Arthur," says Jackie Barnes, administrator at Cypresswood. "He actually came and participated in a sock hop with us and so we called him Arthur Fonzarelli, because he won the dance contest. So when it's official on the record, we call him Arthur. But his nickname's the Fonz."
Jack, who has a wrinkled mug and a bald head speckled with liver spots, thinks Arthur is a swell idea. And as for the rest of the residents? Jack glances over to a row of seniors dozing serenely in wheelchairs by the wall, their heads cocked to the side. "I don't think they even know about it."
While house calls remain a relic of the distant past -- and bedside manner has no check-box on HMOs -- some might worry that the Companion is now further endangering the human touch, if not quality of care. "Obviously the robot does not have arms, so it can't reach out and touch you, but it can be with you in real time where we're able to speak and converse," says Mark Mostow (through Arthur), vice president for sales and marketing at Silverado. Silverado and InTouch representatives say the robot addresses a "demographic crisis in health care" -- an increasing elderly population and a shortage of trained workers to take care of them.
"I think patients, in studies that have been done, almost always say they prefer to see a physician in person, but they've been pretty satisfied with the telecommunications technology," says Dr. Jim Grigsby, an associate professor who has specialized in telemedicine at the University of Colorado Health Sciences Center. He also questions the cost effectiveness of such an application, noting that it would seem to be cheaper to just bring people in front of a camera. (InTouch leases the Companion for $3,000 a month.)
Other concerns center on the fact that the doctor using Arthur has no capability to touch a patient, such as in probing for pain or swelling before making a diagnosis. "The vast majority of what a physician would do, say, doing rounds, the vast majority of it is visual," argues Timothy C. Wright, vice president of marketing at InTouch. "That part of the interaction is very doable. The part that's not doable is if they need to actually physically touch, say, an abdomen, to feel if it's soft or hard." Silverado staff say they can handle such tasks.
Grigsby notes that some in health care believe 75 percent of what a physician does can be accomplished by telephone. With no inherent knowledge of his own, Arthur is, in a way, a glorified telephone or, more accurately, a rolling video conference system.
As for holding down costs, a room at the Cypresswood facility starts at almost $3,800 a month. The center now houses 72 residents -- not including the Fonz.
"I think the positive side of it is that with the elderly population increasing and less physicians to take care of the population, this is the next best thing we can do," says Dr. Kathleen Becan-McBride, vice president of community outreach and education at the UT-Houston Health Science Center. "Otherwise we won't be there at all."