1. INTRODUCTION:

Health care has a rapid growing market for industry and business. There are 580,000 establishments in the healthcare industry and they all vary in terms of size, technology, staffing patterns and organizational structures. The healthcare industry is a combination of medical technology and human touch which provides care and responses to the needs of millions of people from a newborn to the aged. Technology plays a major role in the healthcare industry. But the application of engineering and technology in the healthcare domain is different from the other industrial sectors.

The major difference lies in the product and the professionals involved in this industry. The advanced medical equipments invented and produced for the betterment of this industry is controlled by strict regulations as it involves human lives and therefore cannot afford any kind of error or defects in it. The products have to be absolutely safe, ethical and perfect in every sense. The application of automation technologies in this domain has created the possibility of various methods of diagnosis and treatments. The key sectors of automation in this industry are clinical development, non-invasive surgeries, infection control, gene therapies of cancer treatment and many more. The invention of robots in the medical pill dispersion technology is another area where automation technology is used successfully. With the help of Information technology the patient care and work efficiency has improved with devices like hand held computers to take notes about each patient. The electronic database system has eliminated lot of paper work to store patient information, vital signs and diagnostic test reports.

2. Automation in healthcare:

Automation has the potential of improving the quality of service in the healthcare domain. The key sectors of automation in the healthcare industry are:

· Health Care Delivery:

· Health promotion and non-invasive surgeries.

· Diagnostics:

Home pregnancy tests, MRI scanners, random access analyzers, Blood glucose sensors.

· Pharmaceuticals:

Automated dispensers used by pharmacies and retailers.

· Medical Devices:

Stents and Pacemakers¹.

The application of automation technologies can be observed in various segments of the healthcare domain starting from business processing system to advanced medical equipment. Human beings grow older but not necessarily fitter. The western world has more easy access to healthcare in comparison to other less rich countries which is a great challenge from the business perspective. Healthcare has a significant market for large companies like Philips as they supply a whole range of automated products like complex medical imaging and diagnostic equipments such as linear accelerators and X-rays. These medical devices compliment the traditional pharmaceutical technologies and converge into regenerative medical products. The medical devices used in this domain can be categorized into three categories such as “High value/High cost, High value/ Decreasing Cost and Low Value/Low Cost”. The people who belong to the integral part of this industry come from multidisciplinary background and cultural diversity but the common objective is to bring innovation to technology to make human life better².

3. The Marketplace of Automation Technologies:

Advancement in Healthcare has increased life expectancy and the quality of life in the western countries. The advanced of automation technologies have contributed constantly to the decrease in mortality rates since 1970’s. Medical technology is dominated by innovations in the western countries. USA has been ruling the global market in automated medical technology. The healthcare and medical industry of USA had almost $77 billion dollar worth of production related to this industry as per the data of 2002. Also, the country has been the leader in terms of export of medical technology as well. The data of 2001 as shown in Figure 1 reveals the distribution of business in various sectors of medical technology among the US firms³.

Figure 1. Distrbution of Medical Technology business in US Firms³

4. The Areas of Automation in the Healthcare Domain

4.1 Applications in Lab automation:

Automation has become extremely popular in the recent years but was initially introduced in the areas of chemistry, hematology, molecular biology in the medical and healthcare domain. Laboratory automation is an area which has gained huge momentum and has proved to be beneficial for improving productivity in situations of stiff and constrained budget. The companies, Copan and BD Kiestra are the major manufacturers of laboratory automation systems for bacteriological research. The automated inoculation systems like Autoplak, PreLUD have aided laboratory automation process but Copan and BD Kiestra are companies that has manufactured extended automation systems like specimen processors, conveyors, incubators and digital imaging instruments catering to the need of medical scientists. The extended lab automation systems are of two types – partial lab automation systems and complete lab automation systems. Both of these types of systems consist of specimen processors, incubators, digital imaging systems which are connected with the help of a conveyor. The BD Kiestra’s TLA provides integrated workbenches along with a two-way tracking system that helps in plate delivery^4,
5

The automation of laboratory cycles has improved the efficiency of the doctors. Doctors are able to access the results electronically in real-time and turnaround times for laboratory report preparation is reduced. The report delivery time has reduced from three hours to 20 minutes to one hour. The overall benefits of this automated approach contribute to an increase of 46% staff productivity in three years and cost saving of S$10m in seven years. Doctors and nurse practitioners are able to arrive at the diagnostics at a quicker time providing timely interventions and treatments. The sample transfers for different tests are done through an automated process reducing the risk of bio-hazard exposure. In a typical NHS supported organization the clinical processes contribute to the majority of the costs with a significant variation in a range of performance indicators.

4.2 Application of Lean Management System:

4.2.1 Computerized Clinical order Entry System:

In the past doctors required to complete a hard copy prescription form to order for any diagnostic investigation and medications. This system reigned supreme for a long time but the major drawback of this system was the illegible writings of the medical practitioner and also loss of records. In both the cases the patients had to be sent for the diagnostic test twice resulting in increased wait time for the patients. After a thorough research in this field this manual system was replaced with the latest online system used across healthcare facilities. The system constitutes of an e-processing module which has significantly improved the safety of the patients through automated check for drug allergies and drug-to-drug interactions for certain medical conditions which ensures great benefit to organizational risks. This overall system increases the productivity of the system and improves customer satisfaction with faster turn-around times^{6, 7}

4.2.2 Hospital and Healthcare Management system:

Lean and six sigma approaches has always been a highly researched topic especially in service industries. The term “lean thinking” was originally coined by Womack and Jones (1990, 1996). The emphasis of their study was on the five major lean principles focusing on the process to improve customer satisfaction and achieve continuous process improvement. Lean principles have been adopted by various healthcare organizations to improve their operations of their patient centric systems. One of the major applications of such principles are found at the Virginia Mason Medical Centre where rapid process improvement, value-stream mapping were used to improve quality ^{6, 8}. The implementation of these strategies of lean helped to achieve reduction in lean time, lower staff walking distance thereby providing better treatment to the customers. The studies also showed that the applications of the lean principles depend completely on the situation and domain and cannot be confined to any hard and fast rule. The concept of lean has also been used to increase usage of resources in medical devices production. This would increase productivity, reduce waste and technology investment. The increase in operational or flow efficiency is also enhanced with the help of lean adoption. In the realm of healthcare sector flow unit refers to the patient who arrives at the hospital to get treatment. When the flow efficiency increased the waiting time of the patients is reduced which increases patient satisfaction by providing prompt service ^{9, 10}.

4.3 Application of Simulation and Modeling Concepts:

The automated pharmacy system actualizes medical filling automation procedures, pill dispensing and medical storage systems. The medicines are dispersed with the help of a nonlinear lifter system which is time varying and sometimes leads to inefficiency. This is the area where simulation and modeling concepts are applied to improvise the system. The scheduling policies are used for elevating retrieve and storage efficiency. The performance analyses of the automated systems are done using Genetic Algorithms. The computer aided simulations improve the effectiveness of the controller systems in the automated Robots and equipments for better performance and high efficiency⁷. Simulation and modelling has also been effectively used in nursing education. The nurses trained using such practices and simulated learning environment were able handle critical patient care situations much efficiently and effectively¹¹.

4.4 Application of Enterprise Application Integration (EAI):

Enterprise application integration is an integration of data and business processes which acts as a middleware and interface engine for the integration of multiple systems namely older versions, legacy systems and isolated enterprise-wide systems. It uses concepts like service oriented architecture, data warehousing and business intelligence related concepts. The application of EAI has an immense impact in the automation of Health Information Systems. The application of EAI enhances the health information systems and makes data processing and smoother and thus contributes towards the improvement of administrative decision making. In comparison to the ERP systems, EAI consumes less energy and leads to immense reduction in implementation costs. This new value-added technology although requires rigorous planning but integrates easily with any business processes. The use of EAI in hospitals has helped in managing data and the huge information systems existing in the hospitals supporting all health-care related activities¹².

4.5 Healthcare Automation at Texas Instruments:

Texas Instruments is renowned as a supplier of semiconductors used in a wide range of products starting from audio gears, automotive and consumer electronics to pacemakers. The semiconductors helps in improving the way people see, monitor and reduce pain. Texas Instruments have collaborated with start-up companies to remove blindness with advanced glasses which is an implantable visual tool that creates a semblance of a genuine vision. The technology that is used is a camera mounted on the patient glasses which captures image and sends it to a video processor. The data captured is converted to electrical signal and passed through a transmitter which helps to convey the signal to an implanted receiver. This data finally reaches an electrode array in the patient’s retina. The signal given to the retina responses to the brain with the help of optical nerves and stimulates the patient to understand dark and light spots. This helps the patients to understand real world shapes and sizes. Blind patients are able to see moving shadows. The other important area where Texas Instruments have applied automation technologies is in the area of miniaturization. The research and development is trying to reduce the size of the ultra sound to the laptop size. This kind of ultra sound will help emergency and critical care units to treat the patients in case of accident emergency at the accident site itself. It would also be easier for the expecting mothers to view their babies at under developed medical organizations. Texas Instruments engineers have also produced a low-power microprocessor that generates neuro-stimulation in the nervous system which reduces pain and masks pain messages. The market forecast indicates a double digit growth of this company in the health care domain and expects to continue and revolutionize healthcare in the future time ahead¹³.

4.6 Healthcare Automation in Philips:

Philips is a major player in the healthcare automation market. The products of this company are one of the most popular in the healthcare domain. Few of the healthcare products are Computed Tomography, Ultrasound, Monitoring, X-Ray, Heart start Home Defibrillator, Home Respiratory Therapy, etc. Philips CT products and solutions is a system where in the movement of the patient is not required and also has advance information sharing that helps in providing better results. Philips Medical Systems is one of the best in the Medical imaging market. The main competitors in this field are GE and Siemens. The technology used in common X-Ray systems are made by the same business group who make the generators, tubes, cameras and detectors. The Brilliant CT Solutions consist of complex medical hardware capable of producing 1000 slices or pictures per second. The software running at the server processes the data and generates 3D images of the human organ which helps in accurate diagnosis and interpretation of diseases. The Motiva TV-based remote patient management launched by Philips supports daily vital signs monitoring for the high acuity patients using wireless devices installed at home. This system provides a friendly and familiar environment to connect to the healthcare organizations. This system ensures a perfect balance between quality of life and cost of quality care¹⁴.

4.7 Automatic Drug Dispensing Units:

The application of automation in next generation drug dispensing technology is an example of the advancement of health care domain in the commercial market. The key concepts used in this area are advanced computer power, unparalleled quality control and exceptionally versatile functionality. The drug dispensing units used have in-depth workflow management software and workstations and robust databases, reporting tools and sophisticated design using advanced information technology concepts. An example of automation in healthcare would be Innovation Associates, RXInsider, ScriptPro. The key areas of automation are automated tablets and capsule counters, Infusion and filling automation, Decentralized medical components and the Robot_xsystem. These automated devices and machines ensure convenient, quick and reliable customer service providing a complete pickup tool suite for tools, precision bar code scanning, Electronic signature pad and Patient notification display to ensure workflow efficiency and reduce wait times. The patient notification display helps to notify customers when a prescription is ready for pick up. The systems have advanced report libraries which generates reports about patient wait times to optimum product utilization and system modeling. Therefore the overall automation system helps in making the Pharmacy system lean, optimized and error free performance at every step of operation¹⁵.

4.8 Robotic Applications in Surgery:

The modern day treatments methods are widely dependent on the use of technology and engineering. Usage of technological equipments have become extremely popular in all areas of health care starting from short span care center to ICU/ITU and even operation theatres. The idea is to perform procedures with extreme accuracy and reliability but with minimum invasion. In the late 1980’s use of automated equipments were started in surgeries as well as part of the post-operative healing process. The type of equipments have improvement continuously since then and the present generation equipments are more sophisticated meeting all possible safety requirements for critical operations. Manipulators are also being used to reduce surgical pain enabling patients to recover much faster. One of the major applications of robotic surgery is in the area of total knee anthroplasty (TKA). In this type of surgery a specialized tool is used for cutting bones for diseased joint replacements with artificial joints. Another example of robotic application can be found in Intuitive Surgical, Inc., Sunnyvale, California in USA where tele surgery is being used for cardiac surgeries. This type of surgery is based on Da-Vinci principles wherein the surgeon’s hands are inserted into a systems master interface and with the help of motion sensors and sampling methods are used to perform the surgery with better precision and accuracy⁵. Telemedicine is also one booming area of healthcare automation. The use of telemedicine has helped to ensure treatment reaches huge span of patients using information and communication technologies overcoming all the barriers of distance and time¹⁶.

4.9 Effect of Regulatory, Ethical and Quality Context:

The Introduction of a new technology in healthcare is quite different than any other domain as it is influenced by national and international influence regulation. The introduction of automated medical devices forces the health policy makers to evaluate the treatment procedures, the limitations and the ethical issues involved in the implementation of the new technology. As the rate of innovation is accelerated the rate of assessment of the technology gets reduced from the regulators perspective which finally elongates the product launch time. Most of the Pharmaceutical and medical devices undergo strict medical trials to demonstrate safety and the efficiency. We can consider the example of a Pill Dispenser Robot which is used in a pharmacy. The software has the capability to identify a customer, read the prescription and its medicines, identify the required pills, count them accurately and dispense it with proper labeling to the customer. The device can be launched if and only if all the steps function accurately in a safe environment. If the counting of the pills is done incorrectly, the patient might end up taking additional number of pills which can be problematic or perhaps life threatening in some situations. Therefore a progressively large number of expected results are required at each and every step of the clinical trials conducted. It is necessary to realize that the clinical market is risk averse and very conservative and regulations acts as a constraint on the design and manufacturing of a new product⁴.

5. Recent advancements and future of automation in Healthcare:

Bio-MEMs: Bio-MEMs is an abbreviated form of the word Bio medical micro electromechanical systems. It is basically a technology based operation at micro scale focusing on biological and biomedical implementations. These applications sometimes also include electronic and mechanical functions. The major applications of Bio-MEMs lay in the area of clinical, material, medical, biological sciences. It is also immensely used in genomics, medical diagnostics, tissue based engineering and implantable devices. The manufacturing of Bio-MEMs devices uses various approaches namely silicon, plastics, polymers, biological materials like cells and tissues, paper, electro-kinetics, micro fluidics. The use of these devices creates requirements of manufacturing and producing disposable biological sensors that would aid in this type of process. The concept of “lab on a chip” is once such technology which is used to produce hand held monitors for patient care and treatment¹⁷.

5.1 Human Genome Project:

The human genome project (HGP) was a collaborative international research project aiming to understand and map the genes in human beings. The term “genomes” denotes all the genes available in the human body which is contained inside the double helix structure of deoxyribonucleic acid (DNA) which is the hereditary material for all multi-cellular organisms. The human genome project research has decoded the human genome structure by determining the sequence of the bases of DNA’s and mapped them to show the locations of genes for the chromosomes. The study has revealed the existence of 20,500 human genes. The tools created due to extensive research in this area have also helped to characterize the genomes of other organisms as well which would be extremely helpful for biological research¹⁸.

5.2 Nanomedicine:

Nanomedicine is the application of nanotechnology for the treatment of diseases in the human body. The popular applications of nanomedicine are chemotherapy, pacemakers, insulin pumps, nebulizers, hearing aids, needle-free injectors, glucose monitoring systems, medical flow sensors, blood pressure monitoring system and other drug delivery systems. Nano robots are advanced applications of nanomedicine wherein the system used works as a miniature surgeon and is capable of repairing intracellular structure with high precision and accuracy. As part of ongoing and future research these Nano robots would also be able to correct genetic defects by altering DNA structure or replacing DNA molecules. The future applications of nanotechnology in healthcare and pharmaceutical industry also include advanced drug delivery systems, implementation of new therapies and advancements in vivo imaging. The market of nanomedicine has gained immense momentum wherein sales in this domain has reached $16 billion since 2015 with a minimum of $3.8 billion being invested in R & D related research every year. The prospective areas of Nano machine and Nano robotic implementation include¹⁹:

· Monitoring of the internal chemistry of the human body by the use of mobile nano robots being passed through the circulatory system with embedded wireless transmitters signaling anomalies

· Monitoring of nervous system and activities of the brain

· Advanced usage of in-heart defibrillators and pacemakers

· Use of artificial antibodies, artificial blood cells and antiviral nano robots^{19, 20}

6. CONCLUSION:

Healthcare is an emerging and rapidly growing market from the industrial and business perspective Hence application of automation technologies in healthcare has a bright future. The average life expectancy of human beings is increasing at a rate of two years per decade. Therefore, the cost of availing healthcare benefits by the general mass is also increasing thus creating a market for the healthcare industry. But at the same time, there is immense competition to reduce operational costs to survive successfully in the business. Moreover, demographic variations are also an important aspect to consider for business opportunities. The healthcare benefits accessible to the western world still remain much better and difficult to be achieved by other less privileged locations of the world. If healthcare benefits can be provided to these locations, it would open doors for business and creating opportunities to combat the challenge of providing equal healthcare and medical benefits across the world. The devices require integrated solutions and the machines have to be integrated to a controlled environment. The main challenge in this field is to generate scalable production systems which would enable healthcare providers to customized yet personalized service. Healthcare is a high cost and high value added sector. The application of appropriate technology and product development processes are the key to sustainability and cost effectiveness in high labor cost regions. Therefore it is extremely important for the engineers to emphasize on clinical requirements and provide solutions across the world using biological components

7. REFERENCES:

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Received on 10.11.2016 Modified on 05.12.2016

Research J. Pharm. and Tech 2016; 9(12):2343-2348

DOI: 10.5958/0974-360X.2016.00472.8