Of all the Jetsons? high-tech gadgets, the one adults coveted most deeply was Rosey, the robotic maid. Because in Rosey, unlike the cartoon?s other space-age novelties, we recognized a profound utility. Imagine all the things we could do with our time if we didn?t have to sweep, vacuum, do laundry or make beds. Better yet, imagine that the one doing these pesky tasks did them well every time, never got tired, was never sick--and did not demand a paycheck each Friday.

While most of us mused happily on this future scenario and then returned to the real world of manual labor, others kept musing. The result (several decades and pop icons later) was not Rosey, but Chip, Kent, Stosh, ATLIS and fleets of other robotic helpers tirelessly toiling away in health care facilities nationwide. Though lacking the versatility and charm of their TV predecessor, these robots can perform many basic facility functions at twice the rate and often at half the price of their human counterparts.

So don?t be surprised if one day soon you have robots delivering laundry, carrying medications to nurse stations (without any help operating the elevators), serving up meals, delivering the mail, scrubbing your floors or cleaning your carpets. These tasks are already being done by a small but growing robotic workforce. And as hospital staffs shrink because of constant changes in health care, these faceless workers may take on more and more of the burden.

Meet ATLIS

Taking on burdens--several hundred a day in fact--is this robot?s forte. ATLIS (automated transport & logistics integration system) is an automated guided vehicle (AGV) system manufactured by FMC Corp., Chalfont, Pa. A short, rectangular courier, the AGV transports carts of supplies, including linens, food and medical supplies. It picks them up from designated distribution points, carries them to dropoff locations near nurse stations and returns to its home base, all with only a few commands from an operator.

AGVs are guided by low-frequency radio signals transmitted by wires buried beneath the floors, and they use their own elevators. Although they usually keep to themselves, they do have social skills: A combination of bumpers, sensors, warning lights and horns keeps them from running into anyone or anything in their path. The perfect house guests, they even wash their carts and recharge their own batteries.

Centralized control (via central computer, satellite command posts and closed-circuit TV) is what separates this system and others like it from its earlier incarnations. "In the early days of AGVs, if you wanted to send patient trays up to the second floor, the vehicle would have to be preprogrammed to go up and then programmed to return," says FMC?s Tom Abrams. "Now we can talk to the vehicle from anywhere in the hospital, find out what it?s doing and tell it where to go from there."

So why isn?t everyone using them? With a per-vehicle cost of $50,000, the designated elevators, the computer system and other components, an AGV system can cost from $3 million to $5 million. This is a stiff price for all those small health facilities worried about this year?s bottom line. In the long run, however, the system can make financial sense for larger facilities.

"In an economic feasibility study of 300 to 400 hospitals, we found no facility with more than 400 beds that couldn?t benefit from these systems," says Ed Schachinger, who is a consulting engineer with Lerch Bates/Schachinger, Littleton, Colo. He has designed or assisted with more than 20 AGV installations throughout the country. About three dozen U.S. facilities currently use AGVs, he says, and another half-dozen installations are under way. "But all the changes going on in health care might create more of a demand. Before, either people weren?t as concerned with cutting costs or were wary of the technology. With capitation, there is good reason for people to put in some level of automation or totally upgrade to an automated system."

The fine print

Often, as with robotic applications in other industries, savings are realized by replacing human employees. A large system can replace 2.5 to 3 full-time equivalents, Schachinger says. "Some hospitals are literally replacing these FTEs with robots, while others will upgrade. They?ll say ?Let?s take these people who were doing deliveries and train them to do more.?"

AGVs, however, may not be an option for older facilities without some form of automated delivery system already in place. Most of the systems installed by Schachinger, for example, were replacements for older delivery systems. Many others are part of new hospital construction.

"You really can?t install them after your hospital has been built. With the designated elevators and infrastructure involved, it?ll never pay for itself," says Neil Immegart, assistant chief engineer at the 600-bed VA Medical Center, Houston. His system, built as part of the new hospital, has paid for itself. Installed in 1991 by Control Engineering Co., Harbor Springs, Mich., the VA Houston system has 15 AGVs operating 12 hours a day seven days a week, delivering meals, laundry, central supply reprocessables, and pharmacy items.

Immegart estimates that the system has been well worth its installation costs and will continue to save the center money over its life span. "About a third of this savings is in labor costs. But mostly it comes from high reliability. We?ve had no accidents, no major failures. It can run 24 hours a day if we want. It doesn?t take holidays and doesn?t need to sleep." Plus, it?s easy to use. Training was minimal, and the system was being operated by staff within a month of installation.

One drawback may be maintenance. Some of the parts are difficult to get, says Immegart, and have to be ordered specially in large quantities or replaced with newer substitutes. "Parts availability could be the specter hanging over it, but basically it has been reliable."

The parts problem derives from the continuous advances made in the technology since it was first developed in 1968 by Control Engineering (marketed by American Sterilizer Co.). Improvements have been in the degree of operator assistance required and the guidance systems used. Initially, operators had to load and unload the carts, position the vehicles and program their every move. Now the AGVs and their computers are practically autonomous--loading and unloading the carts themselves and performing all functions with only a little operator programming.

As for guidance, most early and existing installations use the floor wire guidance system (like that used by ATLIS). But these systems can be difficult to reconfigure, which can be quite a drawback in this age of hospital renovation.

Dennis Liss, engineering supervisor at the St. Joseph Campus of Via Christi Health System, Wichita, Kans., has found out just how much of a drawback. Although his AGV has been inexpensive to maintain (about $5,000 a year for batteries and $400 for labor), to have a consultant rework the facility?s old AGV lines would cost $75,000, he says. "With the new AGVs, [when you want to reconfigure] you just drill a hole and put a transponder in it every now and then."

Liss is currently performing a feasibility study to justify an upgrade to the newer nonwire guidance models. At this point, it looks as if it will cost the 500-bed facility $3 million to $4 million. Although it?s a lot of money up front, Liss thinks the long-term benefits are worth it.

Newer systems operate on a variety of nonwire guidance technologies. The transponders Liss describes are part of an AGV system developed by Control Engineering. These vehicles use an inertial guidance system with an internal gyroscope, on-board programming and transponders in the floor that act as correction points. Also, Transcar AGVs from TransLogic Corp., Denver, follow a passive guide tape network. A metal reader on the AGV senses a thin stainless-steel band of tape adhered to concrete or hidden beneath carpet or tile. Because the guidepath is adhesive, it can be reconfigured with relative ease.

Free to roam

Although wire and nonwire guidance systems are restricted to mostly nonpedestrian pathways, a new generation of robots has begun to mingle more with its human coworkers. The HelpMate, from HelpMate Robotics, Danbury, Conn., is a self-guided robotic courier that operates according to a computer-aided design map programmed into its brain, or control center. It doesn?t carry the 1,000-pound loads of its AGV cousins (more like 100 or 200 pounds) so it?s not suitable for large scheduled delivery runs, but it does have some endearing qualities. Because of its CAD guidance system, it can refer to its map, select the best route to its destination and go there on the spot. It can also open doors and operate elevators (with the help of interface systems), which means that no major facility modifications are needed to install it.

Though not much of a conversationalist, HelpMate does speak a few words to announce its arrival. This ability, combined with its more humanlike (albeit squarish) stature of four feet, may be why its coworkers tend to bond with it a bit more than with its low-riding AGV pals: hence "Chip" in Baltimore, "Roscoe" in Danbury, Conn., and "Stosh" in Hollywood, Fla.

Is there a drawback? Again, it could be the price. Each HelpMate costs $104,000 to buy, or about $6 an hour to rent, which varies a little depending on the elevator and door interfaces needed. That could be a lot of money for a small facility, but for larger hospitals or those that are downsizing, it might make sense.

Ralph Prichard, director of food services at Baltimore?s Franklin Square Medical Center, says "Chip" saves his facility about $900 a week when comparing the costs of the robot with the nursing time saved delivering supplies (see related story, page 21). At Franklin Square, as at other hospitals, the robot filled open staff positions. In fact, says Tom Sweeny, HelpMate?s president and CEO, the company draws most of its customers after downsizing, when facilities are looking for ways to make more efficient use of remaining staff.

Another problem could be the lack of dedicated elevators, says Schachinger. When designing automated delivery systems for hospitals, he says, "we favor dedicated elevators. The other kind tend to take over an elevator and kick everybody out, which is not really feasible in many health care scenarios." So far, however, most of the hospitals using the robot have tried out only one or two at a time. None have yet hired a fleet, which could create more of an elevator problem.

Most of the robots in use (about 50) have been considered test models. HelpMate Robotics, in fact, is the recent incarnation of Transitions Research Corp., a technological think tank founded by Joseph F. Engleberger, who is widely considered the "father of modern robotics." Engleberger founded the first industrial robot company, Unimation, and is credited for much of the work robots are currently doing in manufacturing.

The company has only recently set about its work of marketing robots for the service industry, but if Engleberger?s success in manufacturing is any indication, this marketing effort could be considered a deployment of the troops. And so far they have been quartered in a wide range of hospitals--those with as few as 100 beds to those with as many as 1,200.

The clean and green team

Like Rosey, our robotic heroine, modern health facility robots do a lot more than carry things from the kitchen or laundry room. They don?t make pot roasts or dust furniture (yet), but they do clean. In fact, if you happen to run into a short, boxy robot scrubbing floors, say hello. That might be Kent. He and 100 of his clan are busy scrubbing floors and vacuuming carpets nationwide and in Europe. Their charm? They can find their way from one hallway to another, scrubbing all the while, without having to be repositioned by an operator. They clean the same way every time. And like the courteous robotic couriers, they won?t bump into you or knock anything over. One model dry sweeps floors and vacuums carpets.

Kent (short for RoboKent)--a product of the Kent Co., Elkhart, Ind.--also has the remarkable ability to teach itself. When placed in an area to be cleaned, it performs a learning pass, during which it uses on-board sonar and infrared sensors to navigate the hallways it?s cleaning. It then analyzes the length and width information to choose the best path. An operator never has to show it the ropes. It operates on a 24-volt battery, which will power it for 60,000 square feet of cleaning before giving out.

RoboKent also can sense a sloping floor or dropoff, which keeps it from tumbling down stairs or rolling down ramps--an important feature when you consider that each robot costs about $50,000. The price tag explains why the Mountain Home VA Medical Center, Johnson City, Tenn., tested the robot but didn?t purchase one. "It was pretty amazing," says Larry Collins, chief of environmental care at Mountain Home. "As far as its running over people, which is what we were worried about, people tried to startle it, but it never failed. It always worked perfectly." But the cost was daunting, he adds, even for his 450-bed hospital. "It might make sense over the long term for a place that was downsizing and losing staff. Once the price comes down, once there?s more competition, we might think about it."

As for competition, it?s already here. Another product, Dolphin, from the Von Schrader Co., Racine, Wis., is also entering the floor/carpet maintenance scene. It does not scrub floors, but it does vacuum and clean carpets using a low-moisture soil-extraction method. Dolphin shares obstacle avoidance capabilities with RoboKent, but unlike the floor scrubber, operates on a 120-volt a/c current from a 50-foot power cord (it is designed more for use in large carpeted areas). No health facilities have tried it yet, so how well it will go over remains to be seen. The company is cloning the Dolphin prototype and will soon send its first "school of Dolphins" into several facilities for beta testing.

Karl Hickethier, for one, is looking forward to the Dolphin?s release. As director of housekeeping, gardening and grounds at Stanford University Medical Center, Palo Alto, Calif., Hickethier is a robot fan. Not only does his facility have both the RoboKent scrubber and sweeper, but also three HelpMates and a robotic lawnmower. Still, he wants more. "Robots are really the wave of the future in housekeeping," he says.

Stanford is undoubtedly riding that wave. It is the first health facility to use the robotic lawnmower from Poulan/Weed Eater, Shreveport, La. Still in the development stages, the $2,000 mower is solar powered and has an on-board computer system that helps it navigate a lawn. Wires buried around the perimeter of the cutting area keep the mower from going astray, and although its mowing patterns are randomly selected, it remembers where it has been and won?t repeat those segments.

And in case you?re worried about it maniacally chasing down unwitting squirrels or woodchucks, an obstacle avoidance system, like that used on the other robots, protects lawn visitors. It also can protect itself from theft. If someone tries to grab it and drive away, the mower emits the computer equivalent of a cry for help (a loud alarm).

The 640-bed Stanford facility began purchasing robots about two years ago. Employees had already been fired in response to major budget cuts, and "the robots were a way to be more efficient with the remaining staff," Hickethier says. More jobs were eventually replaced through attrition, but no one was ever fired outright because of the robots, he adds. "When people worry that they will lose their jobs because of the robots, I tell them, ?You need to automate anyway, because the cuts will continue to happen. It?s just a matter of time.?"

Also, although the facility has a three-year payback policy for such purchases, Hickethier says his robots paid for themselves in 12 to 18 months.

Our robotic future

Although you may not have noticed, robots are quietly but steadily creeping into all the nooks and crannies of modern health care--not just the facilities side. Shhh. Look around. They?re in the pharmacy, where a robot from Automated Healthcare, Pittsburgh, not only dispenses unit doses according to computer orders but also maintains inventory, which includes discarding old medications and restocking. They?re in the lab: A robot developed at the University of Virginia processes blood tests. They?re in patient care units, where robots now transfer patients to and from beds, as well as position patients for various procedures. They?re in rehabilitation centers and nursing homes: Robotic arms and other devices can help disabled patients perform such basic tasks as retrieving objects and eating. They can also assist with rehabilitation therapy.

One of the most heralded applications of robots is surgery. Robodoc, a robotic arm developed at the University of California, Davis, helps surgeons perform orthopedic surgery. And researchers in Japan are developing microrobots that can be swallowed and controlled remotely to perform a variety of diagnostic and surgical tasks.

Bob Iverson, senior associate principal with the architecture firm Loebl Schlossman & Hackl, Chicago, and something of a futurist, predicts that robots--particularly those used in surgery--will play an important role in transforming both health care and facilities for the future. In a paper written for the 1996 Planning, Design and Construction Conference, sponsored by ASHE, he advises designers to prepare for a much smaller facility, one in which invasive surgery (even disease) is a thing of the past. "Doctors will be mere members of a broad-based health care team that will include robots, technicians, researchers, drug companies and manufacturers of medical products," he writes.

Technophobes and proponents of the status quo might view this advance of robots into the hospital as an invasion, holding tightly to their brooms, vacuums, delivery carts (jobs?). That?s understandable. Robot paranoia is a psychological reflex instilled in many of us by years of Hollywood influences. But others in health care may offer a friendly handshake to their new electronic colleagues (thinking more of Rosey than of the Terminator). The robots, after all, are merely responding to the needs of an industry that is rapidly restructuring. They?re not responsible for those needs--well, as far as we know.

Catherine Quayle is the associate editor of Health Facilities Management.