Summary: In spite of the high priority social agencies, businesses and governments have placed on improving the quality and efficiency of health care, plus a tremendous volume of research and rapid technological advancement, there has been relatively little commercialization of healthcare robotics products. A shortage of serious business-focused analyses has slowed the effort to commercialize healthcare robotics. This analysis, which covers the leading commercial health robotics market segments, and was designed to address that deficiency, found:

• The combined ability to ‘sense, think and act’ makes robotics a transformative technology for the healthcare industry. Also, ‘Autonomy’ is a key cost reduction and functionality enhancer for robotics systems, including healthcare robotics systems.
  
• The leading social driver for the healthcare robotics market is the increasing population of elderly and disabled individuals. Leading business drivers are the need to reduce cost and improve quality. Technology drivers are similar to those for robotic systems in general.
  
• Governments, health services and insurance providers understand that supporting the independence of aging or disabled clients is a cost-effective strategy. A growing elderly population that is comparatively wealthy and politically connected will drive the market for technology that increases the independence and enhances the lifestyle of senior citizens.
  
• While robotics technology is being exploited in healthcare in a variety of ways, most systems are still in the research phase.
  
• The number of minimally invasive surgical (MIS) procedures is steadily increasing, both in absolute number and in the type of clinical procedures available. Robotic technology addresses many of the limitations of existing MIS techniques, enhances the capability of existing systems and increases the number of procedures to which MIS techniques can be applied.
  
• Opportunities in the Robotic Interventional Systems market exist for technology or systems that provide high resolution imaging or immersive interfaces, fine-control and haptic feedback, or come in smaller, lower-cost form factors than current teleoperated systems. Others stem from the enablement of newer MIS techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES).
  
• Robotic Rehabilitation Systems have been proven to reduce costs, improve treatment quality and increase therapist productivity. Yet the number of robotic rehabilitation systems in clinical use is small. Robotic rehabilitation technologies for the home, to enhance or replace expensive in-patient care, have only reached the research phase.
  
• The large numbers of patients with limb loss, including an expected increase due to rising rates of diabetes, is driving the Robotic Prosthetic and Orthotic Systems market. The addition of sensors and embedded microprocessors to formerly passive systems provides for new levels of functionality and movement, as well as supporting wholly new, revolutionary, classes of products.

The healthcare industry struggles from the combined pressure of skyrocketing costs, aging populations in industrialized countries, and a shortage of qualified workers, as well as the need to continuously improve the quality of services and results. For every challenge faced by the healthcare community, however, there are multiple opportunities for businesses professionals, academicians and investors that provide innovative solutions. Robotics and automation technology — healthcare robotics — are one class of solution.

Commercial Paradox

Healthcare robotics technology is viewed by business leaders and government officials as playing a major role in addressing a number of pressing healthcare challenges. The same conclusion has been reached by academics, where healthcare robotics is regarded as a key means to provide better healthcare services while reducing costs. It is not surprising, therefore, that while the market is relatively young, healthcare robotics research is widespread and ongoing. In addition, the functionality of robotics enabling technology continues to increase, while in many instances the price for that technology remains rela- tively flat or is trending downward.

The combination of robust, innovative research, powerful, low-cost enabling technology and the approval of business, government and academic leaders, would seem to bode well for the commercial prospects of healthcare robotics. Despite the monumental potential of the technology and obvious need, commercial development of healthcare robotic products has been relatively slow and market penetration has been minimal.

Market failure is not uncommon, even for products that seemed to show tremendous promise. The discrepancy between the amount of ongoing research and the lack of commercial output is usually ascribed to the limited amount of testing in the field, with lengthy regulatory approval processes (particularly in the U.S.) and the novelty of the technology given as secondary factors. This however, is only part of the answer.

While additional in-field healthcare robotics studies are necessary for future commercial development, they are not sufficient. Other analyses, particularly those that speak to business and economic issues such as reimbursement models, evidence of cost reduction, and proof of productivity improvements, are required, but at this time are largely lacking.

Economic Development

Efforts Economic development and scientific advisory groups in Asia, Europe and the United States have targeted healthcare robotics as a key means of improving healthcare in the 21st century. Such groups typically look to unify research and development efforts across universities and research institutions, industry and governmental agencies. Groups such as the Computing Community Consortium, the National Science Foundation (USA), and the European Commission have developed roadmaps to accelerate the development of a healthcare robotics economy.

The roadmaps themselves are the result of a rigorous, methodical review and vetting process. Most are written by academics and researchers with additional input from healthcare technology solution providers (often with strong ties to specific research institutions).

While these efforts are a laudable and necessary step in the development of a commercial healthcare robotics industry, they are typically not reviewed by those outside a small community of government agencies, along with select robotics and healthcare professionals.

That limited distribution, along with the tendency of authors to write in the specialized language of robotics and healthcare, making even relatively simple concepts difficult for members of the business and investment communities to understand, limits the ability of the studies to foster commercial development.

The Purpose of This Article

The purpose of this article is to provide business development professionals and investors, along with the broader academic community, with an overview of the leading trends in healthcare robotics, particularly as they relate to business development and commercialization opportunities.

It will describe how robots and robotic technology can be used to meet the needs of the healthcare market, as well as the opportunities open to robotics solution providers and others in the healthcare robotics value chain. The overarching goal, shared with those who already understand the potential of healthcare robotics technology, is to hasten the commercialization of robotic healthcare solutions. In very broad terms, and for all markets, business and investment opportunities can be exploited and optimized in three ways:

• First To Market — Entering ‘greenfield’ markets where products, technologies or solutions do not yet exist.
• A Better or ‘Fast Follower’ Solution — Providing products, technologies or solutions that are better than what currently exists in the market (more robust, more effective, less expensive etc.).
• Addressing Technological and Business Challenges — Provide business and technology solutions that overcome commercialization challenges and ‘gating factors.’

This article first describes the business, social and technology drivers for the healthcare robotics market. Next, a taxonomy of the overall healthcare robotics market is provided, with descriptions of the leading submarkets, including research efforts and commercial products. Finally, the leading challenges facing specific markets are described.

Defining Healthcare Robotics

At the most basic level, ‘healthcare robotics’ (medical robotics) is simply the application of robotics technology to healthcare to diagnose and treat disease, or to correct, restore or modify a body function or a body part.

But what features differentiate healthcare robotics systems from other classes of healthcare technology? Consider the definition of healthcare robotics provided by the authors of the European Commission’s Robotics for Healthcare roadmap:

Robotics for Medicine and Healthcare is considered the domain of systems able to perform coordinated mechatronic actions (force or movement exertions) on the basis of processing of information acquired through sensor technology, with the aim to support the functioning of impaired individuals, medical interventions, care and rehabilitation of patients and also to support individuals in prevention programs.

Definitions of what constitutes a robot vary. However, there is a general consensus as to the essential characteristics that robots must possess, three of which were captured in the definition of healthcare robotics given above:

• Sensors — Robots employ sensing technology to acquire information about their environment.
• Intelligence — Robots process information captured through sensor technology and produce outputs for decision making, coordination and control.
• Motion — Robots automatically follow instructions that are pre-programmed, or generated in real-time based on sensor input, to perform deliberate, controlled, and often repeated, mechatronic action.

Autonomy

Many would add ‘Autonomy,’ the ability for robotic systems to move or perform work responding to both environmental and internal stimuli without human intervention, to the classic ‘Sense-Think-Act’ definition of robots.

In other fields where robotics technology is now being applied, such as unmanned air and ground vehicles, intelligent transportation systems, and exploration robots, the addition of autonomous functionality is viewed as a key means of increasing functionality and reducing overall costs. The same will hold for healthcare robotic systems, even given the constrained and highly sensitive areas in which they operate.

To some, giving a basic definition of what constitutes a robot is little more than a semantic exercise. However, it is the combined ability to sense, think and act, with some degree of autonomy, that differentiates robotics from other types of medical devices or computer-aided techniques. It is also the ability that gives robotics the potential to be a transformative technology for healthcare and, as such, a massive business and investment opportunity.

Similarities to the Medical Devices Market

Healthcare robotics share many areas of technical commonality with electrically powered medical devices. Because they both serve the healthcare industry, they share issues relating to funding, investment, testing and approval, not to mention the common goals of improving patient care and the social and business requirement to create new and ininovative product offerings. Therefore, the commercialization of robotics technology, and the investment opportunities it creates, can be better understood when examined in light of the well-understood, mature (and highly profitable) medical devices industry.

Healthcare Robotics Market Drivers

Social Drivers

• An Aging Population — Life expectancies in most of the world, and particularly in industrialized states, have been on the increase since 1900. Due to advances in healthcare, the average age of the older population is increasing (Figure 1). In addition, as the ‘baby boom’ generation reaches retirement age, the percentage of the population above age 65 in industrialized countries is also increasing (Figure 2). The result is that many countries will be severely challenged by what epidemiologists refer to as ‘double aging’.
  Unfortunately, life’s golden years are often filled with illness and physical disability that require costly and ongoing medical care. Government health care agencies have research showing it is more cost-effective to support the independence of the elderly in as many aspects of their lives as possible, rather than ignore that need until it becomes critical.
• Increased Number of Disabled — According to the United Nations, approximately 650 million people, about 10 percent of the world’s population, live with some type of disability, and with a growing population and advances in healthcare, this number is increasing rapidly. Also, despite efforts by many governments, the disabled are chronically
• Increased Expectations — With the certainty of aging, comes the equal certainty of eventual disability. This natural part of the human experience, however, does not diminish the right of people to live independently and pursue meaningful activities. Older adults, who have higher expectations than previous generations and will not age in the same way, will increasingly choose to continue to live at home rather than be in assisted living facilities or in nursing homes. They will demand that advances in technology be leveraged to overcome the disabilities associated with aging. That includes robotics that will allow seniors to live independently, exercise control over their life, and minimize their dependence upon their family and medical institutions.
• Money and Political Power — According to the insurance industry’s MetLife Mature Market Institute, when the last baby boomer turns 65 in 2029, the generation will control more than 40 percent of the nation’s disposable income. In addition, the huge number of baby boomers will guarantee that their political voice will be heard. The result will be that Boomers — a population that has historically been disinclined to compromise on lifestyle issues, unwilling to age gracefully and backed by large amounts of disposable income — will demand greater independence than their parents and grandparents. The development of advanced robotic technology, plus the economic, demographic and psychographic profile of the West’s aging population, creates a perfect storm of demand for products and services that allow seniors to live fuller, more independent lives, for a longer period of time, compared to their counterparts in previous generations.

Technology Drivers

The technology drivers for healthcare robotic systems are similar to those for robotic systems in general:

• Growing computational power and functionality of microprocessor technology.
• Increasing miniaturization of electronic and mechanical devices such as motors and actuators.
• Advances in power systems including smaller, lighter systems capable of holding greater charges.
• New classes of advanced, low cost camera technologies and visioning solutions including 3-D systems.
• New classes of materials.

Business Drivers

• Costs — Healthcare providers are under enormous pressure from payers, employers and governments to reduce costs. In the United States, the incoming Obama administration has even gone so far as to proclaim healthcare cost reduction a national imperative. Robotics is seen as a cost reduction enabler, supporting a shift to less costly outpatient and ambulatory services. Some techniques, such as robotically assisted minimally invasive surgical procedures, have been shown to reduce the length of hospital stays. Robotic assistive technology that allows disabled individuals to stay in their homes and live more independently, provides another example.
• Quality, Consistency and Safety of Treatments — Robotic systems are able to perform extremely precise, repetitive motions without fatigue, with the result that they are more accurate and consistent than their manual counterparts. They are also able to record the history of those motions for later analysis and improvement. Using sensors and feedback, they are also able to constrain movement -during surgery or rehabilitation, for example — increasing the quality and safety of procedures.
• Labor Shortage — While the worldwide economic downturn has increased unemployment in many sectors, the healthcare industry struggles with a labor shortage in many occupations, particularly those that are physically or mentally demanding. For example, the experienced nurses required to staff operating rooms, intensive care and post-surgical units are being lost to retirement more quickly than they are being replaced by younger nurses. Robotics technology holds the promise of reducing the physical demands and monotony associated with some healthcare jobs making them more appealing, as well as increasing staff productivity.
• Marketing Tool — Quantified clinical results indicate that robotic technology can produce better outcomes and more cost-effective processes. Moreover, stories about the positive benefits of robotically enhanced procedures are widespread in the general media, with the result that the common perception is that ‘robotic’ solutions produce better outcomes. As a consequence, hospitals and rehabilitation centers are actively advertising that they offer robotics solutions.

Classes of Healthcare Robotics Technology

The healthcare robotics market can be taxonomized according to the target group the technology supports as follows:

Robotics Technology That Support Doctors, Surgeons	Robotic Technology to Support Patients
	Robotic Technologies For Temporary Use	Robotic Technologies For Continual Use	Robotic Technology That Supports Infrastructure
Robotic Interventional Systems	Robotic Rehabilitation/ Therapeutic Systems	Robotic Assistive Technology Systems	Robotic Hospital Automation Systems
Robotic Learning/Training Systems	Robotic Support Systems	Robotic Prosthetic and Orthotic Systems	Robotic Smart Living Spaces
Robotic Diagnostic Systems	Robotics Nursing Assistants	Robotics Lifestyle Enhancement Systems	Robotic Laboratory Automation
	Robotics Surgical Assistants

Other Classes of Healthcare Robotic Systems: A wide variety of healthcare products and techniques are benefiting from the inclusion of   robotic technologies — sensing, intelligence, movement and autonomy. There is a large   number of products that do not fall into the more common healthcare robotics categories,  or are early in the research phases and far from commercialization. While many of these   technologies are very promising, they are beyond the scope of this article.

Robotic Healthcare Products Still in Early Phases of Research or Trials
Microrobots and Nanorobots	Patient Mounted Robotics Surgical Systems
Robotic Diagnostic Systems	Robotic Lifestyle Enhancement Systems
Portable Robotic Surgical Systems	Robotics Nursing Assistants
Robotic Surgical Assistants

[Editor’s note: Other categories that could contribute to healthcare – including training and simulation systems or those that could support hospital infrastructure — are not covered in this article, but will be featured in subsequent Robotics Business Review pieces.]