Opportunities and Barriers to Rural Telerobotic Surgical Health Care in 2021: Report and Research Agenda from a Stakeholder Workshop

Abstract

Background: There are well-recognized challenges to delivering specialty health care in rural settings. These challenges are particularly evident for specialized surgical health care due to the lack of trained operators in rural communities. Telerobotic surgery could have a significant impact on the rural–urban health care gap, but thus far, the promise of this method of health care delivery has gone unrealized. With the increasing adoption of telehealth over the past year, along with the maturation of telecommunication and robotic technologies over the past 2 decades, a reappraisal of the opportunities and barriers to widespread implementation of telerobotic surgery is warranted. Here we report the outcome of a rural telerobotic stakeholder workshop to explore modern-day issues critical to the advancement of telerobotic surgical health care. Materials and Methods: We assembled a multidisciplinary stakeholder panel to participate in a 2-day Rural Telerobotic Surgery Stakeholder Workshop. Participants had diverse expertise, including specialty surgeons, technology experts, and representatives of the broader telerobotic health care ecosystem, including economists, lawyers, regulatory consultants, public health advocates, rural hospital administrators, nurses, and payers. The research team reviewed transcripts from the workshop with themes identified and research questions generated based on stakeholder comments and feedback. Results: Stakeholder discussions fell into four general themes, including (1) operating room team interactions, (2) education and training, (3) network and security, and (4) economic issues. The research team then identified several research questions within each of these themes and provided specific research strategies to address these questions. Conclusions: There are still important unanswered questions regarding the implementation and adoption of rural telerobotic surgery. Based on stakeholder feedback, we have developed a research agenda along with suggested strategies to address outstanding research questions. The successful execution of these research opportunities will fill critical gaps in our understanding of how to advance the widespread adoption of rural telerobotic health care.

Exploring telerobotic cardiac catheter ablation in a rural community hospital: A pilot study

“…However, the views of numerous other stakeholders will need to be explored en route to mainstream adoption of telesurgical procedures, including HIPAA compliance, cybersecurity, state licensure, liability, hospital privileging, reimbursement models, and patient adoption—to name a few. 8 …”

“…While present-day surgical telementoring systems such as Odyssey (Stereotaxis, St. Louis, MO), Avail (Avail Inc, Palo Alto, CA), Proximie (Proximie, Inc, London, England), and Immertec (Tampa, FL) provide a valuable intermediary step, true single-operator telesurgery represents a substantial departure from the present-day surgical care delivery model. Since telesurgery is disruptive at multiple levels of the healthcare system, it will require addressing the concerns of a variety of different stakeholders 8 —none more critical than the surgical care team. From the perspective of workers comprising the operating room (OR) team, many questions remain unanswered regarding how the surgeon’s displacement during telerobotic operations will impact the functioning of OR teams.…”

Telemedicine Applications in the Era of COVID-19: Telesurgery Issues

“…At the end of the workshop, the researchers identified four main topics of interest (operating room team interactions, education and training, network and security, and economic issues). On these bases, they prepared an operational plan to make telesurgery available in rural settings [ 52 ].…”

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