Joshua C. Hollingsworth, Pharm.D, Ph.D.,
Brent I. Fox, Pharm.D., Ph.D., is an associate professor in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University
Brent I. Fox, Pharm.D., Ph.D.

In Disney’s 2014 Animated feature film “Big Hero 6,” Baymax is a personal healthcare companion robot equipped with artificial intelligence (AI). He is programmed with thousands of medical procedures and has medical equipment, such as a defibrillator, built into his frame. He is also able to carry loads of medications and other medical supplies that can be accessed as needed. Using a quick, noninvasive scan, Baymax can obtain vitals, diagnose injury or disease, and subsequently begin treatment for nearly any ailment, on the spot. Along with the physical assessment and treatment, he can also carry on meaningful conversation, provide education, and give words of encouragement, when needed. (To top it all off, Baymax doubles as a superhero, after a little change in programming, of course). While thought-provoking and awe-inspiring, this is a far cry from reality. Currently, if you even have a personal robot at all in your home, it most likely cleans your floors, and that’s it — other than possibly scaring your pets. If you wanted to chat, it couldn’t hold up its end of the conversation. If you were looking for specific information, its zig-zag pattern of movement across the room wouldn’t provide it. And if you needed healthcare-related assistance, forget about it. However, this is all changing, and possibly much faster than you think.

Globally, the personal robot market is expected to reach over $34 billion by 2022, driven primarily by an aging population and declining technology costs. Within the general personal robot space, there are many different specific domains. For instance, in addition to the personal cleaning robots mentioned above, there are personal robots for entertainment, education, security, companionship, personal transportation, and handicap assistance. Additionally, there are a few healthcare companion robots on the market today. Healthcare companion robots interact socially with patients, with the intent of providing or improving some aspect of healthcare. They are often meant for at-home use, but not always. For instance, there’s QTrobot, an expressive, 2-foot tall humanoid robot that is used by therapists and educators to teach children with autism spectrum disorder about emotions, communication, and other social skills. Then there’s PARO, a robotic baby harp seal that is used in hospitals and nursing homes as a therapeutic tool. Here, we will discuss existing healthcare companion robots that, in addition to other functionalities, offer assistance related to medication adherence.

Mabu

Produced by Catalia Health, Mabu is an AI-powered healthcare companion robot designed for at-home use to help patients deal with chronic illness, such as congestive heart failure, rheumatoid arthritis, and chronic kidney disease. At a height of about 12 inches, Mabu consists of a plastic upper torso holding a small tablet-like touchscreen, and a head with eyes that blink and make eye contact. It’s immobile and designed to sit on a patient’s tabletop or kitchen counter. Mabu’s AI combines psychology and medical best practices to have short (two to three minute), tailored conversations with the patient on a daily basis. While these conversations provide patient education and assessment, they also adapt to the patient’s particular behaviors and preferences and focus on relationship building to deepen long-term engagement and improve patient care. The built-in touchscreen can be used to display and gather information during these conversations. Mabu can assist patients with overall care management, including medication adherence, education, and tracking progression of disease. It can remind patients to take medications, ask them how they feel, and contact a caregiver, if needed.

Mabu is powered by Catalia Health’s Wellness Engagement Platform, enabling reminders and daily conversations to be delivered and carried out on patients‘ mobile phone when, for instance, they are away from home and the physical Mabu device. A summary of data collected by Mabu is shared securely with the patient’s healthcare team, providing insights regarding the patient’s health, progress, and adherence to treatment. In October 2018, Catalia Health joined the American Heart Association’s (AHA’s) Center for Health Technology and Innovation’s Innovators Network, with the aim of delivering guideline-based medical care in an innovative, effective, and scalable manner to those with heart-related ailments, such as heart failure. Currently, Mabu is only available through select healthcare providers and ongoing programs, with cost dependent on the healthcare provider. Although Catalia Health’s website mentions pilot programs, we could find no peer-reviewed publications regarding the effectiveness of Mabu in terms of medication adherence or other outcomes.

Pillo and Pria

Pillo is a voice-controlled, healthcare companion robot with a total wellness program meant for at-home use by those living with chronic illness. Pillo is similar to Mabu in several ways. It is about the same size, immobile, and meant to sit on a table or countertop. Pillo has a circular digital touchscreen on top of a hollow base. Like Mabu, Pillo incorporates AI to interact with and learn patients’ preferences over time. Pillo’s programming includes a daily engagement journal as well as risk tracking. It can deliver medication reminders and other alerts, as well as additional health information, such as the nutritional value of food. It can also play music, give weather updates, set alarms and timers, and answer a variety of questions unrelated to health. In this way, Pillo has functionality similar to an Amazon Echo.

Pillo also incorporates medication storage and scheduled dispensing via an onboard 28-compartment wheel-shaped pill organizer. Medications are dispensed into a cup that is placed under the screen in the hollow base. With a built-in camera, Pillo uses facial recognition to ensure medications are dispensed to the right patient, enabling one Pillo device to be used by multiple users. Pillo also allows users to make and receive video calls that, in addition to calling family and friends, may be used for remote intervention. Pillo’s companion mobile application, Pillo Health, allows users to see their medication schedule, track health data, set alerts and reminders, chat with Pillo, and share information with their healthcare team, all on the go. Pillo can also be set to alert caregivers and loved ones of any missed doses. As expected, data and analytics collected by Pillo are shared securely with the patient’s healthcare team, and can then be acted upon as needed. Currently, Pillo is only available through select healthcare organizations, with no mention of cost. Like Mabu, we found no peer-reviewed publications regarding the effectiveness of Pillo.

The makers of Pillo have collaborated with Stanley Black & Decker to produce Pria, a subscription-based medication management system. Pria looks identical to Pillo and appears to have essentially the same functionality. A primary difference is that Pria specifically aims to help loved ones and other caregivers, aside from primary healthcare providers, remotely assist elderly patients so that they may maintain their independence for longer. Caregivers use the Pria Home Care Companion mobile app to schedule medication dispensing, receive alerts when doses are missed, and make video calls to the Pria device. Although currently unavailable, Pria will be sold through select retailers, including Amazon. The cost of the subscription service is currently set at $39.99 per month.

It is early times for healthcare companion robots, but they are making their way to market and, ultimately, our kitchen counters. This is exciting, no doubt, but we have yet to see the impact such tools can have in terms of boosting medication adherence and improving patient outcomes. In addition to evidence of effectiveness, there are additional features that we would like to see incorporated in our soon-to-come robot companions. At the top of that list is integration with community pharmacies. Although Mabu and Pillo both send data and analytics to the patient’s healthcare team, pharmacy was not mentioned in the information we looked at. Given that these companion robots focus heavily on medication adherence, such integration makes logical sense. That said, we know we may be a bit ahead of the curve, and we fully expect to see this integration as these products are further developed, refined, and brought to market.

So what are your thoughts? Do you have any experience with social companion robots? Have your patients used them or asked you about them? We welcome your comments and suggestions. CT

Joshua C. Hollingsworth, Pharm.D., Ph.D., is an assistant professor, Pharmacology and Biomedical Sciences, Edward Via College of Osteopathic Medicine, Auburn Campus, Auburn University, and Brent I. Fox, Pharm.D., Ph.D., is an associate professor in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy. The authors can be reached at jhollingsworth@auburn.vcom.edu and foxbren@auburn.edu.

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