Robots have sparked imaginations across the globe since the beginning of the 20th century when they first emerged in the literature.1 Robots and robotics were industrialized when General Motors used an automated materials-handling machine in its production process.1,2 The automotive industry continues to use robotics more than any other industry. However, other uses in automated processes and human efforts have emerged, and the current state of the art in robots can be described through industrial (56%), professional service (30%), military (10%), domestic service (2%), and security (2%) purposes.1 Since then, the field of robots and robotics has revolutionized manufacturing, households, and the medical industry through automation to replace or aid human efforts. In fact, the global demand for robots has greatly increased over the decades to become a $17.8 billion market.2
Automotive manufacturers, healthcare, military, and consumer product manufacturers account for the largest robot users. These robots are employed mainly in assembly (26%), surgical (14%), welding/soldering (12%), and painting/coating/gluing (11%) applications.3 Surgical robots currently dominate medical robots, mostly in neurosurgical (30%), orthopedic (23%), steerable catheters (12%), and other robots (35%), including those used to address gynecologic disease.1,4 Hospitals are the central purchasers of surgical robotic equipment (47%), followed by academic institutions (17.5%); 26% of surgical robotic equipment is exported.3 The volume of usage demonstrates healthcare professionals are willing to adopt robots in the clinical setting. Moreover, medical robots, on average, are $1 million per robot, which positions robots as the most valuable equipment in healthcare settings.1 There is significant opportunity for robots in healthcare, based on value as well as the projected market growth over the coming years.
The International Organization for Standardization (ISO) has an entire standard dedicated to robotics (ISO/TC 299), which contains 16 published standards and 12 standards under development.5 Most standards are related to performance, manipulation, and safety of industrial, service, and medical robots (under development). Specifically, the ISO made great advances in 2014 to identify safety requirements for personal care robots, covering interactions between humans and robots.6 This directly relates to nursing robots included in the scope of this study. The ISO 8373 specifically defines a nursing robot as “systems of mechanical, electrical, and control mechanisms used by trained operators in a professional healthcare setting that perform tasks in direct interaction with patients, nurses, doctors, and other healthcare professionals and which can modify their behavior based on what they sense in their environment.”5 This definition of a nursing robot encompasses professional service, collaborative, and intelligent robots. Table 1 offers further definitions and clarifications related to robots used within nursing care areas.5
However, the existing landscape of medical robots does not specifically address nursing robots, despite the fact that nurses account for nearly 45% of all healthcare professionals.7 With patient mortality linked to nurse understaffing,8 employing nursing robots to increase or support efficiency in staffing has the potential to improve patient outcomes. The purposes of this study were to (1) offer a clear definition and description of nursing robotics and (2) to describe and discuss the status and current evidence about developments in robotics used to assist or augment nursing care via the patent landscape.
What is the difference between a robot and a machine, as both are capable of performing autonomous tasks? A machine is an automated tool controlled by end users, or it may be automated. Robots, however, are machines that are able to function autonomously in some way and work without external commands.9 The robotics market is made up of whole robots (50%), robot parts (30%), robot software (14%), and safety materials (6%).10 Whole robots are fully integrated devices operating independently to improve efficiency and maintain or diminish labor costs. Robot parts are the mechanical and electrical hardware that is pieced together to build a robot. Robot software is the electronic interface with the hardware. Examples of robot parts include arms and manipulators; robot software includes electronic controllers. In addition to whole robots, robot parts, and robot software, there are enabling technologies that spur rapid development in robotics. These technologies are the innovations which, as standalone or combined with other technologies, enable capabilities and performance that deliver more suitable functionality to a specific group of people. Figure 1 shares illustrations and descriptions of an “intelligent nurse robot” and a “hospital room assistant robot.”
Recent literature demonstrates an enthusiasm for incorporating innovative technologies in care. Evidence of robotic technology integration exists in the areas of aged care, dementia, home care, critical care, intravenous applications, telehealth/education, and rehabilitation. Recent literature reviews reveal the integration of social commitment robots, those that encourage positive communication and social exchanges, in areas specializing in the care of the aged and those with dementia.11,12 According to Mordoch and colleagues,12 social commitment robots have a calming effect and offer companionship and motivation. Home care, critical care, and telehealth are areas with fewer robotic applications reported in research literature. Domestic assistance, including independent living, frequently uses robots in research studies,13,14 with aging adults as the most common type of sample.11 Telepresence robots, often in the form of a video screen mounted on a moving pedestal, assist nurses in patient triage15,16 and in simulated care environments within educational contexts.17 Other applications of autonomous robotic devices exist, such as robots used to assist in intravenous applications18 including “intelligent” or “smart pumps,” and compounding medications.19
A recent bibliometric analysis focused on robotics in nursing identified qualitative research as the most common study design. Some case study, cluster-randomized controlled trial, exploratory, nonrandomized controlled trial, observational study, pre-post intervention, repeated measures, and survey studies were conducted on robotics in nursing.11
Overall, research with robotics in nursing care is narrow, with limited studies designed as randomized controlled trials. Many of the studies are usability or feasibility studies and therefore do not measure patient-related outcomes. Further, research design is often unclear, and many usability studies feature small sample sizes. For this reason, literature is limited to describing how to best use these robots to enhance the health of individuals and healthcare processes.
Patents can offer understanding into the industrial viability and popularity of emerging technologies. The patent landscape offers insight into developing innovations, which are the ideas that become commercially available and eventually reach widespread adoption. Moreover, patents demonstrate the future outlook of a field by indicating the amount of investment and interest companies and institutions dedicate to emerging technologies. To understand the importance of nursing robotics, this study investigated the patent landscape within the scope of the previously defined nursing robot.
Patents provide insight into the industrial viability of technologies, and the number of patents gives an estimation of the popularity of a specific field.20 In order to assess the patent landscape of robots and robotics used in nursing applications, a search through the issued patents and the published patent applications was conducted in both the US Patent and Trademark Office (USPTO) and the European Patent Office (EPO) databases.
The seven-step search strategy for patents and patent applications was used according to the USPTO guide.21 This strategy allows inventors to explore the similarity of their own inventions to existing patents and patent applications. There were multiple steps to the modified search strategy; first keywords were identified along with Cooperative Patent Classification (CPC) schemes to determine relevancy. Next, patents and patent publications were examined using the CPC schemes. Finally, patents and publications were searched again using keywords. The purpose was to ensure rigor and to capture the most relevant results. The patents and patent applications of interest that resulted from the systematic searches were examined for relevancy and analyzed to assess the patterns and trends in the patent landscape.
Patent and Patent Application Search
The searches described above were performed in four databases: the USPTO issued patent database, the USPTO published patent application database, the EPO database, and Relecura. The USPTO Patent database (http://patft.uspto.gov/netahtml/PTO/search-adv.htm) includes full text for US patents from 1976 to the present. It also includes PDF images for all US patents from 1970 to the present.22 The USPTO Patent Application (http://appft.uspto.gov/netahtml/PTO/search-adv.html) database includes full-text and image versions of the US patent applications.23 Free access to information about inventions and technical developments from 1836 to today24 and data on more than 100 million published patent applications from 90 countries25 can be found in the EPO (https://worldwide.espacenet.com/) database. Relecura (Pleasanton, CA; https://relecura.com/) is a subscription innovation platform, which includes access to worldwide patent databases.26
Patent applications are typically made publicly available through the databases 18 months after the date of filing. All sources available and published or issued between January 1, 1976, and December 31, 2016, were included in the search. Results were relevant if the description of the invention was (1) a whole robot, (2) able to function autonomously, (3) work independent of human control, and (4) able to be used in nursing care. Table 2 describes the search strategy and number of issued patents and patent applications among the databases used in this study.
For the purposes of this assessment, keywords reflected the scope of work and fit within the proposed definition of nursing robot. The authors determined the following keywords relevant: nurse, nursing, robot, robotics, patient care.
After broadly searching for robot/s or robotics in the USPTO databases, 90 133 issued patents and 94 185 published patents applications were found. More than 10 000 results were returned after searching the same keywords in the EPO database, and more than 466 000 results were returned in Relecura. These results were narrowed using keywords and CPC schemes. Table 2 illustrates the total number of results of interest pertaining specifically to robotics in nursing.
Cooperative Patent Classification Scheme Identification and Relevancy Verification
The CPC system is a common system used by both the EPO and the USPTO to organize and classify patents based on subject matter and use. Seventeen CPC schemes were pertinent to robotics in nursing.
A total of 285 issued patents and 308 published patent applications were returned in the USPTO database after a search using a combination of keywords that were related to robots in nursing applications within the relevant CPC schemes. Twenty-five patent applications were found in the EPO database based on the same keywords. Duplicates were removed, and searches were refined to focus on technologies relevant to nursing applications.
Patent and Patent Application Review and Analysis
Results from the searches were reviewed initially for relevance by focusing on information from the title and abstract. The results were further narrowed by information contained in the claims of the patents and patent applications according to year, inventor, assignee, classification, and technology. Next, we compared results to definitions of robot and nursing robot.
Of the 618 results returned after the CPC search and the 242 results returned after the claims search, 14 issued patents and published patent applications from the USPTO database, seven patent applications from the EPO database, and 34 from Relecura had high relevance to the scope of this study.
Review and Discussion of the Nursing Robotics Patent Landscape
The 860 results (611 in USPTO, 25 in EPO, and 224 in Relecura) were reviewed and analyzed. There was overlap between databases because they often use the same sources, which are the patent offices of countries, for example, the USPTO for US items. In addition, there were duplicates between the issued patents and published patent applications because some patent applications were granted patents.22 Regardless of this duplication and overlap, all items of interest were briefly reviewed and analyzed to understand relevance and highly relevant items.
A large number, 126, of the issued patents and published patent applications were surgical robots, including robotic arms, and assistive devices for surgery, some of which require human control. In fact, a published white paper assessed the specific patent landscape of robotic surgery.27 This technology space was not considered highly relevant to the search because robotic surgery does not meet the criteria of autonomy or nursing. One exception to the classification of surgery was a robot that performs the function of a scrub nurse.
Enabling technologies were included within the resulting patents and patent applications of interest. For example, artificial intelligence packages to enable appropriate auditory and verbal responses from humanoid robots were among the enabling technologies encompassed within the results of interest.28 These are considered outside the scope of the current study because enabling technologies typically encompass robot parts, software, or controls that are not connected together to form the whole robot. However, enabling technologies indicate a trend in bridging the gap between fundamental research and commercializing a technology, which suggests the opportunity for robotics in nursing is emerging in industry.
Further, the results of interest included parts of robots or a combination of technologies and not necessarily considered whole robots. Examples include robot arms to grip objects,29 robot control programs to operate manipulators,30 and legs of the lower half of a bipedal robot.31 These were deemed outside the scope of the current study because they did not meet the combined criteria of professional service robot and human-robot interaction.
Patents and Patent Applications of Interest by Year and Country
The overall number of patents indicates the popularity of robotics in nursing. Within the resulting 878 items of interest, the number of issued patents and published patent applications was relatively stable and sustained, with the largest growth in 2016.
The main countries that contribute to the space include the US, China, Japan, South Korea, Taiwan, and World Intellectual Property Organization. Other countries with a notable number of contributions include member states of the European Patent Convention, India, United Kingdom, Germany, Canada, and Russia. Although this list is not exhaustive, it indicates a global awareness and interest in robotics in nursing. Similar to the trend in the country of origin of first authors within the relevant published research,11 the patent space shows the most issued patents and published patent applications originating from the US, approximately 28% of returned technologies. Figure 2 illustrates the number of issued patents and published patent applications of interest by year and country.
Patent Landscape Broken Down by Assignee
The patent landscape is categorized by type of assignee or the individual/entity with interests and rights to the intellectual property. The main types are companies, universities, or individuals. Joint assignees are also possible. The breakdown of assignee indicates the development and commercial viability of the technology. Large companies are showing interest in nursing robotics. They are protecting technologies by filing patent applications and paying fees to maintain patent applications and issued patents. This indicates a strong commercial opportunity for robotics in nursing.
The search yielded 20 individual assignees with five or more patents or patents of interest. As stated previously, many of these technologies are enabling technologies, telemedicine/telepresence technologies, or surgical robots. Of the 20 entities, 12 were companies, with iRobot (US) with the most patents of interest (n = 36). Panasonic (US) held 23 patents of interest; Sony (US), China, and Japan held 22 patents of interest. Three of the patents of interest were assigned by company and university partnerships, while two of the more prolific assignees were individuals.
Patents of Interest With Highest Relevance to Nursing Robots
The 878 issued patents and published patent applications of interest were reviewed by publication number, title, and abstract and content to remove duplicates, yielding 55 relevant patents. These results encompass a variety of robots used in nursing, telemedicine, geriatric care, home care, medication administration, surgery, rehabilitation, pharmacy services, feeding, eating, drawing blood, and patient vitals. Information about the results of interest by robotics definitions and where nursing robots are used is provided in Table 3.
Highest Relevant Results Categorized by Use of Nursing Robot
The results were grouped into nursing specialty categories by similar performance or intended use of the robot. Key groups include rehabilitation, home care, therapy, geriatric, drug, pharmacy, and medication, and the uses were similar to the corresponding literature. Most of the relevant results related to a single use group, meaning the purpose of the nursing robot is specific to one task. By far, the largest single use groups were related to rehabilitation, therapy, geriatric care, and home care. The surgery group was included within the relevant results because the content fits within the defined scope of the work. Specifically, a robot that performs functions of a scrub nurse was included; the robot is autonomous, interacts with physicians and nurses, and is intelligent.32
Some results have dual robot use, mostly related to caring for older adults. Several results were unique to the patent landscape and not found in the literature. One of these related to use for soldiers,33 and another related to an eating aid for people who cannot feed themselves.34
Examples of Nursing Robots
Some of the relevant results crossed groups and provide examples of this work's definition of nursing robot, including 15 results related to three or more uses of robots. Two applications embodied the definition of nursing robot. Patent US20050154265A1 relates to a whole robot that contains multiple functions including speech recognition, human-machine interface, sensors to take physiological measurements of patients, and facial recognition. Physiological measurements included temperature, blood sugar, and heart rate and the comment that “robot 12 is able to take over many of the tasks currently performed by nurses.” The current assignee of this patent application is Matsushita Electric Industrial Co Ltd, which is a Japanese electronics manufacturer whose brands include Panasonic.35
In another example of a nursing robot, KR20150119734A relates to an “autonomous mobile intelligent robot” that can assist healthcare professionals in hospital settings. The whole robot included autonomous navigation, speech recognition, arm, wrist, and hand, with electronic controllers to manipulate its parts. The assignee is Kyungnam University of South Korea.36Figure 1 illustrates and further describes these exemplary robots.
Limitations to Searching Patents and Patent Applications
Many companies use this method to search for areas of opportunities. In fact, inventors are encouraged to search patent databases to determine if similar technologies exist. This search technique using USPTO, EPO, and Relecura databases could be applied to any technologies that could be patented including medical devices, instruments, and even processes used in the clinical settings. It is crucial to identify a variety of keywords in searches that broadly describe the technology to understand the patent landscape. There are limitations to patent and literature review about technologies. It is possible to identify topics and ideas that are simply not contained in these databases, leading one to believe the technology does not exist when in fact it may exist but it is simply not published or categorized in a logical manner. Further, many technologies may be published in research but are not necessarily patented. Initially, one might assume the technology is nonexistent or not of quality, when in fact, patent is a process and the patent application may have been denied based solely on the similarity of the prototype technology to another patent.
Research literature describing the use of robotics in patient care areas is limited. However, reports of robotic applications within patient care areas do exist. In addition, it is evident that many robots in nursing have been used as companions, opposed to the typical application of automating recurring motions.11 Based on the number of patents and published patent applications, the field of robotics in nursing is ripe for innovation. Specifically, many of the technologies of interest were enabling technologies, which suggests the opportunity for robotics in nursing is emerging. Since the major players are large companies, this demonstrates industry interest and investment in nursing robotics. This indicates a strong commercial opportunity for robotics in nursing. The overall patent landscape for nursing robots indicates a significant opportunity for these innovations to revolutionize the nursing profession. Following future trends in the nursing robot patent landscape will determine the sustainability of these technologies.
Overall, the patent landscape revealed areas of nursing that may benefit from robotics. Some areas of opportunity identified in the patent search, including robots used in surgical care areas as a scrub nurse or in home health, may help reduce errors and safe staffing costs. Perhaps robots used to deliver items such as medications, water, food, or other items can meet the needs of patients in a timely manner. Although modern interventions through robots may enable nurses to respond more efficiently, users must determine the appropriateness of engaging robots in nursing care delivery. Patients are vulnerable, depending on their health situations. Nurses have significant positive impacts on a patient's healthcare experience as they provide care with understanding, empathy, and sympathy. We must remain aware of these needs and consider the care recipient's attitude and desire to be cared for by technology as opposed to humans in certain more delicate healthcare situations.
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