LA Children's Hospital Fighting Disease With Tiny Robots, Big Data

If you are a small child at Children's Hospital Los Angeles, about to receive chemotherapy drugs intravenously, IVEY might be at your bedside to distract and soothe you.

IVEY is not a nurse or doctor, but a small, 3D-printed robot—just 13.5 inches tall—named for the IV procedures it helps young patients endure.

Based on the open-source Hello-Robo MAKI model, IVEY was adapted for CHLA in collaboration with Maja Mataric, PhD, head of USC's Robotics and Autonomous Systems Center. It has six Dynamixel Actuators, providing six degrees of freedom in its head—including two adorably big, Manga-style expressive eyes. IVEY is powered by Arduino IDE and built on ROS.

"There's a lot of literature now about how stressful and painful situations in childhood lead to later trauma, and, as an adult, perhaps they'll avoid care, leading to bad health outcomes," pediatric hospitalist Margaret Trost, MD, tells PCMag. "We know there's a lot of affinity for children with technology, and I'm a technology enthusiast generally, working a lot with the Health, Technology and Engineering group at USC, so our work here with IVEY is to examine how best to address this, while the pediatric patient is in a hospital setting."

During a demo in Dr. Trost's office at CHLA, IVEY's sweet voice gently guided us to indicate our pain levels on a tablet, go through breathing exercises, and—through a series of game-style, on-screen visuals—grasp what's about to happen. IVEY was clear, helpful and, quite frankly, enchanting.

"IVEY is part of a clinical study here at CHLA with the Child Life Program to identify the most effective communication with patients," said Dr. Trost, who is also an assistant professor at the Keck School of Medicine at USC. "We're comparing IVEY as a scripted 'buddy' [who distracts] patients with general conversational topics, versus IVEY...as a helper, using more empathetic language, and, finally, comparing reduction in anxiety when working with the human Child Life specialist, but no IVEY."

Founded in 1901, CHLA officially opened a year later in a little house in what is now Los Angeles's Chinatown neighborhood. There were just 14 patients, surgery was carried out in the former pantry area, and a doctor did house-calls on horseback.

In 1932, it became affiliated with the Keck School, and CHLA has since embraced emerging technologies, from limb implants to avoid amputation in 1990 to gene therapy on newborns with severe immune deficiencies (aka bubble baby disease) in 1993.

Family Fitbit Challenge

Today, CHLA is tackling things like childhood obesity using wearables as part of clinical trials headed up by Juan Espinoza, MD, an attending physician at CHLA.

"In our work with pediatric obesity we don't use pharmacological intervention for children," Dr. Espinoza told PCMag. "Instead, we use Fitbits, not so much to track activity, but because we think they enhance our structured multidisciplinary eight-week program. We also believe in a family-centered solution, because you have to engage parents, in the form of a support group, and through education around nutrition. So they wear Fitbits too."

The idea is that Fitbit data doesn't lie, unlike self-reporting food diaries and activity journals of the past.

"That's the beauty of technology like wearables," Dr. Espinoza confirmed. "Because now we have the data to capture, verify, analyze and then propose new hypotheses and test those in a virtuous circle."

The children's data is safeguarded, as required by the Children's Online Privacy Protection Act (COPPA), but Dr. Espinoza, who is also an assistant professor of Pediatrics at Keck, has seen improvement among those wearing the gadgets.

Since the program started in 2015, CHLA has enrolled 132 families, evenly distributed between those wearing Fitbits and those not, and 84 percent of those who wore Fitbits saw a 50 percent improvement over the non-wearables group. "It works," according to Dr. Espinoza.

He's hoping these wearables can be used for some of the trickier aspects of working with young patients. "In pediatrics, one of the things we worry about is unnecessary or painful interventions. It's hard to restrain a 3-year-old to take blood samples and you feel like a terrible person afterwards.

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"We already use light absorption and refraction to non-invasively measure things like blood oxygen levels. Now there are several manufacturers looking at using similar technologies to track changes in other molecules. A wearable that could track these markers, like renal and liver function, would be great, and far less invasive than our current approach for pediatric patients."

Using AI to Care for the Sickest Patients

There were lots of clinical trials we could have seen during our visit; CHLA has an entire program dedicated to innovation. But we closed out our tour with Randall Wetzel, Chairman of CHLA's Department of Anesthesiology Critical Care Medicine. He created the Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit (vPICU), a state-of-the-art machine that's learning to optimize care for critically ill children.

"I want to measure everything: because the real evidence comes from the electronic health records and flowing off the monitors in the ICU," explained Dr. Wetzel.

"We're capturing everything and analyzing it within neural networks inside our virtual ICU (vPICU). It's a vital prognostic tool and we've now developed a lot of advanced algorithms to assess critical care therapies and outcomes. We have over 100 data streams coming off each bedside, with an average of 20 beds per ICU, including drug interactions, test results, interventional settings, IVs, intracranial pressures from head traumas, and now we can understand the simultaneous events as they happen."

All this A.I. deep learning takes an enormous amount of processing power; CHLA uses GeForce Titan X GPU and is an Nvidia data science case study.

The vPICU connects with other medical institutions and research facilities to populate databases and extend telemedicine networks across the globe. CHLA is inviting data scientists and researchers to join as fellows, to extrapolate new studies, based on the vPICU data, extending its reach into underserved communities and rural areas.

"We've giving physicians, at the child's bedside, the benefit of the best data at their fingertips," stressed Dr. Wetzel, who is also professor of Pediatrics and Anesthesiology at Keck. "Information that is entirely current—not from medical journals, or anecdotal evidence, or professorial pass-on. We know the amount of knowledge has surpassed our ability to retain it. We need a cognitive assist, a medical prosthesis, if you like—and that's what we're building here with the vPICU."

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