FW-HTF-P: Toward Collaborative Remote Physical Examination: Transforming Medical and Nursing Practice

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Since the early in in the COVID-19 pandemic, telemedicine has seen tremendous growth in the U.S, providing people in under-resourced areas with broader access to healthcare through remote telemedicine visits with health professionals and experts to whom they may not otherwise have access. However, these visits are currently restricted to video teleconference-style exchanges and lack the capacity for physical examinations, which contribute significantly to diagnoses and the identification of health concerns that may not otherwise surface during a medical visit. This project investigates the possibility of supporting physical examination as a paired practice between a caregiver local to the patient and a remote physician, using touch-based and augmented-reality technologies. Caregivers will perform examinations while wearing touch-sensitive gloves, guided by remote physicians using a physical examination cockpit that lets them see and feel the patient using the outputs from the caregiver’s gloves and a video feed. The technology and practice will potentially transform the work of physicians and local caregivers, opening the door to more effective and more accessible telemedicine visits.The foregoing discussion uncovers a number of questions that the project is designed to address. First, tactile interpretation is active, meaning that one has to typically be in control of the sensing process to be able to interpret the sensory output. The proposal will explore conditions under which one can meaningfully interpret passively received tactile information, such as what the remote physician would feel when a local (to the patient) caregiver is now in control of the sensing motions. One method to be tested for returning agency to the physician is the psychological phenomenon known as the ‘rubber hand’ or body transfer illusion, where one psychologically associates an appropriately-placed rubber hand as one’s own, and an impact on the rubber hand is viscerally felt by the subject. Even if the rubber hand illusion does not fully activate, joint expertise between the local touch explorer and the distant interpreter may facilitate the needed tactile understanding, and this understanding may be enhanced through practice. The project team will explore configurations (e.g., relative positions of the distal toucher’s hands to the subject’s hidden hands, degree of and type of movement/tactile exploration, visual/augmented reality presentation) that allow body transfer illusions or joint expertise to enable interpretation. The team will also conduct a series of video-based grounded theory explorations of physicians performing physical examinations to gain a better understanding of the process and to categorize specific actions that may serve as the basis of communication between the local caregiver and the distal physician, and to inform the technology developments necessary to enable this collaborative examination. Finally, the project team, comprising physicians and nurses, mechanical engineers, human-computer interaction researchers, and perceptual psychologists, will collaborate on the research described, engaging in team development exercises to gain a stronger shared understanding of the joint physical examination process and support future research and development of these practices and technologies.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.