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

自COVID-19大流行早期以来，远程医疗在美国取得了巨大增长，通过与卫生专业人员和专家进行远程远程医疗访问，为资源不足地区的人们提供了更广泛的医疗保健服务，否则他们可能无法获得这些服务。然而，这些访问目前仅限于视频电话会议式的交流，缺乏体格检查的能力，体格检查对诊断和确定在医疗访问期间可能不会出现的健康问题有重大贡献。该项目研究了使用基于触摸和增强现实的技术，在病人的本地护理人员和远程医生之间进行配对的身体检查的可能性。护理人员将戴着触摸敏感手套进行检查，由远程医生指导，使用身体检查驾驶舱，通过护理人员手套和视频馈送的输出，他们可以看到并感受到患者。这项技术和实践将有可能改变医生和当地护理人员的工作，为更有效和更容易获得的远程医疗就诊打开大门。前面的讨论揭示了该项目旨在解决的一些问题。首先，触觉解释是主动的，这意味着一个人必须典型地控制感知过程，才能解释感官输出。该提案将探索在何种条件下，人们可以有意义地解释被动接收的触觉信息，例如，当本地（对患者）护理人员控制感知运动时，远程医生会有什么感觉。一种用来测试将代理返还给医生的方法是一种被称为“橡胶手”或身体转移幻觉的心理现象，在这种现象中，一个人在心理上将一只适当放置的橡胶手与自己的橡胶手联系在一起，而对橡胶手的影响会被受试者发自内心地感受到。即使橡胶手错觉没有完全激活，本地触觉探索者和远程口译员之间的联合专业知识也可能促进所需的触觉理解，并且这种理解可能通过实践得到加强。项目团队将探索配置（例如，远端触摸者的手与受试者隐藏的手的相对位置，运动/触觉探索的程度和类型，视觉/增强现实呈现），允许身体转移幻觉或联合专业知识来实现解释。该团队还将对医生进行一系列基于视频的基础理论探索，以更好地理解这一过程，并对可能作为本地护理人员和远端医生之间沟通基础的具体行动进行分类，并告知实现这种协作检查所需的技术发展。最后，由医生和护士、机械工程师、人机交互研究人员和感知心理学家组成的项目团队将在所描述的研究中进行合作，参与团队发展练习，以获得对联合体检过程更强的共同理解，并支持这些实践和技术的未来研究和发展。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

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.