Hospital Looks to 'Cobot' EHR Integration to Alleviate Nurse Burnout

"Meep, meep!” Moxi, a collaborative robot EHR integration or “cobot,” is here to deliver supplies to a patient room—and mitigate nurse burnout.

A national nursing shortage that is expected to get worse is leaving nurses exhausted with more patients than they have time to care for. At ChristianaCare, an innovative EHR integration is looking to mitigate nurse burnout by automating lower-level tasks through "cobots”—collaborative robots designed for direct human interaction.

Nurses can call on the Moxi cobots to deliver or pick up supplies at specific locations through a kiosk, similar to calling an Uber, Katherine Collard, MS, RN-BC, NP, chief nursing informatics officer at ChristianaCare, told EHRIntelligence in an interview.

Moxi is programmed to say a few things that help it navigate the hospital and use the elevator. Separate from those phrases, the cobot makes a "meep, meep" sound.  

"We call it meeping," Collard said. "People just find that really endearing. They find it very warm and welcoming."

The technology aims to help nurses practice at the top of their license, allowing them to spend more time with patients.

Studies have shown that nurses spend up to 33 percent of their time hunting and gathering supplies needed for patient care. And with nursing shortages creating challenges nationwide, that’s not the best way to design a nurse workflow.

"It does not require a registered nurse to go down to central supply and get supplies or take a specimen down to the lab," said Eva Karp, DHA, MBA, RN-BC, FACHE, senior vice president and chief of clinical and patient safety at Cerner. "It doesn't require a human to do that if Moxi can do it."

ChristianaCare's development group initially brought two cobots into one of its hospitals as a trial using donor money. A grant from the American Nurses Foundation will allow the hospital to leverage three more cobots and integrate them with the hospital's Cerner EHR to save nurses even more time.

"Instead of having an order be placed and then the nurse request that item through the kiosk, the idea is that once the order is placed, the robot will go and fetch the supplies needed," Collard said. "It eliminates the nurse having to go to the kiosk and make that request."

She emphasized that Moxi is not replacing nurses. Instead, it's augmenting their workflows.

"I introduced Moxi to the nurses as a practice partner months before it came here," Collard noted. "I told them, ‘it will help you do lower-level tasks, which should save you leg work and hopefully some time.’"

She said that the technology has been well received by nursing staff.

"The nurses feel that it's really helped them feel less stressed because they can send the robot to go do something, and while it's doing that, they can do something else," Collard pointed out. "There's been a lot of feedback like that, so I think they're pretty happy about it at this point."

While the cobot technology has significant implications for mitigating nurse burnout, it also benefits patient safety.

"Every time a nurse is off the unit going to get supplies or taking specimens to the lab, that's time they're not with the patient, and when you're not with the patient, things can happen," Karp said. "More time at the bedside keeps the patient safer."

Moreover, the cobots have also been well received by patients, Collard said.

When introducing Moxi to the hospital, Collard saw a puzzled expression on a trauma ICU patient's face.

"I introduced it to him, and he thought it was really cool," she said. "The patients have been very positive about it."

Collard said that ChristianaCare is currently building Moxi's journeys and tasks.

"We have it delivering medications that normally can't go in the tube system and equipment from the equipment room," she said. "It can also go down and pick up patient belongings at the front desk that the family leaves for the patient and bring them upstairs."

"Every week, we build a few more tasks for it," Collard explained. "This week, we're building a process where the nurses can return broken equipment to clinical engineering so that it gets fixed and then returned to them."

Collard noted that the technology will help deliver supplies on time for nursing orders.

"One of the things we'll program with Moxi is when patients in surgery have to have sequential stockings on,” Collard explained. “Once the order's placed, Moxi will go get the equipment and the stockings and deliver them to the unit.”

Additionally, Collard said ChristianaCare is working on a program to get discharge medications in patients' hands before they leave to improve medication adherence.

"The reality of life in any organization is that there are patients who maybe can't afford their medications," Collard said. "We send them home with prescriptions, and then they can't pick them up because they don't have money."

"I'm working with the people in the medicine department to look at those cases where we could hook patients into a program so those medications get paid for, and Moxi goes down to the retail pharmacy and picks them up," she continued.

Collard mentioned that when she and other executives first heard about the cobot technology, they were concerned about medication security. However, she said the technology is equipped to ensure the safe delivery of medications and other supplies.

"Moxi's got a huge amount of security in it," Collard said. "It works on artificial intelligence. We have loaded the nurses' IDs attached to their badges, so if you don't have a reason to be in Moxi, you will not be able to open the drawer."

Additionally, Moxi will only open a drawer to dispense the supplies or medication when it has reached its destination.

"Even if I have access and I'm down in the lobby, and there's a drawer that's supposed to be delivered to a unit, if I go and tap my badge, it will not open that drawer because it knows where it is," Collard noted. "We've trained it to know the floors and its wayfinding, so it wouldn't even open the drawer unless it was in the location to which it's supposed to deliver that item."