June 5, 2014
Nearly a year ago, Dr. John Halamka, chief information officer of Beth Israel Deaconess Medical Center (BIDMC) in Boston, told U.S. News & World Report how Google Glass might help medical professionals do their jobs a little better. "Just as the iPad has become the chosen form factor for clinicians today, I can definitely see a day when computing devices are more integrated into the clothing or body of the clinician," he wrote.
Since then, Google Glass has not exactly gone mainstream, but some—including Halamka's colleagues at the Harvard-affiliated hospital—are finding innovative ways of adapting the head-mounted computer to healthcare environments.
Late last year, BIDMC starting employing Glass in its emergency department (ED). In January, project champion Dr. Steven Horng saved a life by pulling up the patient's medical record on Glass to learn which drugs the man was allergic to in time to stop a brain hemorrhage; in April, the hospital decided to expand its Glass pilot program to the entire ED.
BIDMC has integrated a Glass communications platform from San Francisco-based Wearable Intelligence into its electronic health record, allowing data to flow in both directions between the device and the EHR. "It's all about putting the information in the right place at the right time," Horng says.
According to Horng, an emergency physician and clinical informatics specialist, Glass is helpful in streamlining workflows and making sure physicians keep the attention of their patients.
A common critique of PC-based EHRs is that doctors often have to look away from the people they are treating in order to type something into the computer. With Glass, which is operated by voice command, Horng points out he can look up information without having to break eye contact, even in sterile environments. "You can do all this while fully gowned," Horng says.
The hands-free aspect makes Glass particularly attractive for surgeons.
Shortly after Google announced its Glass Explorers testing program in mid-2013, Dr. Pierre Theodore, a cardiothoracic surgeon at the University of California, San Francisco, connected with Dr. Nate Gross, co-founder of physician social networking site Doximity, and the two wondered how they could use the visor-like device in healthcare. "There are not a lot of instances in healthcare where you can't use your hands," Theodore says. "Surgery comes to mind immediately."
Theodore now occasionally pre-loads medical images into his Glass prior to surgery, then brings up the images in the heads-up viewer in order to compare CT and X-ray scans to actual surgical sites. "Effectively, you can have a real-time view of what you're trying to accomplish in the operating room," he says.
UCSF says Theodore is the first surgeon anywhere to receive clearance from a local institutional review board—essentially a medical ethics committee—to use Glass as an "auxiliary surgical tool" in the OR. He has used it for more than 30 patients to date. "It does work really well," Theodore says.
Still, the device does have its shortcomings. "The battery life sure is an issue," Theodore says. (At Beth Israel Deaconness, the four pairs the ED currently has are all fitted with external battery packs to extend usability.)
Theodore also says the verbal commands are rather rudimentary, though they work for what he needs Glass for. "It's not like you're going to type out your memoirs over Google Glass," he notes.
Orlando Portale, chief innovation officer at Palomar Health, a public health district in San Diego County, California, has found that it often can be difficult to give voice commands in noisy healthcare environments such as EDs. He also worries about privacy with Glass, specifically the Health Insurance Portability and Accountability Act (HIPAA) regulations that all U.S. healthcare providers must follow.
That has not prevented him from being bullish on Glass and other wearable computers; Portale expects to see similar products soon from companies such as Epson, Sony, Apple and even Facebook, which spent $2 billion in March to acquire Ocular VR, maker of a gaming headset.
Portale, who founded a company called Glassomics to give Palomar a vehicle for testing and commercializing healthcare apps for wearable devices, has identified six use cases: differential diagnosis; video streaming of patient encounters to EHR scribes; department-specific workflow, such as to help emergency departments triage patients; viewing of patient records and vital signs; video streaming of surgeries for education and remote consultation; and scanning of bar codes to manage medication administration.
Kyle Samani, co-founder and CEO of startup app developer Pristine, sells a secure video-conferencing app for Glass called EyeSight and another called CheckLists that delivers medical checklists to the point of care. (He says Pristine was the first company to generate revenue from healthcare Glass apps.) Since last fall, physicians at the University of California, Irvine, have been piloting EyeSight for remote consultations with anesthesiologists, as well as the CheckLists app for surgeries. Glass worn by nurses supplements the video feed from a fixed camera on a telemedicine cart, providing remote physicians with multiple angles, including a nurse's-eye view of a patient that other cameras can't offer.
In May, UC Irvine announced that it would become the first medical school anywhere to use Google Glass in its curriculum. When new students arrive in August, the school expects to have as many as 40 of the devices available for both classroom and clinical settings.
As of May, Pristine technology is in use in four hospitals: UC Irvine, the Brown University-affiliated Rhode Island Hospital, as well as facilities in the Dallas and Detroit areas that Samani is not ready to name. Pristine also has a deal with Wound Care Advantage, a company that manages hospital wound centers. Samani says the Detroit hospital is connecting caregivers in a nursing home to physicians in the hospital via Glass and EyeSight. "I didn't realize it would be big for nursing homes," he says.
Pristine plans to offer the technology for use in ambulances, Samani adds, and the company is also exploring whether pharmaceutical companies can use it to repair precision machinery in drug manufacturing plants.
For now, though, Glass remains a beta product, only available to a limited number U.S. residents, and with a hefty price tag of about $1,500. There is no scientific literature on the efficacy of Glass in healthcare, either. Theodore is getting ready to present data from his trials at a conference in Italy at the end of the summer.
Horng, too, is working on a study based on Beth Israel Deaconess moving information between Glass and the EHR, though he has no results to share yet, and he has bigger plans. He says he would like to see the Wearable Intelligence software incorporate artificial intelligence and machine learning, including predictive modeling and risk analysis, to help clinicians deliver better care.
However, he has one caveat for this slick technology. "It's all meaningless if you can't get the information to the bedside," Horng says.
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