July 21, 2014
Last July, Stephanie Shine waited an agonizing 18 hours before she could see and touch her baby for the first time. He was delivered three and a half months early, weighing one pound and two ounces, and kept in the newborn intensive-care unit (NICU) for 101 days.
Later that summer, when Shine donned Google Glass, she turned on video streaming to show her baby to relatives in other cities. She started to think how incredible the device would have been during her time of separation from him, as she recovered from the delivery. In those initial 18 hours, she could have at least seen her baby as he was held, fed, and nursed to a healthy weight.
As a practicing nurse at Brigham and Women’s Hospital in Boston, Shine is familiar with the mental and emotional stress of women separated from their babies for hours or sometimes days during the post-delivery process. Now, she wants to bring Google Glass to other mothers in this predicament.
Shine is one of many healthcare providers exploring how wearing Glass can improve quality, communication, and education in hospitals. There has been a rush of enthusiasm for the device’s potential applications in healthcare, with more than 240 people attending an event on the subject in Cambridge, Massachusetts in April. But just as it is in the consumer world, privacy is a big hurdle to Glass’s acceptance in the hospital. Medical professionals testing Glass are getting cautious support from hospital administration, but they say the technology of the device needs to catch up before it can reach its desired potential.
Glass has an array of features responsive to voice commands and head movements, useful if your hands are occupied with, say, surgery. But this very sophistication—which makes it easy to record video or take a picture without someone’s knowledge—has led to growing concern over privacy issues. Some of the curious double-takes the contraption received in its earlier days have turned to paranoia or ridicule, and certain venues have even banned the device.
Doctors experimenting with Glass are sensitive to possible violations of the Health Insurance Portability and Accountability Act (HIPAA), the privacy protocol for medicine. “It’s Google, which wants everything publicly available, and healthcare, which wants nothing publicly available,” said Alexandra Pelletier, manager of the FastTrack Innovation in Technology Program at Boston Children’s Hospital.
Karandeep Singh, a nephrologist at Brigham and Women’s Hospital, is waiting for Institutional Review Board (IRB) approval to research the device in an actual physician-patient setting. In the meantime, he has been engineering apps for the device, brainstorming use cases, and pinpointing holes in its system. Singh believes Glass can successfully improve clinical efficiency and physician-patient interaction if introduced in the right way. “In a medical setting, it will be perceived differently than in a public setting,” he said. “When you’re with a patient, that’s a different social contract. And if you’re viewing private patient information, what better way to display it to you than in a way that only you can see it?”
One of the functionalities Singh has engineered is for Glass to connect to patients’ electronic health records. Though designed to improve efficiency, clicking and scrolling on a computer leads a physician to spend a significant amount of time turned away from a patient. And some physicians find it hard to synthesize disparate pieces of data as they click through. “The big mistake many people make is that they assume that the Glass is replacing static desktop displays,” said Paul Lukowicz, a professor in computer science at the Technical University of Kaiserslautern in Germany who consults for the companyWearable Technologies. He sees great value in “precise cross referencing” that goes beyond the normal desktop interface.
With Glass, a doctor could see your last blood pressure reading without ever turning away from you, along with a data visualization of its fluctuations. Voice-to-text processing could mean the end of scribbling down incomplete notes.
In Singh’s application, which I was able to test with a dummy electronic health record, I could mimic doing all these things. “It took me three weeks to get a functional electronic health record app from programming it at home,” Singh said as he handed me his frames.
After I said, “Okay Glass” to get to the home screen of the device, I saw an array of options. “Show me patient vitals,” I said. The heart rate, breathing rate, and blood pressure readings arrived on screen: crude text, but instantaneous. I was still looking straight at Singh, but I could tilt my head slightly down to scroll down and see more details. If I wanted to, I could wink my right eye and take a picture.
But there are certain things the device can’t do, at least as it comes out of the box. Singh found that he couldn’t connect to Wi-Fi Protected Access II, a type of secure network connection many hospitals use. Key features like photo uploading and voice-to-text processing automatically go through Google cloud servers, since Glass has a limited usable memory of 12 GB. You also can’t disable the camera so that it doesn’t accidentally go off. Singh wants a cap to place over the device’s outer surface, both temporarily disabling the camera and indicating visually to an observer that no recording is occurring. Then doctors could remove the cap only when they truly need the camera—to scan a QR code by a patient’s bed, or track wound healing, for instance.
Google Glass spokesperson Chris Dale said that the company is “very focused on making Glass a consumer device.” Dale said that Google is currently not developing industry-specific software, and instead encouraging developers to work with existing hardware to address niche issues like hospital privacy. There is a growing body of startups rising to the occasion. The startupAugmedix sells software that allows doctors to use Glass to input and retrieve patient data securely to and from the electronic health record; it recently announced a deal with Dignity Health, a company that manages hospitals in 17 states. Another big player is Pristine, a company that markets itself as “the only HIPAA compliant telehealth and checklist solution for Glass.” Pristine currently offers two products for Glass: Eyesight, a video-based communication platform for telemedicine; and Checklists, a voice-controlled checklist app. To make these HIPAA compliant, Pristine must remove all Google services from the device, essentially wiping the software connection to Google. The catch is that if you wipe Glass like this, you’ll miss system updates that Google would normally automatically push to the device.
If privacy issues can be solved, some physicians think this new tool could be especially beneficial in the operating room. The innovation acceleration program at Boston Children’s Hospital is developing “Glass Surgeon,” an application that allows the device to improve and streamline the surgical experience. “Surgeons have to look up and away from the field of vision to see displays. Wearing Google Glass is like having a car and rearview mirror,” said Gajen Sunthara, principal software architect for the program.
I tried on Sunthara’s Glass, and verbally called up a mock radiology image. As I viewed it, a radiologist’s voice in my ear remotely briefed me on what I needed to know about it. I flicked my head up; the scan went away.
This is how Sunthara sees the device as most viable: not something that’s continuously on, but responsive when you need it before or during the operation. Glass’s battery, charged via USB, wouldn’t last through the hospital workday if you kept it on all the time and frequently used features like video recording. Pelletier said that it tends to heat up uncomfortably, sometimes resulting in a headache. And potential side effects of viewing a screen through your right eye for a prolonged period are unclear. Google’s FAQ page for Glassinstructs: “Don’t let children under 13 use Glass as it could harm developing vision.”
Another oft-cited quality issue is that the current Glass screen resolution is not considered clear enough for it to be reliable as a sole viewing point of clinical images or surgical streaming. (The resolution is equivalent to a 25-inch high definition screen viewed from 8 feet away.) Daniel Hashimoto, a general surgery resident at Massachusetts General Hospital (MGH), researched whether surgeons could discriminate differences in image quality when randomly shown videos recorded with Glass versus an iPhone 4S. The results, which he has submitted for journal publication and presented at amedical conference, show that the video from Glass was more often perceived as having poor reproduction of detail and poor resolution of depth.
Hashimoto isn’t wedded to the idea that a verbal and gesture-responsive technology needs to be wearable or head-mounted like Glass. For example, he found that “the camera angle of the Glass camera is not ideal for surgery, particularly open surgery.” If a surgeon’s head is not tilted fully downward, the camera may create a poor recording. You could correct this by angling your head, but Hashimoto said you start thinking: “Okay, do I have to keep operating like this? Because my neck hurts.” Rafael Grossman, a general surgeon at Eastern Maine Medical Center and a telemedicine advocate, performed a surgery with a live-stream through Glass, and didn’t have that problem—but it was a quick procedure, less than an hour.
Ergonomics aside, Hashimoto has found that patients are receptive to the device as long as its use is explained and they are asked for consent ahead of time. He thinks that it is paramount not to wear the device when initially approaching the patient.
There are no official numbers on how many people currently own the device;one estimate puts it at under 300,000. Currently, Glass bears a price tag of $1500. It was an invite-only purchase for designated “Glass Explorers” until this May, when it became open to anyone in the U.K. or U.S. over 18 years old. This high barrier to access for the average consumer means that there hasn’t been opportunity for universal etiquette surrounding Glass to organically form, though Google itself has published some tips. Arshya Vahabzadeh, a child psychiatrist at MGH, is enthusiastic about Glass but emphasized the need for strict usage rules in a hospital. “Some people don’t necessarily want to let it be known that they’re in our waiting room,” he said.
In studies that wearable technology expert Lukowicz conducted, he found that despite liking Glass’s efficiency, some physicians were concerned about seeming unprofessional. But he thinks that as with any new device, social acceptance will evolve quickly over time. Pelletier is confident that the Glass price tag will go down, partly because other players in the marketplace will challenge Google. “When it’s $200, and patients buy it, what then? I think there are a lot of ideas that we haven’t even touched the surface of because it’s $1500 today,” she said. Her department eagerly anticipates technical improvements to the device.
“We would love to deploy this—we’re waiting for Glass to catch up,” she said.
July 21, 2014