Interventionalists See Google Glass as the Next Frontier After Practical Issues Remedied
“Ok, Glass. Activate STEMI.”
This simple command has the potential to become commonplace in a few short years, according to Jordan G. Safirstein, MD, of Morristown Medical Center (Morristown, NJ). What he is referring to, of course, is Google Glass, the latest in wearable devices developed by the Silicon Valley monolith Google (Mountain View, CA), and an idea for an app that could change the face of interventional cardiology.
“You can imagine an EMT wearing Glass and visualizing the EKG without using his hands,” he explained. “He can transmit an EKG to the [hospital] and have a STEMI team waiting before the patient even has an IV in his hand. We could potentially improve door-to-balloon times with that.”
As a member of Google’s healthcare advisory board, Dr. Safirstein was invited to try out Glass as part of their ‘Explorer Program.’ He told TCTMD in a telephone interview that he uses it to create instructional videos from a first-person account and offer remote consultation, as well as film his two sons while skiing.
The device itself is a sleek metal band that rests on the user’s ears like a pair of glasses or can alternatively be built into prescription frames. It is essentially an all-in-one wearable computer, camera, monitor, and battery that uses the Google platform to surf the Internet, share content, and send and receive messages. Explorers initially paid $1,500 for the voice-activated device and had to be invited, but the latest iteration is available to the public for the same price.
‘Telementoring’ on the Horizon
A recent paper published in the Journal of the American College of Cardiology in March 2014 and a subsequent session at the Society for Cardiovascular Angiography and Interventions (SCAI) meeting in May 2014 on the device’s use in the cath lab have begun to stir up conversation about its potential to optimize patient care and increase physician efficiency.
The paper, which described a successful example of ‘telementoring,’ or video conferencing, via Glass on a patent foramen ovale closure case “demonstrated proof of concept,” said Christian Assad, MD, of the University of Arkansas for Medical Sciences (Little Rock, AR), who also presented at the SCAI session. “If somebody is stuck with a procedure that he's not very comfortable performing [and an expert] is far away,” Glass might be the solution, he told TCTMD in a telephone interview.
Unfortunately, Dr. Assad said, Google disabled the video conferencing functionality shortly after the completion of the case described in the paper because “they were concerned that [it] was not ready yet to be used.”
Keeping Out Prying Eyes
For the time being, this exercise of caution might be for the best, argued Juan F. Granada, MD, of the CRF Skirball Research Center (Orangeburg, NY). He told TCTMD in a telephone interview that he has used Glass to test and demonstrate experimental technologies using video conferencing and was concerned with the privacy of that content.
“There is important sensitive information that you don't want to share, especially when you are in the area of innovation,” he said. “Imagine that people use their Google Glass to share products, ideas, inventions with their peers and [the information] gets somewhere in the Google cloud.... I think it's a global concern.”
Without “very clear algorithms for data protection, I really think the potential of the technology will be limited,” he continued.
Likewise, Arthur L. Caplan, PhD, of NYU Langone Medical Center (New York, NY), addressed the issue of patient privacy, noting that it raises ethical questions such as: “Do you tell the patient what you're doing?” and “Does the patient have the right to view it?”
One way to address the issue, he told TCTMD in a telephone interview, would be to “set guidelines about who can see what and with whose permission.” Since Glass might inadvertently capture other people on camera, he continued, “I think you need their permission, too. So we may need to extend the blanket consent and [post a warning] near where you are going to operate Google Glass saying that cameras or other video streaming technologies are in use.”
Although a high proportion of patients are excited about their physicians utilizing the latest technologies, Dr. Caplan continued, “We have to bring the public and our patients with us as we bring our privacy consent [policies] and our notifications up to date… so that they don't get angry.”
Physician privacy is also an issue, Dr. Caplan said, with regard to how “discoverable or subpoenable” the content created or shared on Glass might be in a malpractice suit. “I don't think people are thinking about that,” he noted.
Not Losing Sight of HIPAA
In addition to general privacy problems, compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a growing concern for physicians who use Glass in their practice, Dr. Safirstein said.
“You're not allowed to videotape or take pictures of patients and there's no way to make sure that I’m not doing that if I'm wearing Glass,” he observed. “So, HIPAA is probably the biggest limitation to [Glass] being used in the healthcare setting.
“That said, I think that if you ask most patients, they would be happy,” Dr. Safirstein commented, adding that he has received consent from more than 50 patients since he began using the device “and not a single one has even balked at the idea.”
Third-party companies are currently testing out apps that would render Google Glass HIPAA compliant. One such company, Pristine, markets a stripped-down version of Glass with their proprietary software: EyeSight, designed for teleconferencing, and CheckLists, which allows physicians to customize specialty-specific task lists. Also, Droiders has created profession-specific apps for Glass, deemed “Glassware,” that can be adapted for medical use. Lastly, Augmedix uses Glass to transfer information to electronic health records.
Broadening the Scope of Use
Given the “limited platform” and poor camera definition of the current Glass model, Dr. Granada said he would like to see Google “separate the functions of the Glass according to the most promising applications…. For professional applications, I would put more emphasis on the resolution of the camera, the resolution of the audio, and actually simplify the [device]. I don't want to have web and a whole bunch of functions that are useful for kids but less useful for professional use.”
Dr. Assad likened Glass to a smartphone. “If you don't have the useful applications downloaded and installed, it's not that great of a thing,” he said, adding that the real utility comes when “you start downloading applications, which suit your daily life, entertainment, or learning.”
Going forward, he continued, the technology will evolve as the medical community tests out the device and brainstorms potential uses that can address current insufficiencies and “be used in the curriculum of tomorrow.” Additionally, development will depend on how quickly laws and regulations can be modified to incorporate new technologies into daily practice. “Once this happens,” he said, “the next big and most valuable step will be the incorporation of wearable technologies like this… with electronic medical records.”
Facial recognition technology has been steadily advancing, Dr. Assad commented, and there is potential for its use in conjunction with Google Glass. He envisaged: “Imagine a scenario where you walk in the clinic… and [Glass] automatically [pulls information on] the patient you're speaking with. You can see what was done last time and quickly get the information in front of you about what's going on, the reason why the patient is there, and if the patient already has some wearable technology of his own, which could be monitoring his heart rate, telemetry, EKG, or any other vital signs.”
There is the potential for resource augmentation and telementoring for clinics in Third World countries lacking specialists, Dr. Safirstein noted, adding that interventional cardiologists might also benefit from imaging-specific apps that would allow both old and new FFR and IVUS results to display in the operator’s field of vision and not on a separate screen.
Foreseeing Awkward Interactions
For now though, many of these predictions are just that, as Google Glass will have to overcome several practical issues before becoming mainstream. First, Dr. Granada said, the device requires a robust Wi-Fi connection in order to operate well, and the confines of a leaded cath lab restrict connectivity. Additionally, the proximity of Glass’ screen to the user’s eye can cause dizziness, he said, and “it takes you a few hours and a few uses to actually get used to it.”
Dr. Caplan also pointed to the longstanding issue of sufficient face-to-face interaction between doctor and patient. “We already had that problem… long before Google Glass,” he said. “A lot of patients complain that their doctor's head is in the computer.” A solution, he suggests, might be to emphasize a set amount of doctor-patient interaction at the beginning of each consultation before the physician utilizes any type of technology or wearable device.
“Now, having said that,” he continued, “the younger generation [of patients] won't care about it as much as we do…. The culture will shift. It won't seem as offensive to the next generation.”
- Drs. Assad, Caplan, Granada, and Safirstein report no relevant conflicts of interest.