How doctors will use Google Glass

How doctors will use Google Glass

Google Glass will be like the Segway. It’s really cool but it will have only a few practical uses and won’t be a paradigm shifter. Segway never won widespread acceptance in a culture dominated by cars and Google Glass is unlikely to win over people who prefer to wear their smart phones on the waist instead of on their face.

Still, Google Glass may yet find some niche uses for people who need to use both of their upper extremities in their jobs . . like doctoring. But utilizing a glasses based computer to access medical references while treating patients is not going to go over well unless doctors learn to perform procedures and study at the same time. “Just hold this clamp in place across the aorta for five minutes while I brush up on my open heart surgery.” Yeah, that’s not going to happen.

Neither will point of view video capture be of much use. The video documentation of procedures or exams for the clinical record has not yet been proven to be worth the effort and a point of view  recording is likely to be inferior to that of a fixed camera.  And how will patients react to having a doctor that looks like a family friendly version of Locutus of Borg record video of them while asking detailed questions about their bowel movements?

No, rather the best chance for a super-medical-Google-Glass-app will be as a new and novel way to enter information into an electronic medical record (EMR). Data entry has always been an Achilles heel for EMRs. Keyboard entry is slower than phone dictation or even hand written notes and point and click EMRs can have significant deficiencies when it comes to the ability to enter clinical details.

Then there is the problem with the various devices used for data entry. Most mobile devices that can port EMRs such as laptops are cumbersome and intrusive to use in an exam room during a patient encounter. This can be mitigated – somewhat – by shrinking the EMR devices into tablets or smart phones but the trade offs are that data entry becomes more difficult without a full sized keyboard and smaller screens usually mean less data that can be displayed at any one time.

However, devices like the prototype Google Glass have the potential to display a full sized (virtual) screen of information for the clinician user to quickly reference while appearing not to deviate his or her attention from the patient. Data entry using Google Glass could come in the form of a point and click (or blink) structure or one combined with real time dictation at the point of care. Quite literally, the physician of the future would use eye movements to review a patient’s prior records and switch between data entry fields while dictating the relevant information into each field as the clinical encounter progresses.

Though this won’t happen unless and until data entry is perfected for Google Glass type devices. A physician attempting to review their patients’ recent CT scans on Google Glass can’t appear to be having a partial focal seizure or any semblance of confidence in the doctor wearing the funny glasses is going to be lost.

Chris Rangel is an internal medicine physician who blogs at RangelMD.com.

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  • Dr. Drake Ramoray

    Off topic a bit. Locutus of Borg is a good summary of the role of healthcare providers in medicine. Pay for Performance is on the way. ACA has passed…… Resistance is futile.

  • Guest

    Google glass uploads audio and video recordings of interactions to
    the internet, where they become the plaything of
    not-known-for-respecting-privacy megacorp Google. If any doctor who
    treats me wants to wear Google glass while doing so, I’m going to start
    raising HIPAA questions.

    • C.L.J. Murphy

      That’s a fair point.

    • MarylandMD

      It sure is a fair point. I have been shocked by the cavalier attitude I have seen on many blogs about privacy with Google Glass in medicine. ‘The doctors already write private stuff in the chart, what’s the difference?’ We have become brain-dead when it comes to privacy.

    • Original_Cait

      “Mrs. Jones, I’m just going to videotape this intimate exam and upload it to Google. I’m sure you don’t mind, do you?”

  • Physician Scientist

    They will use google glass like the gynecologist at Hopkins who committed suicde. Are you kidding? no physician will wear this to work.

    • Guest

      “no physician will wear this to work”

      and no patient will let him or her.

    • MarylandMD

      For those on whom the reference is lost, Google the name “Nikita Levy”.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Yes, having some squiggly medical record move around in your field of vision while you talk to patients and even do procedures, will do wonders for safety, quality and error rates….

    • MarylandMD

      “Doctor, are you listening to me or posting on Facebook?”

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Yeah… and the patient should have a pair too… then it will be truly an “encounter”.

        • MarylandMD

          “Let’s start a hangout on Google+!”

  • John Rodley

    Hey Chris – Segway is the wrong analogy. A better one would be desktop to laptop to cell phone. There are things you won’t do on each of those that you would do on another. And each is a massive market. None really displaced the other. You don’t have to believe one will disappear to think the other will succeed. As an example Glass app think of guided, remote diagnosis where a Glass is on a first responder streaming video to an ER doc at a hospital. Patients in an emergency don’t give a damn what headgear their provider is wearing, and if they’re getting the care of a real MD from the hands of an EMT in the bargain they might well be quite pleased. I know that EMR is a pain point and a structural fault in the system, but I think the streaming video is the real opportunity in Glass.

    • Guest

      “where a Glass is on a first responder streaming video”

      And when that video, which is not stored locally but on the world wide web, ends up on Youtube?

      • MarylandMD

        “Hey, Joe, check out what I saw on my shift last night!”

        • Disqus_37216b4O

          It might not even be a breach by the person who took the footage, it could be by any of the thousands of Google techs around the world who have access to that data. “Site Reliability Engineers (or SREs) have access to the company’s most sensitive data. Responsible for a variety of tasks including responding to technical difficulties across Google’s ever-expanding portfolio of products, SREs are given unfettered access to users’ accounts”. See: GCreep: Google Engineer Stalked Teens, Spied on Chats. These people will have access to all data collected via Google Glass as well.

    • MarylandMD

      Have you looked at the sales numbers of desktops vs. laptops vs. tablets vs. cell phones the last several years? Honestly, when you start out with statements like “none really displaced the other,” it makes it hard to take the rest of your argument seriously.

      The value of a first responder video link is being greatly oversold. If I was in an accident, what would make me “quite pleased” is for the EMT to stabilize me, get me into the ambulance, and drive my sorry butt to the ER ASAP so I can meet that “real MD” in person. Goofing around with Google Glass is mostly going to waste time and interfere with that primary goal. So I would give a damn, and I would ask the EMT to quit chatting with his glasses and get me to the ER on time.

      I am a physician and I have a lot of respect for the hard work EMTs do. Your implication that an EMT is a sorry substitute for “a real MD” smacks of snobbery and suggests you don’t understand how our EMS system works. But perhaps I misunderstood you…

      • John Rodley

        You didn’t misunderstand me, but you did insult me so I’ll return the favor. Your inability to envision a place for Glass in your industry smacks of the defeatism one often encounters among the otherwise intelligent and energetic people in healthcare. I will also note that “oversold” and “wrong” are not the same thing. When I started writing mobile apps in 1999, every day there were pundits telling us how “apps are all overhyped beceause people will never do X on a cell phone”. For just a short list, X could be:
        enter their credit card information
        take pictures
        interact with their bank
        browse the web
        and on, and on and on. We saw how that worked out. Now the same guys, and I count you among them, say the same thing about Glass because … (wait for it) … because everyone already carries a cell phone.

        It will be the same with Glass. If it improves outcomes, it will be adopted. Just because you can’t imagine ways that might happen doesn’t mean they don’t exist. And having seen the rest of the commentary I’ll add the observation that, while they may be expert in something, I don’t think anyone here knows the first thing about Glass. Giggling about uploading video to youtube pretty much marks you as a not-serious guy.

        • Guest

          “Giggling about uploading video to youtube pretty much marks you as a not-serious guy.”

          Google owns Glass. Google owns Youtube. You don’t get to keep any data you collect via Google Glass, it gets uploaded to Google servers. Google has a sucky reputation for respecting data privacy, for changing rules midstream, for selling user info to the highest bidder, plus Google Docs gets hacked, why not Google Glass data?

          I am a serious guy. Someone who falls for gizmos without bothering to consider the data security implications is not.

        • MarylandMD

          Ooooh, great straw man action there! So I think that first responder video uses for Google Glass are oversold, and in another thread indicate that I have seen many proposals for the device that are better done with other technologies, and therefore I am a defeatist. Well!

          I didn’t misunderstand you but it appears you sure misunderstood me.

          I was using a Palm Pilot for healthcare when everyone thought it was silly and I looked like a dork (and I probably did look like a dork, but I found it *very* useful). I was into apps before Apple invented the “App Store.” I guess you could say I was into apps before apps were cool. So I knew very well the value of combining my Palm with my cellphone and I very much looked forward to getting my hands on a good smartphone. My iPhone makes me a smarter and more efficient doctor, as I knew it would. I embrace the proper technology applied to the right task. But much of what I see right now doesn’t cut the mustard for a big need begging specifically for Google Glass, including first responder video.

          And I am *not* giggling about Google Glass videos popping up on YouTube. I’m scared. I think Google Glass will further drive a wedge between providers and patients, with the patients worried we will intentionally or inadvertently put something about them up on the web and forever change their lives. Goggle the name “Nikita Levy” and think about it for a while. I am very, very serious. But I have a sense of humor.

          And I don’t snark at EMTs.

        • May Wright

          “I don’t think anyone here knows the first thing about Glass.”

          You’re awfully condescending for someone who doesn’t appear to understand how data collected via Glass is transmitted, stored and accessed, and the HIPAA implications therein.

    • May Wright

      “As an example Glass app think of guided, remote diagnosis where a Glass
      is on a first responder streaming video to an ER doc at a hospital.”

      They won’t be streaming video to an ER doc at a hospital, they will be streaming data to Google servers via the Internet, and the ER doc will then log in and access it. If Glass streamed direct to the hospital with no middlemen, you might be all right. But it doesn’t.

      • MarylandMD

        Defeatist. ;)

  • MarylandMD

    Props to you, Dr Rangel!

    –A more sensible take on the whole “Google Glass in Medicine” theme. This new gadget has people falling all over each other to breathlessly propose uses for Google Glass that are all better done with a smartphone or some other, simpler technology. I have not seen such an explosion of silliness in a long time.
    –You actually consider how patients will respond when their doctor walks in sporting a video camera mounted on the front of their head.
    –Trying to think of some way to improve the human-EMR interface.

    But I really doubt Google Glass will help much with EMRs. Much of the market is fragmented, taken over by different proprietary programs, so getting access to the software in order to interface a new device with it, or getting the companies to adapt their software to Google Glass, will be unlikely if not impossible, at least in a short to medium time frame. But we can always hope.

  • Anthony D

    Looks like these glasses should be on Star Trek.

  • May Wright

    Google Glass data is not stored locally, but on the Internet Cloud, with control of all content belonging to the private corporation Google.

    HIPAA requires that you will:

    –Ensure secure tracking of stored data

    –Ensure secure disposal of used hard drives and other media

    –Ensure secure access to facilities

    –Ensure all employees with access to any data are trained in and
    abide by HIPAA privacy standards. Google engineers have complete access to user data and do look at it. See “Google worker fired for stalking teens via Gmail data”.

    Doctors cannot use Google Glass until/unless Google becomes HIPAA compliant, because your patient’s data is stored on their servers and on their terms, not yours. Google would need to follow all of the steps in the HIPAA Compliance checklist, and more. This is the same reason you cannot use Google Mail (Gmail) for patient data.

    • May Wright

      In case my “in moderation” link doesn’t make it, cut and paste this into your browser bar (removing the spaces):
      http: //luxsci. com/blog/gmail-not-hipaa-compliant-email .html

    • Nehemiah Spencer

      or perhaps the world can continue to improve

  • M.K. Caloundra

    “Or do what hospitals do with every other computer they use – put
    custom-made software on it that sends data where you want it to go,
    encrypted however you want it, over whatever network you choose.”

    Google Glass doesn’t work that way. Google wants your data. And your patients’. That’s how they earn a quid. Have a read of the Google Glass Terms of Sale (http:// www. google. com/glass/terms/ )

    “You acknowledge and agree that Google will determine and use your location, that photos
    and videos taken on your Device will be added to your Google+ Instant Upload album, and that your Device will display information sent to devices that are synced with it (such as text messages). Please refer to our Google Privacy Policy for more information on how Google collects, uses and shares the information we receive from you.”

    You are also not allowed to “install or enable any software or services on the Device through any means other than the MyGlass interface or otherwise authorized by Google, or make unauthorized alterations to the Glass software or Glass services”.

    Google wants your data — and your patients’. ALL YOUR DATA ARE BELONG TO US. This is a HIPAA nightmare.

    • John Rodley

      Which is why, at their own conference Google IO 2013, Google itself hosted sessions titled, if I remember correctly, “Hacking Glass” which showed in great detail how to, among other things, load Ubuntu on the device. Sessions given by top Google engineers. Google is covering its ass with the TOS and people are giving in to fear of the unknown and reading what they want to believe into it. Violate the TOS and you void your warranty. Yup, nightmare.

      • Disqus_37216b4O

        If Google says “all your data are belong to us”, we cannot do anything but believe them. Using Google Glass to videotape patient interactions and then claiming “But we didn’t believe Google was SERIOUS with their (lack of HIPAA-compliant) privacy policy” is not going to fly.

  • Nehemiah Spencer

    decent ideas here. Keep the thinking going.

  • http://ClinicalPosters.com/ ClinicalPosters

    Google Glass has camera and video capabilities. Patients should take their leave as soon as the nurse asks them to disrobe before the doctor enters wearing Google Glass.