Google Glass for medicine: 4 reasons why it could be disastrous

Google Glass for medicine: 4 reasons why it could be disastrous

The buzz is that Google Glass will transform medicine.  But unless it’s carefully vetted it could be a disaster for patients, clinicians and hospitals.  Until the FDA or research confirms its safety, Google Glass is banned from my clinic as a privacy and medical practice hazard.

Here are four reasons why:

1.  Privacy violations. Google Glass make it extremely easy to take pictures or video of someone without permission.  Congress has already raised concerns about Google’s unwillingness to ensure privacy protection for non-users in the general public.   The bar should be higher in medicine than the general public.  The venture capital crew thinks it’s great to let doctors wear it into the operating room.  That should require a patient release at a minimum, but how do patients know whether they’re being recorded or not?

2.  Hackable. Even if used responsibly by clinicians, that doesn’t mean patients and medical practices aren’t at risk of privacy violations and abuse.  Computers can be hacked; remote access software can allow someone to film/photograph without the users’ knowledge.  This kind of violation recently happened to Miss Teen America, resulting in attempted extortion for photos taken of her in her bedroom.

A recent report confirms security flaws already make Glass hackable.  Whether I wear my über-geek lenses to review medical records or examine patients, my medical practice could be at risk of extortion for possible privacy breaches.

3.  Safety concerns with multitasking. Privacy concerns aside, the promise of be able to do more in medicine doesn’t mean we do it better.  There have been recent concerns about “distracted doctors” with too much technology to focus on the task at hand.  To make it worse, doctors may think multitasking improves performance when it actually worsens it.  Some of the decreased performance may lessen with experience, but that means potential distractions like Google Glass may require some formal training before routine use in clinic.

4.  Google’s And medicine’s goals aren’t aligned. Don’t be evil” sounds like it might fit with medicine.  But increasingly Google seems to apply this stated credo to its customers rather than itself.

Despite Larry’ Page’s denial, it appears Google knew and received payment to enable the NSA’s PRISM program.  The company also recently admitted that Gmail users shouldn’t expect privacy from internal surveillance.  The company is now trying to reveal what the U.S. government required for access, but transparency hasn’t been Google’s strong suit.

Responsiveness to its customers has been a longstanding issue.  Historically customer service has been automated, you couldn’t get a human being to discuss technical problems.  It has improved, but Chris Boyer recently outlined problems with Google Maps for patients trying to find doctor offices or hospitals.

If problems come up with Glass in medical care, they need to be identified and addressed quickly.  I’m just not sure that Google is interested or able to adapt this device effectively to patient care.

Looking ahead

Google Glass may have potential, but for now I think the risks outweigh the benefits.     My sense is that the tail is wagging the dog; people are trying to find medical applications for cool technology.  To me it makes more sense to identify a clinically relevant problem and then look at what tools may provide a practical solution.  Maybe Glass will be that solution for some problems in the future, but I will wait until It’s worth adding yet another medical device into my medical practice.

Matthew Katz is a radiation oncologist. He blogs for ASCO Connection and can be found on Twitter @subatomicdoc and Google+.

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  • HappyHealth.me

    #5 should be that if Glass doesn’t practically interface with a medical professional’s practice workflows. Cool technology is great to muse about, but if it doesn’t provide truly valuable solutions that fit well within established workflows, it will never be adopted for the long-term.

    • azmd

      Although as we have all seen with EMR adoption, it would appear that it is frivolous to expect that technology should fit within our workflow as opposed to us all adapting our workflow to accommodate some ultra-cool technology…

    • subatomicdoc

      Excellent point. I don’t find that workflow is better with EMRs necessarily. As a doctor, I don’t need more information, there’s already overload. I need better information design for practical use.

  • Fries

    First, you are correct – Google glass will not transform medicine, period. Even smartphones didn’t make a dent in clinics and glass is simply an iteration of mobile computing.

    Second, your points apply to practically any information technology – phones, computers, etc. How many screens do we already have in medical situations? There must be at least a dozen screens in any modern operating room, double that for laparoscopic procedures, at least half a dozen in any patient room, etc. not to mention at least one beeper and one phone per clinician. All devices are hackable, all have privacy concerns, and please let me know when you find a company whose values align with those of patient care.

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

      Well, yes, but there is a difference.
      Google is not in the medical business, not in the search business, not in the email business, not in the cartography business, not in any other business, except advertising. Google makes money by using technology to acquire as much private information as possible to increase advertising revenue.
      With this context in mind, I question their “transformative” effect on anything.

      • MarylandMD

        This type of analysis is bordering on silly. You could say GM isn’t in the car-making business, or the car parts business, or the auto loan business, or any other business except the money-making business. To me, that degree of oversimplification doesn’t seem to move the conversation forward.

        Google is very much in the search business. And in the email business. And in the map business. But those businesses are all front ends for their advertising business. By offering free maps for navigation, they have transformed (or at least significantly changed) the GPS business. If you don’t think so, you may want to have a chat with Garmin. Google’s algorithms most definitely transformed search. I remember the days before Google came online, and I would not want to go back.

        So I don’t know how you define “transformative”, but the way I see it, Google has had a lead in transforming many aspects of how I use technology. AND they made buckets of money off advertising at the same time.

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

          Everybody is in the money making business. GM does not give you cars and loans for free though, in order to collect information about your driving habits, or to collect toll fees from highway owners or a percentage of gas sales from Shell. For GM you are the customer and the user of whatever they make. For Google you are the product.

          The reason this is important here, is because having any semblance of privacy while using a Google product is by definition impossible.

          • Jane Galt

            “having any semblance of privacy while using a Google product is by definition impossible.”

            BINGO.

    • subatomicdoc

      I agree, Glass is a variation on the mobile theme. I’m in a high technology area, radiation oncology. And I think in my field and medicine in general we too often lean on screens and imaging studies instead of listening to take a decent history and do a physical. Technology is a tool, not a panacea. I want the right tools available, not a cluttered toolbox. As for the privacy issue, please take a look at my response to Aldon and Lucien about the different risk issue with wearable technology vs. a handheld device. Thanks again for your comments!

    • Jane Galt

      But if you take out your smartphone and aim it at me while you’re examining me or getting ready to put me under where I know you’re going to have me laid out naked and vulnerable, I’m gonna object to that, especially knowing that you’re streaming the data your collecting to an insecure internet server.

  • BudgetDoc.com

    I think at some point in the future, glass or a similar technology will find its way into the healthcare world, but more as a convenience or novelty than as something truly revolutionary.

    I also think the technology needs to be around a bit longer to work out all the kinks it may have.

  • http://www.orient-lodge.com ahynes1

    Here is the comment I left on Matt’s Facebook page:

    As a person who has been using Google Glass for the past three months in a health care setting, I believe you have become a technophobe.

    Privacy Violations: The same issue applies to cellphones. Are you going to ban them from your practice?

    Hackable: Personal computers are hackable as well. Ban them? (I worked with security for a Swiss bank two decades ago when they said they’d never connect to the Internet because of security issues. There are risks with all technology, just like everything else in life. You can’t ban life, instead, you need to mediate risks)

    Concern with multitasking: This is probably the strongest point, which also seems pretty weak, based on my experience with Google Glass. Yet the interruptions I get from Google Glass, wearing it all the time, is similar to the interruptions I get from phone calls, overhead pages, and other staff members knocking on my door.

    Google’s And medicine’s goals aren’t aligned: Again, on the surface, this seems like a valid point. However, from my experience dealing with pharmaceutical companies, medical device manufactures, and insurance companies, I suspect that Google’s goals may be more closely aligned with medicine’s goals than most companies working in health care.

    • subatomicdoc

      Hi Aldon: Thanks so much for taking time to respond. Keep in mind I don’t have Google Glass and haven’t had a chance to tinker with it. I’m sure from a curiosity standpoint I’d love it…for home use.

      Regarding the privacy issue, you’re right. Cell phones are a potential risk and have been identified as inappropriate use (for example in the middle of surgery). A key difference is with Glass a doctor is aiming the camera at patients or HIPAA-protected information by simply looking. A cellphone camera requires aiming, and it’s usually in my pocket, not between me and a patient. Hackability sounds wacky, but it’s possible and needs to be considered from a risk management standpoint.

      I do think the multitasking issue can be managed through education but I don’t need another distraction. If it can be structured to eliminate phone calls, pages or knocking distractions that would be worthwhile.

      The main point isn’t specific to Google, it’s to any company. In my opinion, the first two criteria should be meeting a certain health need and ensuring safety. First, do no harm. Maybe Google does fit that mold better, but then it should be comfortable going through the same regulatory processes that other medical device manufacturers do. Once Glass can pass, I’ll take a look :)

    • MarylandMD

      I see this over and over in forums discussing Google Glass in medicine. Someone criticizes Google Glass and gets called a name such as “technophobe”. Or “defeatist.” Wow. Advocate for the right technology for the job, or raise privacy concerns, and you are branded a Luddite.

      We jump on bandwagons way too often in medicine. Like the PSA, for example. Physicians asking that we go slow with the implementation of any new aspect of practice should be complimented, not treated as traitors.

      • http://www.orient-lodge.com ahynes1

        MarylandMD – You are missing important context. Matt started his post on Facebook saying “Am I just turning into a technophobe?” If he had not used that phrase, I certainly wouldn’t have used it, especially about Matt who strikes me as being, in most cases, very far from a ‘technophobe’.

        • MarylandMD

          Thank you for providing the context. That is the hazard of cross-posting–you lose context.

          Dr Katz wouldn’t have gotten far in radiation oncology if he was even remotely a technophobe–it is one of the most technology-heavy specialties in all of medicine!

  • subatomicdoc

    Thanks for commenting, Lucien. I am glad to hear that you also want a more secure service. I would say the following in response:
    1. Too late on smartphones, but most of the time they are in your pocket, not pointing a camera continuously at the patient or health information.
    2. I think many clinicians argue that technology is currently designed for billing, not patient care. I don’t agree but I do think that making privacy technology breaches easy is detrimental to patients and clinicians.
    3. I’m not sure which screens you’re referencing. But I’m citing data suggesting that the multitasking isn’t efficient or more effective.
    4. It’s not specific to Glass but to the attempt to retrofit technology to purposes it wasn’t designed for. That’s great if it is a good fit, but with the potential risks I think Google needs to make a medically oriented version of Glass that meets certain required specifications. I’m not smart enough to tell you what those specs might be though :)

  • subatomicdoc

    Thanks Kevin for your comments. I don’t know enough about the techniques and hacking required to get a trojan on Glass, but the issue is that in a medical clinic it will be focused directly on patients or their records for long periods of the day. I do know that even a server breach of a medical group’s server can be very costly. From a practice management standpoint, why would I wear something that might mean increasing my liability risks unless there’s a real value?

    Interesting on the hackable device issue. I’ve heard many in the epatient community advocate for hacking devices. But I hadn’t thought about the potential for harm. At least in my area of medicine it’s not relevant but other clinicians may want to comment.

    Thanks for the link to The Verge. I had seen some of the early reports of outrage and as a Gmail guy it did annoy me. But this piece is reassuring.

    • Jane Galt

      ” From a practice management standpoint, why would I wear something that
      might mean increasing my liability risks unless there’s a real value?”

      Exactly. If you’re going to be videotaping all of your interactions with me, including when I’m unconscious on the operating table, I demand copies of everything.

      From reading some doctor and nurse blogs where they giggle about all the ways they goof around with unconscious patients, and the jokes they make about their anatomy and such, that sounds like a thousand lawsuits waiting to happen. One nurse blog I read, they called everyone in to laugh at one woman’s labia. If that’s the way you all treat your patients, I don’t know that you really want your patients to have hard evidence of that.

  • EHRworkflow

    “Google Glass is banned from my clinic as a privacy and medical practice hazard.”

    Amazing how physician- or provider-centric this conversation is, not that it’s any different from most conversation about Glass in healthcare. I suspect you’ll also ban Glass-wearing patients (though I could be wrong) and I think that’s unfortunate. Glass may or may not improve healthcare workflow (I believe it will, but that’s not my point here), but it won’t “transform” anything unless patients wear Glass.

    Even if you don’t.

    Chuck

    • MarylandMD

      Patients wearing Google Glass in a hospital or a physician’s office would be even more of a privacy concern than physicians wearing Google Glass! If a physician allows patients to wear Google Glass in the office, I would not go there for care. I would go further to say that if a business did not ban Google Glass, then I would be less likely to shop (or eat or whatever) there.

      It isn’t the responsibility of a doctor’s office or a hospital to provide an environment conducive to “transformation” by Google Glass. It IS the responsibility of a doctor’s office to protect patient confidentiality. So we will protect your privacy. Even if you don’t.

      • EHRworkflow

        To me “ban” means no use whatsoever. If I wish to use Glass to document my care, in the privacy of the exam room or her office, and I am forbidden, I will find another physician.

        Don’t throw the baby out with the bathwater.

        • MarylandMD

          You would have to ask me, the physician, for permission to record me first! And I probably would not give it, except perhaps in very limited circumstances. You are welcome to take notes, though. Ever heard of pencil and paper? Again, we have a demand to make room for a technology when there really isn’t a need and there already are perfectly good solutions.

          Here’s a question: Do you currently record your visits with your smartphone? If not, why do you suddenly insist once you have your Google Glass? This seems to be a recurring theme: people insisting on a “need” for Google Glass because they have this nifty toy, not because they really have a true need.

      • guest

        “It isn’t the responsibility of a doctor’s office or a hospital to provide an environment conducive to “transformation” by Google Glass.”

        Very well put. Couldn’t have said it better. Seems like a lot of technology is made that one wonders what the real benefits are. It seems like doctors/ healthcare is here to advance industry whether Medical Devices or Pharmaceuticals. a great example are the me too drugs. I’m afraid with enough political power Google can get past these privacy concerns and even make a new law to fit their new device. Always under the guise of how helpful this new advanced technology is.

    • subatomicdoc

      I see both sides of your and Maryland MD’s comments. There’s nothing wrong with empowering patients with technology. But in what context will Google Glass do that in an office visit?

      I can see the value of having a visual output device being really useful for patient education while they’re in the waiting room before they meet with me. I see the value in being able to pull up images to review that are relevant to that person’s care. None of that requires a wearable device, an iPad or tablet would be fine.

      If it’s for documentation, that is the purpose of Meaningful Use implementation. Hospitals and physicians complying with Meaningful Use will give you much of the information you’d like. There are ways to balance between pen and paper and Google Glass but that is based upon the relationship between each patient and doctor.

  • lucienengelen

    would like to add Garners Hype Cycle to this, it will take a while. Like i said I see Glass now where the iPhone was in 2007. and we know where we are right now based on that launch back then.

    • azmd

      Right. So our teenagers are glued to their iPhones 11 hours a day, engaged in vacuous entertainment hyped as “transformative” activities like posting pictures on Instagram, and doing “multitasking” which has been scientifically proven to reduce the operating efficiency of the human brain.

      The problem with most of these technologies is that they are a huge time suck, away from other, more productive activities that humans could be more healthfully engaged in. We all spend much more time sitting at computers now, which has been proven to be metabolically bad for us. The response? Some geniuses coming up with “exercise apps.”

      Pardon me for my skepticism, but although I believe that technology can be a useful tool, too often it is poorly designed and we became its slaves rather than its masters.

      • https://www.facebook.com/arobert6 Alice Robertson

        LOL It’s true, but it’s here to stay. I homeschooled so I would control phone usage (where else, online at the cellphone site), and password protected the computer. But the buggers grew up and got jobs, and their own phones (complete with Track My Walk apps or whatever exercise apps are out there. The NIH uploaded their apps recently…that was almost scary). Newsweek did such a good article about MRI’s and addiction to technology and what it’s doing to kid’s (and our own) brains. Tina Brown was pretty hard hitting. It was a great editorial that completely agrees with you. WIRED magazine did a response that shared historical panic over phones and TV, etc. The Atlantic did the reporting on why social media makes us more lonely and again WIRED jumped on it. WIRED has a youthful staff…Newsweek an older staff…and I surmise WIRED was using…what else…their cell phones and probably some medicinal Mary Jane:)

        • azmd

          I find the whole situation very alarming when I think about my own children, and their futures, and how they may be controlled by technology, rather than the other way around.

          And pieces like this just typify the problem. Mindless flag-waving over the latest “cool” technology and how we should find applications to use it, since it’s just so cool. As opposed to developing a technology in order to meet an identified need.

          I see this all the time in my workplace, where we have adopted EPIC which in so many ways has a user-unfriendly interface, and yet, when clinicians make suggestions about how the system could be modified to meet a bona fide clinical need we invariably hear “But a PROGRAMMER would need to do that!” As though the suggestion that the technology be used to make our jobs easier is just so, so outrageous.

          I didn’t use to be a Luddite but I am rapidly turning into one…

          • MarylandMD

            azmd, I, too, am a victim of the EMR called Epic. You have my deepest sympathies. But I have to say, calling Epic “user-unfriendly” is being way too kind. Epic’s UI is “user-hostile.”

          • azmd

            Well, I have been diligently schooled to have a good attitude about EMR so I try to use less inflammatory language. But yes, I very much resent the fact that the primary goal of EPIC appears to be to control and monitor our workflow, as opposed to facilitating it and helping us to be more efficient.

            And I am deeply, deeply tired of meeting with IT types who dismiss all input with the comment that “it’s a user problem.” The arrogance is really quite breathtaking.

  • subatomicdoc

    I do see the advantage of Glass allowing me to face the patient while accessing information; some exam rooms are designed poorly and require that I turn away which is annoying to both patients and me.

    And in a trauma setting I can see where traveling light with equipment could make Glass very valuable to give a hospital lead time to know what resources will be needed when a trauma patient lands, and those in the field access to key data or medical records. I work in cancer care, where I see less applicability. I do hope Google (and other medical device companies) do pay attention because in some cases these new technologies may be a great help. We just need to determine where it’s worthwhile and how to pay for it.

    • Jane Galt

      “And in a trauma setting I can see where traveling light with equipment
      could make Glass very valuable to give a hospital lead time to know what
      resources will be needed when a trauma patient lands, and those in the
      field access to key data or medical records.”

      And it’ll be TOTES AWESOME when the video you’ve just taken without your patient’s permission ends up going viral on the Youtubes.

  • subatomicdoc

    Therein lies part of the problem. If Glass isn’t even in ALPHA, why are surgeons bringing it into the OR? It’s become so easy to bring portable technology that healthcare isn’t prepared for how to deal with it. I’m sure it will take a while to get into mainstream use, but the latency/lag time will be much less than Xerox or smartphones.

    I’m glad my post has stimulated conversation because I don’t know the right answer. But if we start preparing for it in advance, then we can avoid potential pitfalls that may turn off eventual adoption of helpful wearable computing medical devices.

    • http://www.orient-lodge.com ahynes1

      I think your reply brings up an interesting issue. At what point should surgeons be on the cutting edge (no pun intended)? When should they do research about new developments, either in medical technology, or even in commercial technology?

      This seems like more of an ethics question than a technology question. When should IRBs be involved? When should the FDA be involved? As technology, and culture starts changing more rapidly, are our institutions, like prepared for the change? If not, what needs to change in our institutions?

      • subatomicdoc

        Agreed. I’m not against Google Glass, but it does boil down to an ethical question not specific to the product. I suspect most folks in healthcare are usually busy enough that these technologies creep in before we’re aware of it, then have to figure out how to cope with it rather than being prepared. Hopefully that can change. I have an idea about how to develop criteria but that’s another post and a fair amount of time thinking about it.

        • http://www.orient-lodge.com ahynes1

          I look forward to your subsequent post. I think this discussion is beneficial in exploring some of the ethical issues around new technologies and we need much more discussions like this.

  • http://www.myheartsisters.org/ Carolyn Thomas

    Thanks so much for this, Dr. K. As you correctly point out, this may well be a case of “the tail wagging the dog” and “trying to find medical applications for cool technology.”

    When I spent some time in Silicon Valley last fall (while at Stanford’s Medicine X conference), I had the same uneasy niggly feeling about the many, many tech startup hypemeisters I met there. I’m now seeing the same hype among those who are busy high-fiving each other over the Next Big Thing, which is, of course, Google Glass in medicine. As one sage noted during MedX (about the excitement there around bigger and better information-gathering capacity):

    “Why do we think self-tracking technology like health apps will work when mirrors and bathroom scales have so far failed?”

    I’d love to have us all take a small step backwards and pose this question, not about the whizbang promise embraced by some doctors who are wearing Glass but about the poor schmuck seated (or lying) across from the wearer: What will this actually be like for THE PATIENT in a health care environment already known for a disturbing pre-Glass lack of skills like good communication, common courtesy, and even basic eye contact? As Dr. Ted Eytan responded to me recently in this blog post – http://ethicalnag.org/2013/08/15/google-glass/

    “I think I/we should listen to what the patient thinks is good communication for them – it’s their health and health care, not the physician’s.”

    • guest

      A relief to read your post. I live close to Stanford and feel like a fish out of water at these types of Conferences. I think to a large degree they like playing with their toys but are out of tune with the practice of medicine.

      • MarylandMD

        Many that I have seen posting about Google Glass are non-physicians (or MDs who are heavily embedded in the IT industry and are not really providing patient care–I guess I could call them non-physicians, too) who don’t know jack about the practice of medicine. Many are young and healthy, and thus don’t know jack about being a patient as well!

        One of the reasons that almost none of the EMR offerings have a good user interface is that they are designed by non-physicians, bought by non-physicians, and implemented largely by non-physicians. We don’t need to repeat this mistake with Google Glass.

        • https://www.facebook.com/arobert6 Alice Robertson

          Could that be because you are a paid agent by your patients and they want control? Or that doctors and hospitals kept information from patients to the point we have movements like Gimme Me My Damn Data because doctors harbored not just their private notes, but necessary data.

          I like the story a doctor shared here that he is paying his colleagues and he distrusts them so much he turns his cell phone on to tape his visits with them. If he is paying for a service he felt entitled to all the information shared at that service.

        • http://www.orient-lodge.com ahynes1

          As a technologist who wears Google Glass working at a Federally Qualified Health Center, I think you’ve just made a very good point why I believe physicians need to work with Glass. Unless they do, how Google Glass is used, similar to how EMRs are designed, will be determined by non-physicians.

          • MarylandMD

            Mr Hynes, I have no problem with doctors playing around with Google Glass in the privacy of their homes or other non-patient-care locations. Like you say, they should be encouraged, as they should be encouraged to play around with all sorts of technologies. But before they bring any new technology into the office, I feel they must identify a clear need, and work out all the technical and privacy issues that Dr Katz has delineated.

          • http://www.orient-lodge.com ahynes1

            As a person working to bring innovation to health care, especially the patient relationship in primary care, I mostly agree with you. However, too often people make categorical comments like banning a technology, instead of saying that a clear case needs to be presented for it and seeking discourse about what the pros and cons of a new technology would be and then doing proper risk analysis.

          • MarylandMD

            Fair enough, Mr Hynes, but I feel that the huge privacy implications (especially given Google’s distinct lack of concern about privacy) warrants a total ban in the patient-care environment until the issues are sorted out. Google and Facebook are working hard to keep the slope away from protecting privacy as steep and slippery as possible. Every day they are trying to whittle away at us, as less privacy = greater profits for them. We must be very firm in cases like this, so total ban for now.

            I am a big technology nerd, so, believe me, it gives me no joy to say that. But as big a fan as I am of technology, I am an even bigger fan of privacy. Also, I am a physician, and protecting my patients’ privacy is part of my job.

          • Jane Galt

            Thank you MarylandMD. I am no Luddite, but I do not trust random medical providers to film their encounters with me, including intimate exams and questions-answer sessions, and entrust them to Google’s keeping.

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

            I don’t know that I understand how Google Glass is proposed to be used in primary care. Since you just mentioned that you are working on that, could you please expand on what you do with the thing?

        • guest

          That’s what I have seen too. These IT people are in their own world and as you say don’t have a clue about medicine or pts. But i am afraid with enough political power Google can insert itself into the practice of medicine just like IT companies do with EHR. Private industry know that healthcare is a gold mine for them so would not be surprised if google finds a way.

  • MarylandMD

    Great points, Dr Katz, especially the one about the tail wagging the dog. True visionaries focus on visualizing the future, then trying to map out how we get there. Similarly, truly inventive people find a clear need and then determine (or develop) the tools or technology that fit that need. So many of the breathless posts about the future of Google Glass don’t seem to spend any time trying to figure out why portable cameras and/or portable computers have failed to meet the user’s (in this case, doctors) needs well enough to be implemented yet. Very small, inexpensive and portable cameras have been around for quite a while, yet they haven’t made significant inroads into medicine. Why not? Maybe there isn’t the need?

  • guest

    It seems to me that the more doctors are already multitasking-EMR’s, filling out mindless forms, less time with pts, they actually have much less time to ponder about more complicated cases where they need to think about the Differential Diagnosis. it seems to clear to me that industry is shaping medicine. Not the other way around.

  • EmilyAnon

    If google glass is used in recording a patient encounter, does the recorded content then enter the patient’s medical record? If so, I gather the patient will have legal access to the data as with their other medical records.

  • subatomicdoc

    EHRWorkflow/Charles Webster brought up on Twitter that Glass is more [privacy] regulation-friendly than traditional computers smartphones” and cites this:

    http://histalkmobile.com/glass-3-fda-hipaa/

    I know that I don’t fully understand all of how Android complies with HIPAA. And maybe CIOs know how to make Glass work in a hospital health IT infrastructure.

    But who said that’s how it’s being used? Or that doctors, nurses, or others are educated enough to use it like the CIO would?

    Another point made in the post says that first-person medical cameras are a “non-issue”. Two problems.

    First, false argument that because hospitals get patients to sign waivers that new technologies automatically assume that the rules haven’t changed. It’s a disruptive technology, so why wouldn’t it also possibly disrupt the policies and procedures in place?

    Second, show me the data. Patients are entitled to their own data. I’m entitled to data showing that this technology is safe for my patients. Let Google do the studies to prove it, and I’ll consider adopting.

    Also, new reports again suggest there may be problems with Android, whether CIOs understand it or not. Android accounts for 79% of mobile malware targeting:

    http://bits.blogs.nytimes.com/2013/08/28/u-s-government-issues-warning-about-security-on-android-phones/?_r=0

    Apple iOS is 0.7% of mobile malware.

    If we want the best the IT can provide, then we should expect better data supporting Glass. The absence of problems (yet) for an alluring medical device isn’t the same thing as proof of security.

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

      Two simple questions:
      1) Where is all the data captured by Google Glass stored?
      2) Does permission to treat include permission to videotape visits and examinations, all of which may be used for “health care operations” according to HIPAA?
      Calling Dr. Webster: please jump in if you read this… :-)

      • Jane Galt

        All data captured by Google Glass is stored by Google on Google-owned servers that many unvetted Google employees and contractors have access to.

        • EHRworkflow

          Simply not true. See:

          https://twitter.com/wareFLO/status/380014159686934528

          https://twitter.com/wareFLO/status/379413370669391873

          Flame on!

          I’m sure this comment (was gonna wait ’til comments hit 100, but they’ve appear to have slowed) will get lots of thumbs down. But most of this convo is classic hysteria driven by misinformation and premature jumping to conclusions.

          Google Glass is in alpha testing, not *even* beta testing. It’s like critics piling on a movie they haven’t even seen. The final product, if it even gets that far, will likely be different and address many concerns, both valid and hysterical. That’s the point of an alpha.

          Don asbestos suit… fire at will. :)

          –Chuck

  • buzzkillerjsmith

    5. Goofiness. Wearing one of those things is about as cool as wearing a beanie with a propeller.

    • MarylandMD

      Or “truck nuts” on your pickup.

      • buzzkillerjsmith

        Your comment is beyond the limits of good taste. Well done.

        • EmilyAnon

          Oh my God, I had to do an image search for that. I’m shocked. I thought doctors were, you know, like serious. Well, OK, it would be a funny gift for someone. Wonder where you buy them?

          • buzzkillerjsmith

            You can buy them in rural area. We have a fair number around these “parts.”

  • eddy

    . . . and watching porn can really mess things up–

  • Martha Deed

    Thank you very much for this timely message, Dr. Katz. In a June 24, 2013 story and video, the Bangor Daily News told and showed a surgeon using Google Glass for the first time ever in an OR. Almost immediately, the surgeon (and others) removed their masks in order to enhance production values, and other hygiene compromises appeared to be taken as well. I was horrified, as were others. We contacted the chief medical officer at the hospital. Result: the video (which had already gone viral) was removed from many websites. But the story still exists.

    And who knows whether the safety and privacy issues have been addressed since the hospital and surgeon aren’t talking. But I certainly hope those issues are being addressed.

    My own take — as a psychologist who is a fairly early adapter of many of these technologies — I’m not certain if the device is the problem as much as the ego of those who want fame for using it.

    • subatomicdoc

      Thank you for sharing this story, Martha. I agree it’s not the tools but the people using them that are usually the problem. However, ideally the tools are designed to minimize the risk of harm. We’ll see what happens!

  • drneelesh

    Its just a tool.

    I am sure it can be put to a multitude of good, productive uses; and of course evil things too are possible from it.

    The “policy” of using Google glasses is good, and presence of criminal elements who try to benefit by breaking laws cannot be an excuse to stop using it.
    The potential of Google glasses actually improving healthcare delivery is enormous and cannot be ignored.

    • MarylandMD

      drneelesh, I have read a lot of posts on a lot of websites regarding the use of Google Glass in healthcare. Nothing I have seen even remotely approximates an ‘enormous potential to actually improve healthcare delivery.’ I haven’t seen anything that even comes close. So maybe you should flesh out a bit more that grand claim you made.

      I agree this little toy for nerds with a bit of money can find a place as one of many tools used in healthcare. But even if it has a lot of potential, Dr Katz and others have identified a number of areas of significant concern. What’s wrong with addressing those concerns first, instead of moving too quickly and blindly to implement this tool?

      • drneelesh

        This is a data capture point. I cannot prophesize what we may find, but we can be sure that we will create new Knowledge as we start dissecting all the video captured.

        • MarylandMD

          We have had very small, portable video cameras that you can clip to your pocket (or head or other places) for years. Why would Google Glass have such “enormous” potential when existing tools haven’t?

          Further, “dissecting video” is not a very efficient process. Who is going to watch all those videos? If I have a choice between reading an article on a topic or watching a video about the same subject, I will chose the article hands down. I find video very slow and inefficient medium, and very difficult to scan. We already have plenty of information in health care. The problem is making sense of it all. Adding a dump of a bunch of videos to the mix is no help, and seems more of a distraction at this point.

          • Improveoutcomes

            MarylandMD: I understand your concerns with the unproven nature of Google Glass in medicine. I have a hard time understanding why you wouldn’t want patients to be able to view video from the visit (assuming both parties are on board with the process). Studies have shown that patients forget or misunderstand over 50% of what they hear in a visit. A recent Consumer Reports survey found that patients’ biggest complaint is “unclear communication”. A pencil and a notepad has not been shown to significantly change this. Technologies now exist that currently allow providers to capture and share actual video/audio from the visit in a HIPAA-compliant way. Providers concerned about liability/exposure from the sharing of this content might want to rethink what they’re telling patients. Malpractice attorneys have said that more documentation is better and video documentation can remove the he said/she said aspect of many disputes. Patients that have providers “banning” them from having a recording of their encounter may want to find a new provider. Patient-centeredness and healthcare consumerism is here to stay and that’s a good thing.

          • MarylandMD

            “A pencil and notepad has not been shown to significantly change this.” Do you have a study on this you would like to share? Honestly, I find it hard to believe. In another thread, I said I wouldn’t give permission to record **except in limited circumstances.** If a patient wants to record the part where I explain what the treatment is and how to take the medication I am prescribing and those things, I am fine with it. For the patient’s sake, I think recording the entire visit is a waste and will just give the patient tons of data that they won’t review later–it would take too long! But get this: I have been practicing for over 15 years, and I have NEVER had anyone ask to record any part of any visit. We have had cheap, small dictation recorders for decades, yet patients aren’t using them. Why do we expect a $1500+ nerd toy is going to be used by patients when they haven’t bothered with the little tape recorders?

            The real question is, if pencil and paper don’t help, why would we expect recordings would? Do we have studies to show that giving patients a video of the encounter will improve adherence and long-term outcomes?

            It seems we are getting Google Glass advocates trying to demand room for the technology in the medical environment under the guise of promoting “healthcare consumerism” and “patient-centered care”, without having a shred of data to prove that it actually advances those goals.

          • Improveoutcomes

            While I absolutely agree that expensive nerd toys like Google Glass are not the answer, the fact remains that unclear communication is a patient’s biggest complaint and a patient’s ability to remember/comprehend what they hear is still a huge problem. You suggest that patients could use a pencil/pad and you contend that no patients have asked to record a visit or used a cheap recording device in your 15 years. Some contend that it should be the doctor/teacher’s responsibility to make sure the information is comprehended and understood and not the other way around. I’d agree that recording and sharing the entire visit is definitely not the answer, but having a provider record and share key instructions so patients and potentially caregivers can revisit the visit is a step in the right direction. A recent study looking at impact of discharge instructions plus video: http://www.ncbi.nlm.nih.gov/pubmed/23714763

          • MarylandMD

            That study does **not** have patients recording their visits with portable cameras or Google Glass!

            This is from the Methods section of the paper you cite:
            “The standard written discharge instructions used in our pediatric ED were reviewed, and a video script was written to include key points. Videos were designed to present information comparable to the information found in the written instructions. The goals developing the video discharge instructions were to make the instructions simple, clear, and concise and to focus on the key points regarding diagnosis, management, and follow-up. Methods of effective teaching, including audio and visual aids and repetition of key points, were used when making the videos.”

            I am sure a semi-professionally made video that concisely summarizes standard discharge instructions from an ED could be helpful. This is a very, very far cry from the jiggly amateur video recording of an entire primary care visit without any editing or even chapters. So your paper doesn’t prove anything in this discussion of Google Glass in the exam room.

            You can try to put all the responsibility on me to be absolutely sure everything is perfectly understood, but I see communication as a 2-way street, and I see the patient having a significant share of the burden of communication–for example, asking questions if things aren’t clear. Taking notes has been shown to help retention in general, so I encourage patients to take them. We give handouts and specific instructions at the end of every visit. But if you are asking me to record, edit, and provide in some format (DVD? thumb drive? email?) a video of the visit, then I am sorry. Primary care barely makes a profit, and we will not add to our overhead by also doing video production in addition to providing care.

            Don’t get me wrong–I am happy to help with communication with patients. I am sure we all can do better, and I am open to exploring alternatives to the standard patient education techniques we use. But that is a discussion for another article (how about if you write it–KevinMD doesn’t seem too picky in what is published). Here you are coming in on a thread which is talking about a specific question: should Google Glass be allowed in the exam room? I still say no, except in perhaps in very limited circumstances. Nothing you have said indicates Google Glass will be much if any help in patient education or improve adherence. Or do you have another paper that more directly relates to this question?

  • Jane Galt

    Hey, if you all trust Google so much, upload naked pics of your wife, mom and/or daughters at their most vulnerable to Google’s allegedly “secure” (cough, cough) cloud servers. And cross your fingers it doesn’t end up going viral on Youtube!

    But if YOU are not willing to trust the tech geeks who have access to ALL google data with YOUR loved ones’ privacy and dignity, don’t you dare ask me to trust them with MINE.

    FACT:> I will not be giving any medical personnel permission to videotape their interactions with me and hand it over to Google, friend of the Obama administration and owner of Youtube (and employer of sociopaths who have ALREADY been sprung accessing young girls’ google-stored chat and mail data in order to stalk them).

    My local bar & gill has a sign up banning Google Glass. It’s telling that they “get” peoples’ desire for privacy (and distrust of Google/Government) more than most of you doctors do.

    • https://www.facebook.com/arobert6 Alice Robertson

      Well that means we still think we have some privacy left. Naked pics of their wives? Hmmm…..ya’ know there has to be a market for that and most women don’t fit the bill! Ha! Oh teasing, but your point is well taken, yet the debate about privacy is being lost. Have you visited the UK recently? The underground network that literally follows you like a google satellite is both annoying, reassuring, scary and brilliant. It helps them solve crimes, people like it….they gladly trade privacy for crime solving…and so it is with medical…we will give up privacy if it helps us (that’s the stickler).

      The government is fighting google over their gmail data. The government? Big Brother themselves! The same government that wants our medical data.

  • subatomicdoc

    Thanks everyone for taking time to comment. A controversial topic which hopefully we’ll come to a reasonable sense of how best to use this technology effectively and safely.