Changing the vision of medicine
How will Google Glass change healthcare?
Google Glass is a wearable computing device in the form of a pair of eyeglasses with a camera, microphone, and a small screen built into the right lens. The wearer can command the device by voice—by saying “OK Google.” This means it can be used hands free as well as by using a touch pad on the arm. The device has a wide and expanding range of applications. These include live video streaming, taking photos, making phone calls, and searching for information online. Different applications allow uses such as navigation, language translation, and email. A major selling point is that it is hands free, which Google says allows you to “be more active, explore your world, and live lighter.” This article looks at how Google Glass is being used by medical students and doctors around the world.
Researchers trialling Google Glass in paediatric surgery found it a useful way to take photos and videos, make phone calls, and carry out internet searches, all hands free. Oliver Muensterer, a paediatric surgeon at Children’s Hospital at Montefiore, United States, led the study. The hands free option is a huge bonus for surgeons, he said, because “workflow remains virtually uninterrupted, which is particularly important when performing surgery on sick children who may not tolerate prolonged anaesthesia well.” Muensterer said the ability to document important findings while surgery is in progress is particularly useful in paediatric surgery where there are a variety of rare operations to inform future practice.
Google Glass also allows surgeons to hold a web conference with other healthcare professionals so they can give feedback during procedures. Iltifat Husain, founder and editor in chief of iMedicalApps.com, gave an example of paramedics using the technology in an ambulance while transporting a patient to hospital. He said the paramedic could start up the video application and stream it to the emergency department or relevant doctor. “You can talk to a physician with the microphone built into the frame, and then get real time feedback with the built-in headphone. The EMS [emergency medical services] provider can do all of this hands free while getting IV [intravenous] access and pushing life saving medications.”
Virtual medical education
Medical schools are already exploring how to make best use of the technology. In May, the University of California Irvine School of Medicine said it planned to incorporate Google Glass into its curriculum.
Warren Wiechmann, assistant clinical professor of emergency medicine and associate dean of instructional technologies, explained that students would benefit from the ability to view “an unprecedented first person perspective.” He added that being able to track what students are doing in exercises would also be helpful for their teachers. “Conversely, when students are wearing Glass, faculty members can see exactly what a student sees and thus better guide a dissection or simulation exercise,” he said.
The technology can also show medical students what it is like to be on the other side of the consultation, if patients are asked to wear the device. Wiechmann believes that this use enables students to “experience patient care from the patients’ perspective, and learn from that information to become more empathic and engaging physicians.” Stanford University School of Medicine has used the technology to demonstrate how to conduct examinations of patients. Abraham Verghese, a professor of medicine at Stanford, created a video that demonstrated a simple examination of the hand. The video’s sensory and visual components allow students an insight into good communication skills and the art of the bedside manner, as well as basic examination technique.
One medical school in the United Kingdom is experimenting with how Glass can be used to teach globally. In May, Shafi Ahmed, associate dean at Queen Mary University of London, Barts and The London School of Medicine and Dentistry filmed a surgical procedure to remove cancerous tissue from the liver and bowel of a 78 year old man using Google Glass and broadcast it live over the internet. He advertised the broadcast on social media 18 hours before the event. More than 14 000 people from 132 countries tuned in to view the procedure. Viewers were able to submit questions online and have them answered by Ahmed, as he performed the surgery. Ahmed said, “I wanted to see whether we could create a truly global teaching session, [to see] how many countries and participants we could include, particularly from remote places in Africa and Asia, and also to gauge the level of interest and to determine whether the hardware and software were robust enough to deliver this level of exposure.”
This form of telementoring from a surgeon’s eye view could be particularly valuable to students, who often have limited opportunities to observe surgery when on a clinical attachment. This use of the device could allow the democratisation of medical education and make better use of time for traditional medical students. Ahmed said, “It represents a paradigm shift in teaching in the operating theatre. I think it is no longer acceptable to have students spending a whole day in theatre with little or no teaching and the session being of poor education value.”
Medical education online using Google Glass
Questions remain over Google Glass’s ability to store confidential patient information safely. Google’s marketing materials emphasise its ability to share what you are doing with others. Although this is fine for social and educational purposes, it raises concerns for patient confidentiality and privacy of healthcare records. Technology companies including Google have attracted suspicion about how secure their users’ records, broadcasts, and emails actually are, and about the companies’ willingness to allow access to individuals’ data by governments and security services. As a recent court filing by Google attests, people sending email to any of Google’s 425 million Gmail users have no “reasonable expectation” that their communications are confidential. Ethical concerns about the technology must be dealt with before it can be used as a matter of course in patient care and question marks over security are a large barrier. The authors of the exploratory study into the uses of Google Glass in paediatric surgery also raise further concerns that the data on live broadcasts are by default streamed over a potentially unsecured Google server. The ease with which you can command the device to take a photo or video could mean recordings are made without the patient’s consent.
So do privacy concerns outweigh potential gains in efficiency? Users of the device say that it will give clinicians quicker access to patient records at the point of care. Rafael J Grossman, general and trauma surgeon at the Eastern Maine Medical Center and Google Glass explorer, said, “Imagine a doctor accessing patient’s images, medical history, tests, and laboratory results or any EMR [electronic medical record] data, all of these without leaving the patient’s presence, or turning away from them to look at the computer screen. Not just obtaining data but uploading it, with verbal commands, right to their charts, in real time.” Younger users such as medical students, more comfortable with sharing of their own information via social media, may have fewer concerns about privacy. Jeremy Chui, a third year medical student at the University of Sheffield and UI/UX (user interface/user experience) developer, said, “If anything, I feel that patients should feel more comfortable with doctors wearing Glass, as doctors would be less likely to be negligent, knowing that all interactions are recorded.”
Taking hands free phone calls can distract the attention of drivers. Could the same thing happen to surgeons? The authors of the paediatric surgery study raised this as a potential hazard: “This could be particularly relevant if a surgeon is distracted by accepting a call during a complex or critical portion of a procedure.” Other technical improvements that the researchers identify as necessary include longer battery life, inbuilt LED flash, and a more in depth medical dictionary. But for some of these practical concerns, healthcare professionals have the opportunity to develop their own apps for Glass. However, Google did not design this technology solely with healthcare in mind. It is primarily a consumer product. Muensterer says that the manufacturers and designers need to listen to the medical community and make adaptations, if they want it to make a true impact in healthcare. “The most important changes would be a hinged camera that can look downward at an angle to allow the surgeon’s typical working region of interest to be captured, the inclusion of a zoom function, a flash, and better audio quality,” he said.
Google Glass promises much for surgery, emergency care and medical education. So would you pay the £1000 (€1260; $1600) it now costs in the UK to buy your own device? And how would you use it?
Tom Lewis, foundation year one doctor at Kingston Hospital, London and writer for iMedicalApps.com, said, “I would use it, but only in certain circumstances and with the patient’s consent. Examples would include recording operative procedures or developing clinical skills videos. I think there is a lot to be gained from using Google Glass, but first we need to understand how to make best use of wearable technology.”
Matthew Katz, a radiation oncologist, is more cautious. Medical use of new technology should start with identified clinical problems, he said. ‘‘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,’’ he said. Google Glass is in its early days. When smart phones were first introduced, few would have predicted how quickly they would become an essential tool. The next few years will demonstrate whether this wearable technology joins—or even replaces—the ubiquitous tools of today.Yu Han Ong, fourth year medical student
1University of Aberdeen
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
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- Muensterer OJ, Lacher M, Zoeller C, Bronstein M, Kubler J. Google Glass in pediatric surgery: an exploratory study. Int J Surg 2014;12:281-9.
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Cite this as: Student BMJ 2014;22:g5580