July 1, 2014

Google Glass in the Operating Room

In May, I wrote about the possible uses of the new wearable computer -- Google Glass -- for people with Parkinson's. Now – as reported in a recent New York Times blog post – the technology is entering the hospital operating room (OR).  It was inevitable.

A refresher: Google Glass is “smart eyewear” that provides voice-activated access to the internet and to any saved files. It also has a camera that can record or stream video. The wearer sees whatever he requests floating on a small screen projected on the lens above his right eye.

Many Potential Uses
Of course, there are many new ways that OR surgeons might use the new technology.

Info availibility.  Doctors and nurses can immediately access important info, like surgical checklists, patients’ vital signs, lab results, X-rays, CT scans, etc.

Video archive.  Doctors can record and archive operations on the video camera. If questions arise later, the doctor can consult the video to see exactly what happened.

Support from specialists during procedures.  Surgeons can live-stream operations so specialists anywhere in the world can observe and offer recommendations as the procedure takes place.

Training opportunities.  Doctors can use the video camera as a training device.  Said Dr. Selene Parekh, an orthopedic surgeon at Duke Medical Center: 
In India, foot and ankle surgery is about 40 years behind where we are in the U.S. So to be able to use Glass to broadcast this and have orthopedic surgeons around the world watch and learn from expert surgeons in the U.S. would be tremendous.

Focus on the patient:  Surgeons don’t need to turn away from patients to get information during delicate procedures. Dr. Pierre Theodore, a cardiothoracic surgeon at the University of California, San Francisco, uses the device to float X-rays and CT scans onto the small screen while he’s in the OR. He said:
In surgery, Google Glass is incredibly illuminating. It helps you pinpoint what you’re looking for, so you don’t have to shift your attention away from the operation to look at a monitor somewhere else.
He describes wearing Glass in the OR a “game changer."

Hands-free sterility.  With infection an ever-present danger in hospitals – especially in ORs – hand-held devices introduce risks to the operating arena. The hands-free character of Glass maintains sterility in the OR.

Automation to the next degree.  Already, ORs are remarkably automated. Surgeons have been using camera-guided instruments, robotics, and 3D navigation systems for years. Google Glass simply adds new technology for doctors and nurses in the OR.

Critics Speak Up
As one might expect, many people have expressed serious concerns about using Google Glass in the OR. Some bars and restaurants have already banned the devices from their premises for privacy reasons. Legislators, concerned about the device’s capacity for distraction, have proposed restricting drivers from wearing Glass behind the wheel. It’s no wonder that Glass-in-the-OR has vocal critics, too.

Dr. Oliver J. Muensterer, a pediatric surgeon who has studied the use of Google Glass in medicine, said:
I’m sure we’re going to use this in medicine. Not the current version, but a version in the future that is specially made for health care with all the privacy, hardware and software issues worked out.

Privacy.  Perhaps the greatest concern is patient privacy. Dr. Muensterer has used Glass in the OR, but is vigilant to keep the device disconnected from the internet most of the time. He worries that patient information might be accidentally uploaded to the cloud. He said, “Once it’s on the cloud, you don’t know who has access to it.”

Dr. Matthew S. Katz is medical director of radiation oncology at Lowell General Hospital in Massachusetts, and also serves as an outside advisor to the Mayo Clinic Center for Social Media. He’s afraid he might inadvertently stream confidential patient information online. As a result, he doesn’t allow Glass in his OR:
From an ethical standpoint, the bar is higher for use in a medical setting. As a doctor, I have to make sure that what I’m doing is safe and secure for my patients — ‘First, do no harm.’ Until I am, I don’t want it in my practice.

Hospitals experimenting with Glass in the OR report being careful to obtain patients’ consent beforehand, to use encrypted software for security, and to comply with all federal regulations under the 1996 legislation known as "Hippa" -- the Health Insurance Portability and Accountability Act -- designed to protect patients’ privacy.

Pristine is a software development company in Texas that's eager to cash in on the new trend. Its designers are creating a customized version of Glass to sell directly to hospitals. Their product replaces Google's software with its own Hipaa-compliant programs.

Video drawbacks.  The video feature would seem to offer huge potential in the OR. But when Dr. Muensterer tested Glass for four weeks, he found two problems. First, filming quickly drained the battery. Second, the camera – mounted to shoot straight ahead – didn’t always record what he was actually looking at, especially when he was hunched over a patient, with his eyes looking down.

Distractions.  Glass will bring voice-activated information – patient CT scans, etc. – into the surgeon's field of vision. Here's the rub, critics say: she can also call up her email and surf the web, which takes “multi-tasking” into a new kind of life-and-death danger zone. Dr. Peter J. Papadakos at the University of Rochester Medical Center has published articles on electronic distractions in medicine. He wrote:
Being able to see your laparoscopic images when you’re operating face to face instead of looking across the room at a projection screen is just mind-bogglingly fantastic. But the downside is you don’t want that same surgeon interacting with social media while he’s operating.

Tunnel vision.  Pilots who wear head-mounted units that display key flight information sometimes miss what really happening outside. Dr. Caroline G. L. Cao studies image-guided surgery at Wright State University. She said, “Pilots can get so focused on aligning the icons that help them land the plane that they miss another plane that is crossing the runway.”

Similar issues have occurred for Glass-wearing doctors in the OR. Studies have shown that displays surgeons use to locate tumors, for instance, induce a kind of tunnel vision -- or “perceptual blindness” -- that increases the likelihood they’ll completely miss problems in surrounding tissue.

The New Apps Race is ON
Here’s just one interesting example of a new and useful application for Google Glass: Dr. Paul P. Szotek, a Level 1 trauma surgeon at Indiana University Health, is developing an app for Glass for use by paramedics, which he calls “1st Sight.” The app would stream video images – and sounds – from the accident scene directly to the nearest trauma centers or ORs. Surgeons there could see in advance what’s coming their way. 

The doctors could also provide important – possibly life-saving -- information directly back to the EMTs based on what they’ve seen and heard. Said Szotek:
Last year, I lost a lady on the table from a spleen injury that was absolutely survivable because she was taken to a local hospital and then the delay was over two hours to get her to me. With this wearable technology, we’ll be able to assess patients on the scene and decrease the mortality associated with trauma significantly.

Szotek met with Google reps in March to discuss his software. With other Glass-using doctors, he founded the International Society for Wearable Technology in Healthcare. In July, they’ll hold their first meeting in Indianapolis.

Watch this space for developments from that session.

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In February, NIH's PubMed website published the results of the first peer-reviewed study on the use of Google Glass in clinical medicine. Here's the summary abstract: 

Google Glass in pediatric surgery: an exploratory study.

Personal portable information technology is advancing at a breathtaking speed. Google has recently introduced Glass, a device that is worn like conventional glasses, but that combines a computerized central processing unit, touchpad, display screen, high-definition camera, microphone, bone-conduction transducer, and wireless connectivity. We have obtained a Glass device through Google's Explorer program and have tested its applicability in our daily pediatric surgical practice and in relevant experimental settings.

Glass was worn daily for 4 consecutive weeks in a University Children's Hospital. A daily log was kept, and activities with a potential applicability were identified. Performance of Glass was evaluated for such activities. In-vitro experiments were conducted where further testing was indicated.

Wearing Glass throughout the day for the study interval was well tolerated. Colleagues, staff, families and patients overwhelmingly had a positive response to Glass. Useful applications for Glass were hands-free photo/videodocumentation, making hands-free telephone calls, looking up billing codes, and internet searches for unfamiliar medical terms or syndromes. Drawbacks encountered with the current equipment were low battery endurance, data protection issues, poor overall audio quality, as well as long transmission latency combined with interruptions and cut-offs during internet videoconferencing.

Glass has the some clear utility in the clinical setting. However, before it can be recommended universally for physicians and surgeons, substantial improvements to the hardware are required, issues of data protection must be solved, and specialized medical applications (apps) need to be developed.

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