Perils and Pitfalls of Adopting Bleeding-Edge Technology in the ED

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“Wearable technology” has become a part of daily life for millions of individuals. Who can remember the last time they navigated a typical day without encountering someone wearing a Fitbit®, an Apple Watch, a bluetooth headset, or some other high-tech device masquerading as jewelry? These devices provide enhanced connections to mobile phones, email, the internet, and even the human body.

The impact of this integrated technology on health and wellness is being debated even while these advances make inroads in the field of healthcare. Investigation continues on whether there is a practical and beneficial use for such devices in medicine.

Google Glass is one device that has caught the eye of many providers. Glass is a wearable device consisting of a frame, such as those used for eyeglasses, combined with a small heads-up display (HUD). Computer processing and wireless communication circuitry are built into the frame, allowing for constant connectivity. While similar devices exist, none have achieved the level of mainstream attention afforded to Glass. Physicians took notice and have explored its use in orthopedic surgery, general surgery, pediatric surgery, and emergency medicine.1-4 The utility of this technology has also been explored in medical education, pharmacy, and laboratory medicine. 5-7

Google Glass seems to have great potential. The possibilities are many, including critical updates pushed to a provider’s HUD in real-time, remote procedural guidance and evaluation, remote evaluation of patient interactions, automatic algorithm reminders during codes — and the list continues.

Lesson 1. Ensure society is ready to accept use of the new technology.

Wearers of Glass in public quickly came under fire, largely due to misconceptions about when the device was recording video. Users were ejected from restaurants and even assaulted.8,9 We braced, knowing that – if approved for use in the clinical arena – our patients would be even more skeptical of the technology.

Lesson 2. Confirm that your hospital IT department has the necessary infrastructure to support the technology.

Glass, and any other devices requiring an “always on” wireless connection, rely on either a cellular connection or Wi-Fi. With spotty cellular coverage in many large hospital buildings, Wi-Fi may be the only option. Make sure your IT department can provide a way to connect your chosen device. In our case, Glass had no option for connecting to a public Wi-Fi network (such as the one provided for patient use), and connection to a secure network was not an option (see Lesson #3).

Lesson 3. Utilize technology that is HIPAA compliant.

The built-in apps in Google Glass, including the video chat functionality that was key to our study, use Google servers for data processing. While our study did not collect any HIPAA protected data, this would be an obstacle to overcome prior to deployment in any clinical environment. IT departments may be reluctant to allow non-hospital-supported devices (ie, not Apple or Android smartphones) to access their secure networks.

Lesson 4. Determine whether the company that manufactures your device will continue to support the hardware (and software).

Midway through preparing for data collection in the study, Google discontinued the video chat software functionality in the Glass unit, remotely removing it during a firmware update. This would have completely derailed the study if we had not been able to restore the functionality by transferring old firmware to the device (not an easy task, unless you’re an IT professional). In addition, Google stopped selling Glass in January 2015, taking the project in-house with no announced availability to the public and only rumored availability to businesses.1 This left us exploring a technology with a questionable future.

Lesson 5. Account for unexpected delays.

The unexpected removal of the video chat functionality delayed our study while we attempted to restore the application to the Glass unit. Unexpected difficulty obtaining permission to use standardized patient models further delayed the project. If you are a resident hoping to complete a new study in 3-4 years, make sure you develop a contingency plan for handing off the project to another resident if it cannot be completed before you graduate.

Lesson 6. Know when to throw in the towel.

Ultimately, we had to abandon our study. The unknown future of the Google Glass technology was the final straw. We could no longer continue to invest time in a grand vision that relied on technology that may or may not be supported in the future.

Firsthand Experience

After pitching the idea to my residency program director and department chair at The Ohio State University, we secured a Google Glass unit through the Google Glass Explorer Program.

That was the easy part. The rest of my experience translating an IRB-approved concept into reality resulted in several lessons that I hope will serve as both a guide and a cautionary tale to practitioners seeking to investigate the utility of similar technology in the future.

I continue to hope that adoption of cutting-edge technology advances the quality of care we provide for our patients and the education we provide to residents. In no way do I want to discourage those with a shared interest in pushing the technological envelope. Most important, I hope the lessons we learned from our experience will allow for smoother and more successful approaches to applying new technology in clinical settings.

Acknowledgements
Special thanks to The Ohio State University Department of Emergency Medicine, Diane Gorgas, MD, Thomas Terndrup, MD, FACEP, Ashish Panchal, MD, PhD, Creagh Boulger, MD, FACEP, and David Bahner, MD, FACEP. Without their support, the undertaking of this project would not have been possible.

References

  1. Comstock J. Rhode island hospital ER begins google glass dermatology study. MobiHealthNews Web site. http://mobihealthnews.com/30855/rhode-island- Updated 2014.
  2. Ford G. IU faculty member first in Indiana to use google glass in surgery. INScope Web site. http://inscope.iu.edu/headlines/2014-02- 27-headline- google-glass.shtml. Updated 2014.
  3. Muensterer OJ, Lacher M, Zoeller C, Bronstein M, Kubler J. Google glass in pediatric surgery: An exploratory study. Int J Surg (London, England). 2014.
  4. Ohio State University Wexner Medical Center. Imagine seeing a surgery live through the eyes of the surgeon. http://medicalcenter.osu.edu/mediaroom/features/Pages/Google-Glass.aspx. Updated 2014.
  5. Feng S, Caire R, Cortazar B, Turan M, Wong A, Ozcan A. Immunochromatographic diagnostic test analysis using google glass. ACS Nano. 2014;8(3):3069-3079.
  6. Fox BI, Felkey BG. Potential uses of google glass in the pharmacy. Hospital Pharmacy. 2013;48(9):783-784.
  7. Russell PM, Mallin M, Youngquist ST, Cotton J, Aboul-Hosn N, Dawson M. First “glass” education: Telementored cardiac ultrasonography using Google Glass- a pilot study. Acad Emerg Med. 2014;21(11):1297-1299.
  8. Murphy D. Seattle restaurant boots Google Glass-wearing patron. PC Mag website. http://www.pcmag.com/article2/0,2817,2427804,00.asp. Updated 2016.
  9. Vazquez J. Woman wearing Google Glass says she was attacked in San Francisco bar. http://sanfrancisco.cbslocal.com/2014/02/25/woman-wearing-google-glass-says-she-was-attacked-in-san-francisco-bar/. Updated 2014.
Philip Kray, MD

Philip Kray, MD

Emergency Medicine Resident, The Ohio State University, Columbus, OH
Philip Kray, MD

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