Why I think that Google Glass is Not a failure

The interaction between medical providers and patients has been really compromised over the last few years.

According to Dr. Eric Topol ( as in his new book The Patient Will See You Now ),  in the US, the average return visit to the doctors office lasts seven minutes and a new consultation twelve minutes”.  Administrative requirements, reimbursement rules, government regulations and the inadequate use of technology, are among the factors to blame for this decline in the quality of medical care, at least in respect to the HUMAN quality of healthcare.

We have allowed technology to sequester what it meant to be a doctor, a healer-person connecting with the one seeking our help, our advice, our touch; a direct eye-to-eye link that could comfort and bring relief just by the mere act of taking the time to do it.

The SMART use of the RIGHT technology, can indeed improve the process, enhance the time and the interaction, paradoxically making us more, better HUMAN healers.

That’s one of the things that Google Glass can do in medicine.

Wearable devices, and specifically GoogleGlass, has started a tide of change and innovation, a true awakening of the minds, that only can be viewed as a major success, at least in that respect.

As a surgeon and innovator, the FIRST one to ever use Glass in the operating room, and NOT the only surgeon excited about this technology, I see this trend as the beginning of a new way to do medicine.

http://bulletin.facs.org/2014/07/surgeons-see-future-applications-for-google-glass/#.U7raMMRDbC8.blogger

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@ZGJR

Is GoogleGlass immortal?

Well, I do think so!     In a way.

Would you say that the Ford Model T is dead?

Or did it actually represent the beginning of a revolution, the evolution of transportation?

You see, lately, there has been a lot of press regarding the demise of GoogleGlass. A few articles have explained that the time of Glass has passed, that developers are not interested anymore, that units are for sale in eBay.

Some have called it “the Segway of this era!”. I have read most of those editorials and releases. I have to say that I don’t agree with the basic premise of GoogleGlass being a failure.

As any new step, the first one is always shy and careful…Glass represents the next generation, the beginning of the future for the wearable device. Again, the beginning of a revolution, the evolution of the computing and communication platform. It was not invented in a day!

As a “pioneer” device, a “pseudo-beta” product ( a ready-product, not ready for the general public but instead for a very select group of skilled individuals in specific disciplines), Glass has awaken the imagination and creativity of the technologic community, the industry and the geeks out there.

I think that we all like he idea of having a “wearable” device in our forehead, as part of us, almost integrated with our selves, able to allow us to stay connected in the ways that we need or like, to perform our specific tasks more efficiently.

Glass has done that. It has shown that it is possible, and that the road to an ideal and trouble-free device is still being travelled.

Yes, we all agree that GoogleGlass is not perfect, in fact, it is far from it.

But we all remember the amazement of the first time when we saw the screen projected in front of our eye, and the awesomeness of navigating a menu with our voice, or listening to it without a headphone.

We all concur that the battery is poor, the connectivity slow, the voice recognition fair to good, the heating issues feel wrong and that for the day-to-day routine, is definitively not ready…but that’s not the point.

Glass represents the leap to something better, to a way of not texting with our fat fingers, bending our neck down to a screen or bringing a hand up to our ears. A way to look up and tap into vast human knowledge, available in the internet, just by talking aloud.

Glass will allow us to stand up again (like humans do), to speak our commands, to look directly at the eyes of our patients, not turning our backs to them looking at the other screen, or typing orders in.

If anything, it will allow us to connect in a more direct, personal and human way, in those times when we have to use technology.

In a recent article, Noor Siddiqui, COO and co-founder of Remedy ( http://remedyonglass.com ) quoted:

“Google Glass broke through that mental block, and got doctors to rethink the big clunky computers in our offices… that maybe it would make for a better bedside relationship if we turned away from those computers and got close to our patients again,” Siddiqui said. “…And what’s great is, now that doctors are thinking that way, it’s not about Google Glass anymore.”

I trust that Google is working in the next generation of Glass, and I know that it will be better, and that the feedback and outcries of those with and without faith will be addressed in that next device.We will be surprised.

Let’s wait and see what the future is going to be like.

Be Scared of Telemedicine, Really Scared!

I had been thinking of this title for a long time. Actually, I had been thinking about writing this post, for even longer.

The idea to get people’s attention to the reality and the future of virtual presence medicine has been going around, inside my head for many months.
I admit it and I apologize, the title was only meant to catch your attention. No matter in which “team” you are right now, patient or healthcare provider (by the way, there should be only one team !), know you have a real potential to switch sides in a “sneeze”, literally.

You should NOT be afraid, UNLESS you are a healthcare system or a hospital that haven’t realized that telemedicine or e-medicine, is already becoming a very popular way in which YOUR patients are doing healthcare transactions, or at least getting the initial medical advice; I don’t mean in a distant future, I mean today, I mean yesterday, I mean in the years to come!…And their options and choices are multiplying quickly, morphing, improving, adapting to their needs, like the free-market economy does.

You see, I’m a medical doctor, a full-time surgeon.I love technology and its potential to help us take better care of people, when used in a smart manner.

After giving a few TEDx talks in the subject ( “OK Glass: I need a surgeon http://youtu.be/fo3RsealvGI
“OK Glass”:Disrupt Healthcare Now”
http://youtu.be/DVzkw7y4_u4 ), attending ExponentialMedicine (a Singularity University program that injects its participants with the knowledge and the passion for how exponential technology can impact the future of healthcare delivery. http://exponential.singularityu.org/medicine/ ) and soon after that, performing the first ever documented surgical procedure with Google Glass
( http://t.co/W0EJQy9U8s ), I have become some sort of an “evangelist”, traveling the world as a keynote speaker, sharing the vision for e-medicine, of “how much better it could be” (or IT SHOULD BE!).
Preparing for the talks, I try to keep up with the most up-to-date information in the subject, curating the internet and healthcare social media, seeking inspiration and following brilliant colleagues and blogs like the ones of Bertalan Meskó/ @Berci, Christian Assad/ @Christianassad, John Nosta/@JohnNosta, Lucien Engelen/ @LucienEngelen, Daniel Kraft/ @Daniel_Kraft, Kevin MD, 33Charts, the 3GDoctor, etc.

Over the last year, one common trend has been the amount of new developments regarding the availability and variety of telemedicine options. I not only mean that hospitals are slowly adapting to the reality of e-visits, but that it seems that every couple of weeks there are news of a direct mobile option for a patient to get health advice in a very efficient way, over the internet; quickly, inexpensively, reliably and in most instances covered by insurance.

Who doesn’t want that? Why would you choose the less attractive option of making the appointment, waiting for the date, driving to the doctor’s office, waiting to be seen, being seen, getting a prescription (maybe), getting a follow-up appointment date, filling the prescription and then going back home (or back to work or school, which, by the way, you missed because all of the above routine) ?

This is just a brief, partial list of some of the available stand-alone telemedicine options that offer what I just described:

Curely (@CurelyMD -see http://medbonsai.wordpress.com/2014/10/08/the-future-of-healthcare-is-here-and-it-is-a-telehealth-marketplace/ ), Teledoc (Teladoc.com), Healthtap (www.healthtap.com), Memd ( http://www.memd.me ), ZocDoc (www.zocdoc.com), DoctorSpring (www.doctorspring.com) , DoctorOnDemand ( http://www.Doctorondemand.com), Better (http://recode.net/2014/04/16/better-puts-healthcare-in-your-pocket/ ) and even Google, who is rumored to be getting ready to offer a service in the Helpout platform, for patients to get medical advice in a mobile fashion thru the internet (http://www.zdnet.com/the-google-doctor-will-see-you-now-search-giant-trials-online-medical-consultations-7000034705/ ).

Imagine that you are a patient living in a rural area (or not so rural, even metropolitan), suffering from a non-emergent medical problem that does not merit a 911 call or a visit to the ED, and you are thinking  about calling your primary care provider (PCP) to get some advice on what to do. How easy would that be? How soon will you be seen? How much of a hassle will be involved? And what about if the office is really far away, or if you are home-bound because of disability or just because you don’t own a vehicle? I know you can get the picture!

The “legality of these interactions is becoming not an issue anymore, and HIPAA compliance is being addressed in all of these services, so…the argument of “privacy” concerns, is not such any more.
I truly believe, that health organizations that don’t confront this issue right now, will definitely suffer the consequences.

I think that it is imperative for them to make this modality, Telemedicine, a main pillar of their “survival” strategy (along with Finance, Community, Employees, Patients, etc.), in order to be able to keep their market share, to even increase it, but most importantly, to provide better, overall care to their patient population.

If they don’t do it NOW, they will for sure do it in a few years, BUT UNFORTUNATELY, right behind their competition!

So What I’m really telling them is: IF you want to survive,

DON’T BE SCARED OF TELEMEDICINE….EMBRACE IT!

 

PS. This link just came out, minutes after I published my post:

PlushCare launches telemedicine service with Stanford, UCSF doctors on call

These services will virally multiply!

“OK Glass: hand me the scalpel, please…” GoogleGlass during surgery!

Obviously, one of the MAIN concerns regarding the use of Google Glass during surgery, with live streaming of data, would be to take every measure and to ensure the privacy of the patient’s health information (PHI).

That’s exactly what I did. Not only I obtained informed consent about what we were going to attempt (and documented it), but most importantly, made sure that no recording or transmission of any identifying information was done. The streaming of video and photos, to “myself” thru Google Glass, did not reveal any PHI, or even show the patient’s face.

By performing and documenting this event, I wanted to show that this device and its platform, are certainly intuitive tools that have a great potential in Healthcare, and specifically for surgery, could allow better intra-operative consultations, surgical mentoring and potentiate remote medical education, in a very simple way.

To my knowledge, this is the first time that Google Glass has ever been used during live surgery, by a surgeon, and Glass Explorer, with streaming of non-identifying patient information thru a Google Glass Hang-Out.

The patient involved needed a feeding tube (Gastrostomy) and we chose to placed it endoscopically, with a procedure called PEG (Percutaneous Endoscopic Gastrostomy. You can Google that to learn more…). Being the first time, I wanted to do this during a simple and commonly performed  procedure, to make sure that my full attention was not diverted from taking excellent care of the patient.

I arranged for a Google Hang-Out (HO) between my Glass and a Google account I created ahead of time for this very purpose.

The connection is remote. The iPad used as a receiver was just yards away, but it could have been practically thousands of miles away.

Before starting the operation, I briefly recorded myself explaining the planned event, and once again, talked about the importance of not revealing any PHI.

I had Google Glass on at all times, with the HO active thru-out the procedure. The live video images that I saw thru Glass, were projected in the iPad screen, remotely.  We kept the volume down on purpose. We tried to keep it very simple (the KISS principle!) and straight forward. As I said, even the procedure was a simple one.

I was able to show not just the patient’s abdomen, but also the endoscopic view, in a very clever, simple and inexpensive way. I think that there should be ways to directly stream the endoscopic view thru Google Glass ( My friend @Julianmb, also a Google Explorer, and his team of experts from @Droiders are working on that !) but this was a “Poor’s Man’s” set up…

The whole thing was fairly quick and went very well. We used “home-made” techniques, so the pictures and video are not optimal, but I think the point stands: Google Glass Streaming During Live Surgery…By  a Glass Explorer Surgeon…IS POSSIBLE.

OK Glass: hand me the scalpel, please” !

For other links on disruptive Healthcare Innovation, watch TEDx talks, TEDx Dirigo 2011 “iPodTeletrauma, the $229, 130 million sq. ft. Trauma Room, in your pocket”,

TEDx Bermuda 2013: “OK Glass: I need a surgeon http://youtu.be/fo3RsealvGI

TEDx Dirigo 2013 : “OK Glass”:Disrupt HC http://youtu.be/DVzkw7y4_u4

 

 

“OK GLASS”: Improve Health Care! Now

June, 2013.

Well, a couple of weeks ago, I finally got my Google Glass.The experience to pick them up was just as great as I expected; they host you at Google and present you with several options of colors to choose from.I decided on black, just to be neutral, and thinking that it would probably make them less noticeable, since my main idea and objective is to use them at work, caring for patients. They custom fit them to make them comfortable and to make sure they do not block your field of view.They register and connect them for you, and suddenly, “OK Glass”: magic starts to happen…right in front of your eyes (Your RIGHT EYE, actually!).

For weeks, I have been thinking of ways to apply Glass to my daily routine of taking care of patients.I’m a surgeon and depending on the day, I can be in one of many areas, from the clinic, to the OR, from the ICU to the ED or the Trauma Bay;taking care of patients during rounds or teaching third or fourth year medical students.

The idea of having a device that allows me to instantly and effortlessly look up a concept or an image, take a picture or record a video
(and share it, if I choose to do so) or connect with someone by live video (thru a “Hang Out”) is a bit mind-blowing.

I imagine performing an operation and connecting live with group of students or surgeons, anywhere, doing a live “Hang Out”, letting them virtually “BE” in the OR with me, SEEING what I’m seeing, pointing to anatomic structures and different steps of the procedure, THRU my eyes…I envision the possibilities in distance MedEd, taking surgeons thru a complicated procedure, or one that they might not be so familiar with (surgical missions without leaving the country!).

The potential for remote presence medicine, TELEMEDICINE, is also amazingly exciting. I could be “video-connected” with a physician who needs my advice, and then even see and listen to the patient him/herself. I could advice a child’s parent and give them reassurance, while looking at their eyes…All these without having to go to a tele-station, hold a device in front of me or be limited by “where and when” I am. What I see and what I hear thru Glass, ONLY I can see and hear (the image is right in front of the users right eye, and audio happens via bone conductivity, so it is not audible to anyone else but the Glass user)

I imagine being in the middle of a difficult surgical case and suddenly finding the unexpected. Just by a voice command, being able to call for help, having a colleague to “virtually join” me and and give advice; or encountering an unusual finding, and sending the image or recording of it to a pathologist or sub-specialty colleague, for their opinion on the gross appearance and their opinion on how to proceed.

Imagine how “Grand Rounds” could be revolutionized. Doing them at a distance, with both presenters wearing GoogleGlass, and doing a simultaneous “Hang Out”. Even connecting two groups or classes, in different schools/surgical programs (even different countries). The potential for a better exchange of information, ideas, experiences, knowledge, is only limited by our creativity.

There are so many ways to use GoogleGlass in medicine and not have to worry about breaching patient’s privacy. Until there are “secure”, “encrypted” and HIPAA compliant applications, its use can exclude any mention of a patient’s identifying information.
But when this applications are developed (and they will be!), the game will change even more radically. Then, we will be able to exchange any health private information without worrying about legal or ethical penalties. Envision Glass on the field for EMS providers, connecting them to hospitals, being guided thru difficult procedures if needed; or having them advise the receiving hospital’s set up in case of disasters or major traumas. Giving set up instructions before patient’s arrival, based on their “first responder’s” knowledge of the situation (chest tube set-ups, massive transfusion protocols, OR teams, etc.) It would certainly be a “time saver” and, in trauma, “Time is Gold”.I think that if one aspect of the trauma care process could be improved, it is the communication between the teams.

Have you been to a doctor’s office and then have someone sit close to you, turn around and look at a monitor screen, while they ask you questions, while you face their backs? Imagine then, a doctor accessing patient’s images, medical history, tests and laboratory results or any EMR 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. Medicine will be “personalized” again. We could be in front of a patient, face-to-face, again.

There have been a few, well publicized and ingeneously marketed reports of live “Tweeting” during surgeries in recents
months. Well, I ask myself, what’s a tweet in front of a “Hang Out”? (Sorry Tweeter!). A story like this would be all over social (and “regular”) media.

A Health System should embrace this innovation. A system should support and encourage this radical thinking, which can only bring advertisement and great PR to its grounds.

A professional association (I mean you, American College of Surgeons) must BE THE CHANGE YOU WANT TO SEE. Surgeons are leaders, innovators, “ground-breakers”! Let’s do it! Help me do it.
I, and a few other physicians and surgeons, would really like to lead this revolution. Not a revolution, BUT the EVOLUTION of the current, decadent Health Care. From inefficient to efficient. From obsolete, to “cutting edge”.From slow to “as-fast-as-your-High-Speed-or-Fiber-Connection”; from error-prone, to designed-for-safety; from unsustainably expensive, to cost conscious ( I do believe that, while technology can be expensive, the smart use and application of technology to solve problems and improve processes, is the best way to decrease costs in healthcare).

For many years now, doctors and health care providers have been using machines, technology and the internet to optimize the care of patients.
GooGoogle Glass is just one more step in the right direction. One more gadget people might say…but what a gadget! This is the natural evolution of the interaction between human, device and the Virtual Highway.I do believe that in medicine, it will make our work better, and that only means, “OK GLASS”: improve patient care, now!

Rafael J. Grossmann, MD, FACS

@ZGJR

Rgrosssz@Gmail.com

Rgrosssz.com