APR 24, 2014

Since the release of smartphones and the iPad, the healthcare industry has taken a keen interest in adopting portable computing for a clinical environment. And just as quickly as mobility has arrived, those form factors may have to make space for another new gadget, Google Glass.

Over the past two years, clinical staffs have been dipping their toes in the water with a handful of small experiments using Glass, and recent successes have led to a greater interest in the product as a viable medical tool.  Not only are doctors and hospitals intrigued by the prospect of Glass, a number of startups have emerged with the goal of building healthcare-specific software to make the most of Google’s hi-tech headgear.

Google Glass—from search engine giant Google Inc.–comprises a pair of glasses equipped with a camera, microphone and small LCD display that connects to the user’s phone. Glass enables its users to record video and make gestural commands using the camera, as well as give voice commands over its built-in microphone, all while showing the user what they need through the display.


Early healthcare adopters are collaborative groups composed of clinical users, facilities and software startups. An example is the partnership of Beth-Israel Deaconess Medical Center (BIDMC) in Boston, its emergency department, and Wearable Intelligence.

BIDMC garnered attention earlier this year when it first began trials on Glass, which made CIO John Halamka, M.D., the de facto healthcare poster boy for the technology.  At the outset, the identity of the company designing the software for the trial was kept secret, but on April 9, Halamka announced that Wearable Intelligence was responsible for turning Glass into a medical tool.

BIDMC has a history of getting out front: it’s served as the alpha site for Microsoft’s HealthVault and Google’s short-lived Google Health service, among other initiatives. It’s also one of the few health systems to operate its own proprietary EHR software, which ensured Wearable Intelligence and BIDMC had in-house resources to ensure Glass could be integrated into the HIT environment.

BIDMC and Wearable Intelligence opted to utilize a handful of Glass features. A central application is QR-code based “context switching”.  In the emergency department each patient is given a QR code which is posted in their room; when the Glass camera “sees” the code, it automatically brings up all of the patient information on the LCD screen, which means clinicians don’t have to issue commands to the device and also ensures patient information relayed more or less stays in the room.

Keeping information where it’s supposed to be was a central priority for BIDMC. All the Glass devices function exclusively behind the hospital firewall and only work on the hospital grounds; the software has been designed so the devices can’t communicate beyond BIDMC’s internal network.

“There are significant concerns that force us to restrict [connectivity],” Halamka says. And by using Glass devices tethered to the hospital’s physical location, information will be more secure than it is now, he notes.  Rather than a doctor taking photos or recording video on a smartphone or tablet, which can be taken and used off grounds, Glass ensures that “any media taken at the hospital stays there,” according to Halamka.

BIDMC’s partner Wearable Intelligence is not the only startup trying to gain a foothold in healthcare, and not the only one trying to design for the uniqueness of the environment.  Another startup, Augmedix, has focused on tailoring Glass for a clinic setting.  For Augmedix, it’s all about “pushing to and pulling from the EHR,” according to co-founder and CEO Ian Shakil.

Like Wearable Intelligence’s program at BIDMC, time saving is the focal point of Augmedix’s product, which is being used at six California clinics. But the rationale behind it comes from a very different place; Where the BIDMC team sees Glass as a tool to enable doctors to react and respond more efficiently in an ED setting, Shakil sees it as an opportunity to “turn three doctors into four.”

Augmedix is focused on a patient-centric application with an emphasis on workflow and making clinic encounters more personal by freeing up clinicians from having to type information into an EHR and otherwise spend time facing away instead of speaking directly with a patient. Its software utilizes the audio and video recording and speech recognition capabilities to compose and retrieve records on the fly while interacting with the patient. During an encounter, the application is designed to capture the visual/audio stream of the conversation and convert it to structured data that’s entered into the EHR.

It doesn’t sound easy, and it hasn’t been, Shakil says. Hardware has proved to be a persistent problem for developers.  “The hardware inside Google Glass is fairly underpowered, and limitations on the memory, CPU, and GPU meant that we really had to stretch every resource to get it to do what we wanted it to do,” he says.

Running on the same processor as the Samsung Galaxy Nexus, Google’s 2011 flagship smartphone, Glass does not leave much headroom for the developers to expand the capabilities of the device.  Another hurdle has been the microphone; because of Glass’s original purpose as a mass-market product, it was designed for voice recognition to be usable in public settings where the user’s voice may not be the only sound present.  “The microphone is great at getting audio from the wearer, but not the environment,” said Shakil, which makes recording audio from patients one of the platforms weak points.

In addition, security remains a concern for Augmedix, or rather the trade-offs between security and convenience.  Because of the sensitive nature of the information being stored and transmitted through the device, ensuring that it remains secure has complicated what software can and can’t be used.  A major focus during the design was “device hardening” to make sure data is going exactly where it’s meant to, a difficult task when many of the default features of Glass relay data through Google servers.

The program at BIDMC circumvented this problem by limiting their devices to communicating exclusively within the hospital’s internal firewall, something Augmedix isn’t doing because of its reliance on its own cloud-based service linked with the device.

While the use of Glass is limited now to a handful of early adopters, it’s hard to ignore the potential of wearable technology in an information-rich profession that also happens to require significant hands-on, face-to-face work.  Halamka calls it a “productivity enhancement that doctors need.” The specialization of the technology is another major draw; by building software which makes Glass into a single-minded tool for doctors, privacy and security are easier to maintain than on tablets and smartphones, proponents say.

For Augmedix CEO Shakil, the future of the technology lies in making the jump from showing doctors information to helping them use it, such as crunching numbers and using analytics to provide a “Watson-like” experience. “Or maybe you have a doctor with their hand on the door and their device chimes in ‘Wait, you forgot this important thing.’”


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