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Google Glass in the Emergency Department

Google Glass

Google Glass is trying to make inroads into the medical field and there have been several stories about how it is being used in the emergency department.

One story begins with how Boston’s Beth Israel Deaconess Medical Center is the first hospital in the world to use the glasses for direct patient care. The benefits are reportedly legion: “Information like the patient’s name, their past medical history, even X-rays can all come up with Google Glass and could be life-saving, especially if a patient can’t communicate or doesn’t know their allergies and medications.”
Yawwwwn … er, um … WHOA!
The physician who is spearheading the Google Glass program at Beth Israel says that “I can say, ‘Page nurse,’ and say, ‘Nurse, can you get me some more sedation, thanks!’ And it will page them automatically all through voice commands and voice dictation.”
That’s great. But there are other products out there that do the same thing. Think Vocera.

And in Dr. Horng’s example, the nurse would then page the doctor back and say”
“Doctor, I’ll get you some more sedation as soon as you put the order in the computer. Administration doesn’t let us take verbal orders, remember?”
Then the doctor would have to walk out of the patient’s room, with Google Glass flashing e-mails and cat videos into his peripheral vision, so that he could enter the sedation order into the computer, then re-page the nurse and tell her that the order has been entered, which she’ll probably already know about and will only serve to piss her off because of the needless interruptions from the doctor playing with his new toy.
Either that, or the doctor will sit in front of the patient having the following argument with an inanimate object …
OK Glass …
OK GLASS!
Open patient John Smith chart. No, not that one.
Close patient John Smith chart.
Open patient John … what’s your middle name, sir? … Open patient John Francis Smith chart.
Close patient Francis Smith chart.
Open patient JOHN Francis Smith chart.
Open orders.
No, I don’t want hors d’oeuvres.
O-PEN OR-DERS.
By now, the patient is either annoyed or laughing. In either case, Google Glass probably cost more time than it saved.

No sooner did the pixels dim on the first story than another story pops up about how not only did Google Glass just *work* at Beth Israel Deaconess Medical Center, but how Google Glass SAVED A LIFE!
It turns out that the same Dr. Horng was treating a patient with a “severe brain bleed” and that the priority in brain bleed patients is to lower the blood pressure.
However … dun dun dun duuuuuhhhhhh … the patient was *allergic* to some unknown blood pressure medication
and … dun dun dun duuuuuhhhhhh … the patient was also taking an unknown blood thinner.
Dr. Horng was able to find the answers “almost instantly” using Google Glass and “was able to administer the right medications to slow the bleeding and save the man’s life.”

I call bullshit.

Let’s walk through a typical patient experiencing a “severe brain bleed.”
First, the patient doesn’t walk up to the registration window saying “Pardon me, ma’am, but I happen to be having a severe brain bleed – left hemisphere, temporal region.”
The patient walks up to the registration window (or is brought in by ambulance) saying “I have a headache.” Perhaps the patient has “weakness.” Or maybe the patient is brought in by ambulance unconscious. But a “severe brain bleed” is a diagnosis made after workup, not a presenting symptom.
So even with the help of Google Glass, a doctor wouldn’t know to give blood pressure medications “almost instantly” when the patient got into the room — even if blood pressure medications were indicated.

In any of the above scenarios, stabilizing treatment comes first. Airway, breathing, circulation.
Once stabilized, testing has to be done first.
Generally, only after the results of the testing are known will anything more than stabilizing treatment be performed. Treating before knowing a diagnosis may make a patient worse or could even be life-threatening.
There may be certain information about a patient’s medications available in the patient’s prior records, but doctors have no way of knowing whether the patient is taking the medications that are on the screen (see screen capture from CBS newscast below), whether the medications have been discontinued, or whether new medications have been added. According to the Joint Commission, making such a determination requires medication “reconciliation” which takes about 10 minutes of a nurse’s time – if she’s lucky. Therefore, that information is not immediately available in the patient’s medical record. So until “reconciliation” takes place, Glass may “almost instantly” be providing physicians with outdated and inaccurate information about a patient’s medications when the patient hits the door.

Google Glass Patient Info

Regarding management of a severe brain bleed, blood pressure medications are almost never an emergent concern in acute strokes. Several papers note that in acute ischemic stroke, the normal regulation of cerebral perfusion is disrupted and rapid lowering of blood pressure in these cases may worsen cerebral ischemia. This recent Lancet article (published after the patient in the article was treated) questions whether lowering blood pressure in ischemic or hemorrhagic stroke is advisable at all since the changes may worsen a patient’s outcome.

So before the lifesaving medications can be given (if those medications are indeed lifesaving), first a CT scan needs to be performed and then the results of the CT scan need to be reviewed. During that time, the doctor has more than sufficient time to look through a patient’s chart. The “almost instantly” available information from Google Glass would have made no difference in this patient’s care – much less have saved the patient’s life.
If the same patient is on an anticoagulant (a blood thinning medication), perhaps the doctor would want to reverse the effects, but again, that determination would depend upon the CT results and upon the results of the coagulation studies. Again, the doctor would have plenty of time to go to the old-fashioned computer to look up the patient’s results.
So this whole “Google Glass saved a life” is a crock of hooey.

But you can see x-rays right on your Google Glass screen, the article continues. It even shows a picture of a chest x-ray during the news segment (see screen capture below). How convenient. And if you miss a pneumothorax or free air under the diaphragm, or Hampton’s Hump, or a Westermark sign on that fancy little 128 x 128 pixel picture on the newfangled screen in your peripheral vision, you’ll get your own little article about how Google Glass killed a patient. Then you’ll get your Glass handed to you in a lawsuit – and deservedly so.

Google Glass CXR

But you can look at the patient while you access the information, Dr. Horng says. In reality, you’re really *NOT* looking at the patient. You’re looking in the patient’s direction, perhaps off to the patient’s right a little. You’re actually looking at the Glass screen and you’re not paying attention to the patient when you’re doing so. This is about as much of an advantage as me holding up my iPhone in front of the patient and saying “I’m listening to you. Really! Keep talking. I’m looking at you.” Only with Google Glass, the doctor’s distraction is hidden.
Think about it. Would you want someone driving your kids around in a school bus while wearing Google Glass? After all, they would be looking at the road, right?

Both of these articles are nothing more than hidden advertisements for Google Glass coupled with the logical fallacy of an appeal to authority. Dr. Horng is obviously very technologically adept and there is therefore a predisposition to believe what he is saying without weighing the risks and benefits of the claims he is making.
We also have to consider that just because we have new technology doesn’t mean we need to use new technology – especially when that technology hasn’t been proven to improve patient care.
We need formal studies to prove those claims, not a surreptitious informercial.

Personally, if a doctor came into my room wearing these things, I’d whip out my phone and begin video recording everything he did … in high definition. You’d see it on this blog later that same day.

However, when Google Glass can take me through the byzantine set of steps necessary to log into a computer, pull up a patient’s chart, and order some Tylenol for a kid with a fever … while simultaneously acknowledging the fact that the dose is 1.7713 mg too much for his weight, that he hasn’t had a serum creatinine done in the past 60 days, and that he is taking Similac with iron which may cause a statistically insignificant increase his AST [am I SURE I want to continue?] … then come talk to me.
For that, even I’d consider wearing them.
Until then, keep them out of the exam room. They’re distracting, unnecessary, and a potential HIPAA violation.

And now that this article will cause this blog’s Google search engine rankings to go from page 10 to page 116,813 (just do a search for “Whitecoat” or “white coat” and try to find my blog), everyone make sure to bookmark my blog … and search using Bing or IxQuick or DuckDuckGo.

Hat tip to SeaSpray for sending me the link that started this whole rant.

[yop_poll id="8"]

P.S. To the person who voted 22 times in a row that he was totally fine with his doctor wearing Google Glass, you’re now getting held back in third grade another year. Grow up.

 

2 comments

  1. Easy way to avoid this:
    Convince hospital administration the negative impact an idiot wearing these goofy things can have on your Press-Ganey scores.
    Problem solved.

  2. Or just point out to your physician group the pain involved in removing them from the rectum after some patient (or, ahem, nurse) shoves them there.

    I point out for the record that even law enforcement puts little rounded circles on the pointy tips of badges, for some unknown, but apocryphally similar, reason.

    BTW, if talking on a cell phone is classified as distracted and reckless driving on a par with driving DUI, how could any physician, after a 5 minute chat with their malpractice attorney, not come to the same conclusion regarding practicing medicine with this gorram contraption on??

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