A Vision Beyond Simulation: Capturing the Power of Wearable Technology in the Clinical Setting

Jessica M. Ray, PhD, David Dias and Stephanie Sudikoff, MD from SYN:APSE Center for Learning, Transformation and Innovation, Yale New Haven Health discuss the pros and cons of wearable smart glass technology.

Jessica M. Ray, PhD, David Dias and Stephanie Sudikoff, MD from SYN:APSE Center for Learning, Transformation and Innovation, Yale New Haven Health highlight advantages and healthcare cautions in using google and other smart glass technologies that they found from their simulation experience.

Improving healthcare environments and delivery of services requires analysis of the healthcare system from multiple perspectives. Emerging wearable smart glass technologies such as Google Glass provide the technology to observe patient, family, and provider interactions from multiple perspectives. The first two articles in this series explored how smart glass technology can be utilized to advance knowledge and training by capturing new views from both patient and provider perspectives. Yet, as with any new technology, the introduction of smart glass technology into healthcare comes with caution, special consideration, and an interdisciplinary approach to implementation. This article reviews how these new technologies can help advance patient care delivery, the challenges faced before deploying new technology in the healthcare arena, and the role of simulation in preparing for the adoption of smart glass technology in patient care.

An emergency response call arrives to a patient at home in a remote rural area. The patient presents with weakness to the right side, slight confusion, and dizziness. Through the use of smart glasses the response team begins the National Institute of Health Stroke Scale under the watchful eye of a stroke expert hundreds of miles away. The patient is transported to the local community hospital, where the CT scanner has been prepared for immediate scanning, and the results are reviewed by a team of local and specialty physicians located in different hospitals, all able to see both radiological records and the patient through the use of new communication technologies. Within hours of symptom onset the patient receives a potentially lifesaving medication and a level of expert care often available only to those in the area of a large medical organization.

Advances in medical technology have improved patient outcomes across a wide range of potentially fatal events from Stroke to Myocardial Infarction (Amadi-Obi, Gilligan, Owens, & O’Donnell, 2014), yet disparities remain in the ease of access to critical services and expertise from rural to urban areas (Lowery, Bronstein, Benton, & Fletcher, 2014).

Telemedicine allows for the bridging of this service gap by bringing experts to the patient and clinical environment remotely through communication technologies such as broadband video. Today, wearable technologies hold promise to be the next step in broadening the availability and use of telemedicine.

A recent review of literature exploring telemedicine in pre-hospital care found that its use leads to better clinical outcomes and quality of care, particularly in the areas of stroke treatment and ECG interpretation (Amadi-Obi, et al., 2014). However, the review found that telemedicine technology was both expensive and often limited to views fixed to one physical location (e.g. the ambulance). The introduction of wearable smart glass technology could expand telemedicine capability by allowing a higher level of care, both during pre-hospital care and in transit between physical locations. While more research is needed to demonstrate the true capability, it is expected that equipping small community hospitals and larger hospital transport teams with wearable technology holds the potential to advance the efficiency and continuity of care by providing expert advice faster and throughout the transfer process.

The technological capabilities of smart glass technology reach beyond those of traditional telemedicine technologies. In addition to providing a mobile communication medium, this new technology also provides the user with the ability to pull reference information. In the clinical setting this could provide community and pre-hospital providers quick access to cognitive aids to guide the treatment of patients both in the absence of and coordination with expert specialists.

Wearable technologies such as Google Glass provide an exciting potential advancement in patient care. Yet the adoption of this technology both in simulation and patient care settings faces a number of challenges. The next sections review both challenges and potential solutions for implementing smart glass technology both in simulation and the clinical arena. First is a review of the logistical challenges to implementing this new wearable technology. Then a consideration of the larger organizational issues faced in adopting smart glass technology.

Logistical Challenges

Early pilot sessions utilizing Google Glass with multiple providers in a simulated environment demonstrated one of the first challenges to successful implementation. These sessions quickly demonstrated the difference between a fixed head mounted camera and human visual tracking. For Glass to capture an image, the user must point his or her head in the direction of view, yet as humans we constantly scan our environments by moving our eyes across the visual field. This often led to views that were not aligned with the user’s narratives or line of sight. This problem is slightly compounded by the offset positioning of the glass camera, which sits just above the eye.

To overcome this challenge, training is required to teach users to move their head in congruence with their line of sight. For objects distant in the field of view this is less critical, however for near objects head placement is of special consideration. Since currently available smart glasses sit just above the eye line, it is best to instruct wearers to point their brow towards their visual focal point so that camera on the smart glasses can capture it fully. Similarly users may need to be coached on the amount and speed of head movement as this can quickly impact the quality of the image captured. The amount of training necessary to overcome this challenge requires further investigation as it is expected that users may revert to natural head motion and visual scanning without continued feedback across time and in higher pressure situations.

Video streaming is a key feature for the support of telemedicine through smart glass technology. This allows the view of the wearer to be distributed to one or more recipients in real time. However, this also presents a critical point for security concerns. Being able to operate within a healthcare system’s own firewall with secure video streaming is a key feature that will need to be present in smart glass technology implemented in the clinical setting. Accessibility to wireless networks providing the bandwidth for streaming video is also a consideration. When expanding smart glass-supported telemedicine to more dynamic environments such as pre-hospital care this can be an increasingly important challenge.

Reaching the full potential of smart glass technology interoperability between technologies is critical. To achieve distributed consultation as well as effective handoffs in transitions of care between healthcare facilities it is important that the smart glass technology infrastructure be capable of supporting different types of smart glasses. For telemedicine to work efficiently the technology accessible to providers across a region must be capable of connecting seamlessly to the support technology at the specialist’s hospital.

Smart glass technologies hold promise for advancing healthcare delivery both in traditional and telemedicine settings. (Photo: Authors)

Organizational Considerations

While wearable technology holds considerable promise for advancing care, deploying the technology in the actual care environment must come with careful consideration. As Barwa, Bhute, and Rani (2014) reviewed, telemedicine carries with it a number of legal and privacy considerations from licensing to concerns of confidentiality. The adoption of new wearable smart glass technologies must consider and overcome a number of unique challenges before implementation in the healthcare arena.

As with any healthcare technology, privacy is of paramount concern. The ability to meet HIPPA compliance represents the first requirement of any new technology. The ease of sharing pictures and video as well as connection to cloud storage, all attractive features in a consumer product, make the current consumer versions of this type of wearable technology inappropriate for the healthcare arena.

One example of this challenge is that the content on the initial factory release of Google’s Glass automatically uploads to Google cloud servers so that the user can easily share content that they have captured. In the testing environment disabling the Google+ application so that it will not upload content while it is charging circumvents this issue. For the clinical environment security needs are greater than simply disabling the cloud storage.

Several new start-up companies are addressing security solutions for deployment in the clinical setting by modifying devices and providing the requisite back end services and device management that would allow for the secure use of smart glass technology in the clinical environment.

Privacy concerns will likely remain one of the largest challenges to the adoption of smart glass technologies. For providers and health care facilities consideration must be given to any potential legal and ethical issues associated with introducing video whether streaming or captured to new clinical areas. Beyond the concern for capture and storage of patient data, the discreet capture of video in any setting often brings forth cultural resistance and privacy concerns. Within each individual healthcare organization policies and education will be necessary to address proper use of the technology, consent process, if and how video will be saved, and ways to address concerns of both providers and patients.

Anticipating and strategically engaging key members from of a variety of departments across the organization may ease the adoption of smart glass technology. Representatives from legal and compliance provide counsel on the considerations for the specific organization and locale. Multiple areas of information technology can support, with regard to security concerns as well as interaction with the institution’s electronic health record. Enlisting representatives from both patient and family advisory groups as well as marketing and public relations can provide guidance and support in transitioning the use of smart glass technology from the simulated to the actual environment.

How Can Simulation Help

The role of simulation in the actualization of these advancements is multi-faceted. First, simulation provides a critical testing environment to develop best practices in distributed communication and coordination of care. Through the use of rapid cycle development methods utilizing simulated patient care scenarios, testing can highlight both issues and solutions for deploying technology.

Introducing smart glass technology in the healthcare environment takes special consideration of privacy and cultural concerns. (Photo: Authors)

Specifically, simulation can be utilized to plan provider and patient care workflows, formalize provider communication, and examine the impact of this distributed care format on patient and family interactions. Once best practices are identified, simulation should play a key role in training providers to utilize the new technology and care processes in their respective environments.

A phased introduction of this new technology is expected to provide the opportunity to identify new challenges and solutions both technologically and organizationally. Initial testing should be completed in the simulation lab. This initial setting provides feedback on usability, training needs, and initial connectivity processes. From here, simulation in a contained in situ environment such as a new unit prior to opening or a radiology suite provides information about implementation in the real environment. Eventually simulation in less restricted spaces across the healthcare environment will allow for testing of both logistical and organizational challenges and their identified solutions.

Despite challenges, wearable technologies hold the potential to advance telemedicine by offering an affordable, portable, and largely unobtrusive technology capable of capturing a variety of different views of the healthcare setting. As healthcare networks prepare for these technological advances in the clinical setting, simulation training and innovation centers hold the power to support and guide the successful implementation. Simulation can be an integral part of preparing providers to offer the highest levels of care in new distributed healthcare formats. This preparation reaches beyond the transfer of clinical knowledge and skill, into a new distributed, care environment, and encompasses the workflows that must be developed to support implementation. Such thorough testing will allow us to optimize the impact telemedicine may have on the provider-patient relationship.

About the Authors

Jessica M. Ray, PhD is a Simulation Learning Consultant with Yale New Haven Health System. She holds a PhD in Applied Experimental and Human Factors Psychology. Her background includes specializations in observation and training for complex environments.

David Dias is a Simulation Assistant for the SYN:APSE Simulation Center. He is studying Computer Engineering at the University of New Haven with an emphasis on Mobile Technologies.

Stephanie Sudikoff, MD is the Director of Simulation at Yale-New Haven Health System’s SYN:APSE Center for Learning, Transformation, and Innovation. She is also an Associate Clinical Professor of Pediatrics in Pediatric Critical Care at the Yale School of Medicine.

References

Amadi-Obi, A., Gilligan, P., Owens, N., and O’Donnell, C. (2014). Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment. International Journal of Emergency Medicine, 7, 29-39. Doi:10.1186/s12245-014-0029-0

Barwa, J., Bhute, A., and Rani, A. (2014). Insight into various aspects of telemedicine: An overview. Medico-Legal Update, 14(1), 107-110.

Lowery, C. L., Bronstein, J. M., Benton, T. L., and Fletcher, D. A. (2014). Distributing medical expertise: The evolution and impact of telemedicine in Arkansas. Health Affairs, 33(2), 235-243. Doi: 10.1377/hlthaff.2013.1001