Google Glass is expanding its medical applications far beyond capturing and transmitting videos of surgery. Google Glass is now entering and retrieving patient information into and from electronic health records. A pilot test of Google Glass and Augmedix taking place at Dignity Health’s Ventura Medical Clinic involves three family practices and over 2,700 patients. Physicians using Google Glass have reported a major drop in daily time spent entering info into the EHR from 33% to 9% and an increase in direct patient care time from 35% to 70%. Participating doctors put on Google Glass prior to meeting with the patient. During the visit, Augmedix software captures the audio and video through the device and enters it into the EHR system. The doctor can also ask questions to retrieve certain types of information such as lab-test results. (See related OrthoBuzz item from May 2, 2014.)
Augmedix, one of several start-ups devising applications for Goggle Glass in health care, is developing a seamless way for Glass-wearing doctors to push information to and from electronic health records (EHRs). A recent study in the International Journal of Medical Informatics found that doctors who use EHRs in the exam room spend much of their time looking at the computer screen rather than at the patient. The Augmedix product would record information from the doctor-patient interaction automatically and potentially boost “face time.” Meanwhile, Austin, TX-based Pristine has developed an app that lets Glass-wearing physicians transmit HIPAA-compliant video and audio of patients to authorized computers. The idea is to enable real-time consults with specialists located remotely from the patient. (See related OrthoBuzz item from Jan. 30, 2014.)
After reading our item about Google Glass in the January OrthoBuzz, Dr. Ran Schwarzkopf, assistant clinical professor of orthopaedics at the University of California, Irvine (UCI), wrote us to explain briefly how teams of surgeons, nurses, and anesthesiologists use the technology at UCI. Dr. Schwarzkopf kindly responded to our follow-up questions in the following interview.
JBJS: Thank you, Dr. Schwarzkopf, for sharing your experiences with OrthoBuzz. First, can you tell us a bit about yourself?
Dr. Ran Schwarzkopf: I am an assistant professor in the Department of Orthopaedic Surgery at UCI, where I head the Adult Reconstruction Joint Replacement Service. I trained at NYU Hospital for Joint Diseases and completed a fellowship in adult reconstruction at Brigham and Women’s Hospital in Boston. I am part of the UCI Joint Replacement Surgical Home, which is a perioperative clinical care model jointly run by orthopaedics and anesthesiology.
JBJS: We understand that you’ve been using Google Glass in some interesting ways. How did the program get started?
Dr. Schwarzkopf: UCI has always been a pioneer in incorporating new technology into medical care. We have a long tradition of innovation and entrepreneurship. Due to the orthopaedic department’s close relationship with our anesthesia department and our successful Joint Replacement Surgical Home, we were approached by Pristine, a company that develops platforms for integrated medical systems. Together we decided to explore the use of different interactive glasses for operative applications. We started working with Google Glass as our first glass prototype, but we have also examined similar products from other companies. Together with the developers at Pristine, we designed different clinical pathways for optimizing the use of the Glass to enhance our clinical work from both the orthopaedic and anesthesiology perspectives.
JBJS: Was there a particular challenge you hoped Google Glass would help you address?
Dr. Schwarzkopf: In today’s orthopaedic operative environment, efficiency, cost reduction, and successful outcomes need to go hand in hand. We were looking to increase team interactivity and real-time communication while decreasing waste and unnecessary traffic in the operating room. We also wanted to enhance our resident learning options. Our anesthesia colleagues were looking to improve communication between their team members with real-time visuals.
JBJS: Please describe some of the things you and your colleagues have done using Google Glass?
Dr. Schwarzkopf: The orthopaedic team was able to broadcast surgery live to team members who were not inside the operating room, giving residents and visitors the ability to observe the procedure from the “surgeon’s point of view” without increasing traffic in the operating room. The surgeon was also able to view both check-lists and images on his glass view screen during the procedure. The nursing team inside the OR was able to communicate with our nurse manager without needing to exit the room or use the phone through a tablet screen outside the OR. Our anesthesia team includes an attending anesthesiologist and two residents or nurse anesthetists in two separate rooms. The anesthesiologist can observe both rooms from his tablet and can communicate with the physician/nurse inside. He can see both the monitors and the patient and help with decision making and problem solving without the need for constant paging and phone calls.
JBJS: What is the greatest benefit from this technology?
Dr. Schwarzkopf: I think the greatest benefit is the increased integration of the operating team and the streamlined processes that the technology affords us. We are able to communicate and provide oversight in a whole new way. It decreases traffic in the operating room and increases the speed of communication and care given to the patient.
JBJS: What surprised you the most about your experience with Google Glass?
Dr. Schwarzkopf: The ability to build a complex control tree, which enables one supervising physician to oversee others in a completely new way. We can now see through other peoples’ eyes and we can help and communicate in real time, without old-fashioned back-and-forth information transfer.
JBJS: By using several pairs of Google Glass simultaneously, you have been able to link surgeons, nurses, and anesthesiologists. What are the most important benefits of that type of teamwork? What barriers remain to greater collaboration?
Dr. Schwarzkopf: The ability to pair several glasses together is one of the main advantages of this new technology. We observed greater and more efficient teamwork on all sides—surgical, nursing, and anesthesia. The benefits include decreased OR traffic and cost reduction through reduced procedure times. The ability of a supervisor to see through his trainees’ eyes is priceless. We can now directly control actions beyond our immediate line of sight and we can do it without time-consuming back-and-forth communications. When you can see what your resident sees, the phrase “lost in translation” will no longer be relevant. The main barriers that remain are mostly technical, such as the hands-free or voice-activated ability to control the camera angle and “wink” control of the Glass activity. That’s being worked on as we speak.
JBJS: In honor of the 125th anniversary of JBJS this year, we are interested in what orthopaedists think might be important trends in the future. Looking ahead to the next 20 years or so, what do you think might be three significant advances or changes in orthopaedics?
Dr. Schwarzkopf: We will see significant changes in the way health care is managed and provided, mostly due to changes in regulation and federal guidelines. Resident education will incorporate more advanced methods to allow residents to improve their proficiency while still abiding by increasingly restrictive work-hour regulations. On the technological side I think we will see much more influence from the “gaming” world, like enhanced/augmented reality technology.
JBJS: Thank you very much, Dr. Schwarzkopf. We wish you continued success with all the innovations taking place at UCI.
Earlier this year, Dr. Christopher Kaeding became the first surgeon to use Google Glass during live surgery. He used the new technology to consult remotely with a colleague who, thanks to the head-mounted computer/camera, could see the procedure live from the surgeon’s point of view. Several students at The Ohio State University College of Medicine also watched the successful ACL surgery. Google Glass could conceivably give surgeons the ability to instantly call up radiographs, MRIs, and pathology reports during surgery, while giving a unique perspective of surgical procedures to others in remote locations. A thousand people in the U.S. have been chosen to test Google Glass as a part of Google’s Explorer Program.
It is not often that readers of scholarly journals have a “Wow!” moment, a chance to be unexpectedly delighted by a new discovery.1 In the September 14, 2016 edition of JBJS Case Connector, Zhang et al. provide readers of the JBJS family of journals the first of what we hope will be many such moments: the ability to link to and navigate a digital, whole-slide image (WSI) of an entire microscope slide.
Illustrating the histology of tumors and the tissue-level details in basic science studies has long been a challenge. Until recently, readers were usually subjected to the few fields of view that the author chose to photograph. The more senior among you may remember with nostalgia attempting to make sense of fuzzy, black-and-white, circular, histology images viewed as if seen through an antique monocular microscope (Fig. 1). The advent of color printing (often at the author’s extra expense) and eventually digital photographs improved somewhat the quality of each image, but readers were still required to accept that the author had selected fields of view that were truly representative of the subject matter.
In their case report titled “Morphological Transformation of Giant-Cell Tumor of Bone After Treatment with Denosumab,” Zhang et al. include two links to whole-slide images. In the first, readers can link from a conventional digital photograph of a core needle biopsy to the whole-slide image of the giant cell tumor. The authors also include several conventional photographs of the tumor after resection, along with a link to the corresponding scanned microscope slide.
The use of a viewing algorithm similar to that used by Google Earth allows readers to navigate and zoom in on not just the few isolated fields of view selected by the authors, but the hundreds to thousands of additional fields contained in the original microscope slide of this complicated tumor. While it’s very helpful for illustrating tumor histology, we anticipate that WSI technology will be even more valuable when applied to basic science studies of fracture healing or cartilage, nerve, and tendon repair—as well as many other possible applications.
Thomas Bauer, MD
JBJS Case Connector Co-Editor
- Glassy EF, Rebooting the Pathology Journal. Learning in the Age of Digital Pathology. Archiv Pathol Lab Med 2014;138:728-729.