Before you add the latest OR gadget, Google Glass, explore cautions, limits
Executive Summary
Google glass is being tested by surgeons across the country and is in high demand. The device can be worn during surgery and used to teach, archive, and access other documents.
• Obtain consent from patients and from providers in the OR.
• Surgeries cannot be broadcast without addressing HIPAA compliancy issues.
• Know the limitations, including limited battery power and line of sight issues.
It looks like glasses, on steroids. Google Glass is part computer, part camera, part microphone, and part phenomenon. Surgeons can wear in into the OR and use it to train surgeons on the other side of the world. They can see X-rays or scans without turning to look at a monitor.
A recent blog from The New York Times said Google Glass might be a good fit for surgery because it’s voice-activated and it’s hands-free.1 It’s normally difficult to take pictures and record videos when a surgeon is scrubbed in for a procedure and sterile, says Oliver J. Muensterer, MD, PhD, of the Division of Pediatric Surgery and director of the Pediatric Simulation Program at The Children’s Hospital at Montefiore and Albert Einstein College of Medicine in Bronx, NY. Muensterer published a study on Google Glass in The International Journal of Surgery.2 In this study, Google Glass was positively received by surgeons, as well as other staff, patients, and families, he said.
While some kinks are being worked out, Muensterer remains confident that Google Glass will be used in healthcare. "Glass lets you photodocument unusual findings for educational, academic, or forensic purposes," he says. "You can also perform searches of unusual medical syndromes on the web, and look up diagnosis and procedure codes in real time." Software is being developed by outside companies that displays patient test results, as well as items such as a surgical checklist.
He’s not alone in his enthusiasm. Surgeons recently formed the Wearable Technology in Healthcare Society that, at press time, had scheduled its first meeting in Indianapolis in July. University of California, Irvine plans to become the first medical school in the United States to integrate Google Glass into all years of its four-year curriculum.
Many surgeons around the country have been designated "explorers" of the technology, which they have purchased for $1,500 each. There is a high demand, according to "The New York Times" blog. Google has obtained a patent on a contact lens version of Google Glass.
What do you need in place, in terms of technology, to bring it into your OR? Just a wireless internet, says Selene G. Parekh, MD, MBA, associate professor in the Department of Orthopaedic Surgery and adjunct faculty in the Fuqua Business School at Duke University in Durham, NC. Parekh has been using Google Glass since October 2013 to record and archive surgical procedures and videos. When he is involved in charity work abroad, namely India, he can broadcast live foot and ankle surgeries. In January he performed the first total ankle replacement Google Glass broadcast.
Google Glass (GG) offers the unique perspective in that the viewer can see the surgeon’s view of the patient, the surgical field, and the anatomy, Parekh says. "In the past, I was able to either use cameras in my surgical lights, or have a camera man in the operating room with me," Parekh says. This situation was difficult, as he needed the camera to be where his head is, he says. "Therefore, I am constantly `fighting’ with those other cameras to see and perform the surgery," Parekh says. "With GG, this major problem is solved."
Will your surgeons go web surfing?
Concerns have been raised that surgeons could use Google Glass to surf the web or look up email, potentially during the procedure.
However, this problem isn’t likely, as it is difficult to focus on the small screen for more than 30 minutes due to eye fatigue, says Teodor Grantcharov, MD, PhD, FACS, associate professor of surgery (upper GI laparoscopy) at St. Michaels Hospital, Toronto, Canada. Grantcharov acquired Google Glass several months ago and has several pairs. "None of us uses it to check email or find information," Grantcharov says.
There are some concerns with the new technology, however. Concerns raised in Muensterer’s study are echoed by users, including low battery endurance (about 45 minutes) and quality of the audio.
Additionally, the line of sight is a problem, because the camera is located just above the eyes. Parekh says, "For a surgeon focusing on items within arm’s reach, it is problematic." Other problems include the inability to zoom in or out, and an issue with glare, he says. The camera doesn’t have a flash, so lighting is important, Muensterer says.
There also are privacy concerns, he says. "The main issue is that pictures and video are uploaded to the Google cloud when Glass is connected to the internet," Muensterer says, raising the concern that they could be access on a potentially unsecured server. Simply disable the internet connection when patient pictures are taken, he advises. "I certainly do this, then download the images and erase them from the device," he says. "I also make it a policy to share all images with the patient and parents, for the sake of complete transparency and trust."
Broadcasting from Google Glass won’t happen in the United States until protocols have been adopted to address compliance with the Health Insurance Portability and Accountability Act (HIPAA). Parekh says, "For my institution, I hope to have this by the end of the year."
In the meantime, third party companies are developing HIPAA-compliant software to secure transmissions, he says. "I believe if everything is HIPAA-compliant, liability is minimized," Parekh says.
Still consent should be obtained from the patient, Muensterer says. "I think that any consent form should contain a patients’ [signature], or parents can sign, allowing photodocumentation," he says.
Consent also should be obtained from the staff, Grantcharov says. "In the OR, depending on what’s going on, the image can include the surgeons or the anesthetists or the nurses," he says. "In our hospital, we always acquire informed consent from everyone in room. If someone in room doesn’t wish to be taped, we don’t use the Glass."
Good news and bad news
One potential use of Google Glass is that people at a distant location can view the surgery and provide guidance and advice for the person performing the surgery, Grantcharov says. However, that usage also raises concerns, he says.
"There are definite concerns about liability, especially since there have been suggestions that surgeons with limited experience could have the ability to operate on patients while an expert at a different facility guides them through surgery," Grantcharov says.
However, if safeguards are put in place, Muensterer says, "I don’t see where the device is any different than a smartphone in terms of liability." (For liability issues concerning cell phones, see "Comments recorded on cell phone — Patient says staff was mocking him," Same-Day Surgery, July 2014, p. 69.)
However, the bottom line, according to Grantcharov, is the value to healthcare. "There’s no question that, like anything else, it’s a great gadget, and all surgeons and doctors love gadgets," he says. "But if there is any addition to our practice that makes it safer or better, this is to be determined No one has shown benefit, just potential."
- O’Connor A. Google Glass enters the operating room. June 1, 2014. The New York Times. Web: http://nyti.ms/1n4hRkE.
- Muensterer OJ, Lacher M, Zoeller C, et al. Google Glass in pediatric surgery: An exploratory study. Int J Surgery. 2014; 12(4):281-9. doi: 10.1016/j.ijsu.2014.02.003. Epub 2014 Feb 15. Web: http://1.usa.gov/1lzdJcp.
- To see a video clip of a surgeon using Google Glass, go to http://nyti.ms/1n4hRkE. The video is at the bottom of the article.
SDS editor wins 2 first-place awards
Joy Daughtery Dickinson, executive editor of Same-Day Surgery, recently won two first-place national awards from the Specialized Information Publishers Association (SIPA).
For the second year in a row, Dickinson shared a national award for "Best Blog or Commentary" for the Hospital Report blog (http://hospitalreport.blogs.reliasmedia.com). She also was awarded for a story package she edited in Healthcare Risk Management that won the "David Swit Award for Best Investigative Reporting." Her awards were two of eight won by AHC Media, publisher of Same-Day Surgery. AHC is the winningest healthcare information provider, by far, at SIPA and its predecessor organization.
