Google Glass Passes IRB Muster, Assists in Cardiothoracic Surgeries

Surgeons are justifiably excited by the possibilities of using Google Glass in the operating room. Despite Wi-Fi hurdles, privacy concerns, and speech recognition issues, this device will inevitably become another indispensable tool in healthcare.

Forget the new iPhone. The gift every healthcare technologist wants under his or her tree next month is Google Glass.

Suddenly, talk of Glass in healthcare is snowballing. It's the newest bright shiny object in tech, and we're hearing it could be a panacea for all that ails healthcare—unusable software, patients irritated by doctors glancing at their screens or iPhones, even infections spread by lack of handwashing and further spread by the vector of the keyboard.

Whoa. Not so fast.

Google Glass is undoubtedly a cool step forward in healthcare technology. For one thing, it's the latest marketing tool for the very modern hospital. Second, it's from Google – a company that has already changed the practice of medicine forever. Show me a physician who hasn't Googled something as part of their day's work, and I'll show you an out-of-touch physician.

The hardware of Google Glass itself is a wonder of miniaturization : a forward-facing 5-megapixel camera, hands-free high-definition video control, and a small prism that presents the wearer with an effect of looking at a 25-inch monitor as seen from 7 or 8 feet away.

While it has already been used in orthopedic and gastrointestinal surgeries, the University of California at San Francisco is the first to receive IRB approval for use of Google Glass during cardiothoracic surgery. Already, Pierre Theodore, MD, a cardiothoracic surgeon at UCSF, has performed 10 of 15 planned surgeries using Google Glass.

Image Handling
Such is the interest in Google Glass that last week Theodore was a star speaker at Salesforce.com's "Unusual Thinkers" annual conference track, and he spoke to a packed house of several hundred.

Theodore showed a photo of one of UCSF's most advanced operating rooms, and noted with some irony that the 48-inch monitor provided for surgeons to review radiographic images was in a corner of the operating room, behind two anesthesia monitors and a storage unit. "It's not pointing towards the surgeon, so its overall accessibility at the point of care is limited," Theodore explained.

To use Glass, Theodore's team transferred these images to a secure Web site, taking care to remove all personal health information from the images before transfer. At a surgeon's voice command, Google Glass displays the image.

"We did a series of dry lab experimentations to demonstrate that hand-eye coordination and the distraction using the Glass was minimal, and that the images could be readily brought up and removed from the vision of the surgeon," Theodore says. "We sought limited use in a single specialty for the first pilot trials, and we set certain metrics and aims."

Wi-Fi and Privacy Considerations
Among the early findings: operating rooms contain lots of equipment that interferes with Wi-Fi. Google Glass depends upon Wi-Fi to receive data, so data transfer protocols may need to be more forgiving, and the need for a more robust Wi-Fi infrastructure is clear. (That's a subject I'll write in another column.)

It's clear that it's still early days for this technology. Technicians are required to magnify images. "Down the road what will be important is the hands-free manipulation, so no additional technician will be required to project the images," Theodore says.

Despite the initial security precautions already taken, Theodore is concerned about Glass data that lives in the cloud, and moves over the Internet. "A lot of this information is actually transferred over networks, of which certain portions of those networks can be less than perfectly secure," he says. "That of course becomes more and more important as we think about transferring information over a whole variety of wireless networks."

A Distraction?
The potential for Google Glass to be a distraction in the OR came up during the audience Q&A afterward.

"It's a really important question, because, in fact, it can potentially be extraordinarily distracting," Theodore says. "The advantage of Google Glass, at least as we've designed it, and used it in our early implementation, is that it's a voluntary decision to have the image actually show up in the field of vision, which means that when the Glass is off, it's virtually as though you're just wearing your glasses or your contacts or what have you."

So, at the moment a surgeon activates Google Glass, "you have made a frank decision that you wish to cognitively turn your attention away from the patient in front of you to the image that's displayed within your field of view, without needing to leave the operating table or in some cases even leave the operating room to see the X-rays elsewhere."

Another questioner brought up privacy and security again. "Largely the data right now does have to transfer outside of the hospital before it ends up coming back to the Glass itself," Theodore says. "So the way that we've worked about this, and the way we introduced this to our IRB, was to anonymize completely all of the data, so in principle there's no patient identifying information – names, birthdates, what have you – that can be identified in the information that's transferred out onto the network. But your point is well taken.

"Certainly as you consider trying to expose the entirety of either the medical record or a digital radiographic archive, it will be all the more important that the security protocols be essentially watertight."

Speech Recognition Needs Work
Lastly, Theodore was asked what was tops on his wish list for improvements.

"From our initial pilots what I would say is that the speech recognition element of the Google Glass as it stands is extraordinarily rudimentary," he says. "With all due respect of course to the amazing work that's been done, one could certainly imagine a far more robust speech recognition system that allows a clinician really to interface much more with the content of the Glass.

"I imagine that it's going to come down the line and we have coders at UCSF who are helping us develop that at present, but I'd say, improving speech recognition would help."

Whichever way it plays out, it seems that devices like Google Glass will inevitably become another indispensable tool in healthcare. Theodore noted that doctors already use head-worn lenses for image magnification, and that Google Glass is "not too big a leap" from that.

I predict it won't be that long before the use of Google Glass in medicine will no longer be news.