Karandeep Singh, MD, Clinical Fellow, Renal Division
A wearable computer in the form of eyewear, Google Glass, often simply referred to as “Glass,” has become quite the spectacle in academic medical centers nationwide. At BWH, Glass has found a home in the hands and on the face of nephrologist Karandeep Singh, MD, who is working to leverage the innovative eyewear for the electronic health record. His goal is to harness Glass’ capabilities to improve information access and doctor-patient interaction. BWH Clinical & Research News sat down with Singh to learn more.
How did you become interested in Glass?
When Glass was first released last year, people in the medical community were using it in the operating room, as a way to teach students, or to get second-opinion consultations. In my world of internal medicine and nephrology, we deal with clinical data all day long, but I didn’t see anyone at that time using Glass to manage clinical data. Here was this device that could wirelessly connect to the Internet and display information on an as-needed basis. So I thought Glass would be a remarkable tool to interact with electronic health record information.
What impact will Glass have in the clinic?
Glass has a significant potential to change physician work flow and positively impact patient-physician interaction. Currently, physicians have adapted a work flow around the traditional electronic health record. When you walk through the hospital door, you spend the first hour looking patients up on the computer before ever stepping foot in the patient room. This is partly because you don’t have access to the information at the bedside where you need it most.
By having access to information at the bedside, a doctor would not necessarily need to print labs or review medication lists in advance. Instead, the doctor can pull up relevant patient information onto Glass’ screen while interacting with the patient.
Nurses and allied health professionals face similar challenges. Nurses in particular are responsible for keeping a constant eye on patients. Having the ability to chart vital signs and assessments at the bedside may change the way they spend their time, hopefully resulting in fewer interruptions in patient care.
What steps are being taken at BWH to integrate Glass with the electronic health record?
We are undertaking a security review to make sure we can interface with clinical information on Glass in a safe, responsible way that protects patient privacy. We will also need to figure out best practices for the technology and support when implementing Glass in the hospital. There is a crucial research piece to this project as well. We have applied for funding to study patient-doctor interactions that occur when using the Glass-based electronic health record.
Where should Glass first be implemented at BWH?
Anytime new technology is implemented in a clinical setting, it is wise to start small so that unintended consequences can be addressed quickly. Like other institutions that are using Glass clinically, we anticipate that we will need to educate patients about how and why we are using Glass as part of the clinical encounter.
We are planning to pilot the Glass-based electronic health record in the inpatient dialysis unit for a number of reasons. Dialysis patients are medically complex, there is a large volume of information being generated throughout the day, and for each patient, there is a fixed set of information that must be reviewed daily to provide the best possible care.
What are the challenges of using Glass in the clinic?
Two major concerns are physician distractibility and absence of a shared screen. When implementing Glass, we have to make sure that the interface in place allows doctors to maintain eye contact with patients to preserve the patient-physician interaction. The interface needs to be invisible most of the time and visible only when prompted by the physician or for life-threatening medical emergencies. Etiquette will also need to be in place that allows doctors to ask for permission to view patient information in the room that they would have typically viewed prior to entering. The absence of a shared screen means that physicians will need to communicate what they are seeing to the patient when they are referring to the medical record.
Also when using the speech recognition feature on Glass, there is a privacy and noise pollution piece we need to address to make sure doctors are using it in a way that is not infringing on patient privacy. If there is another patient next door or staff walking by, the interface needs to be flexible enough to allow access to information in multiple ways so that you don’t have to use speech recognition in a setting that may not be appropriate.
Where do you see Glass having the most impact?
The ability for new or existing technology to make an impact is probably highest in rural and underserved areas. When there is a relevant problem that local experts cannot solve, they can use Glass and other technologies to refer to someone else who is more experienced. For instance, a first-line responder or emergency room doctor wearing Glass may get a second opinion from a specialist who is looking through his eyes, seeing the patient and giving feedback on how to proceed.
How did you become interested in information technology?
I began programming when I was 9 or 10 years old. My dad is a software developer and automotive engineer in Detroit, so my interest in technology began very early. When I was at the University of California, Los Angeles, as a chief resident in Internal Medicine, I developed a mobile Web platform for education that is currently being used by several departments throughout the hospital. We piloted it in the Department of Internal Medicine, and now it is being used hospital-wide to interface with information and for mobile paging. It is also a way for residents in different departments to share educational materials and report quality and patient safety issues.
I also developed the world’s first iPod email synchronization software for Windows, allowing users to download emails to their iPod before the availability of Internet-connected iPods.