Nahum Kovalski

Google Glass in the hands (and eyes) of doctors

An 'early adopter' discusses how the new in-the-eye computer system can help save lives
Participants wearing Google Glass during Google's I/O Developers Conference in San Francisco, May 1, 2013. (photo credit: Justin Sullivan/Getty/JTA)
Participants wearing Google Glass during Google's I/O Developers Conference in San Francisco, May 1, 2013. (photo credit: Justin Sullivan/Getty/JTA)

For those who are unfamiliar with the technology called Google Glass, it can be summarized as a being a computer interface that sits in front of your eyes, on a pair of glasses. In fact, such interfaces exist in many forms and have been around for many years. Google Glasses (GG) are from the first attempts to make this technology an option for the general public. Ultimately, this is all part of the concept of “computers everywhere” and adds to the process by which the need for using a desktop to perform common tasks (like receiving a message, sending a photo, and so on) will be eliminated.

Google has actually been very slow to release GG to the public (it is now available in the US for purchase by anyone). Initially, Google very much wanted to build up a set of apps and an “ecosystem” so that the final release of version 1 of GG, would already have many tools and a clear set of uses. One of the early adopters of GG were physicians, and GG was very famously used to record an operation, for the purposes of sharing the experience with medical students and colleagues. Click here to read about one perspective on the outcome of this whole experience.

Early adoption means that the developers and users are both involved in actually using a technology for the first time in real world experiences. It is understood that what is learned from early adoption will likely significantly change and/or augment the service or device being tested. Unfortunately, people sometimes jump to conclusions and immediately rule out any value to the service and/or device based solely on the early adoption experience. Sometimes this is borne out of a true desire to protect the public. And sometimes, there is a personal agenda that challenges the value of the service and/or product.

Years ago, I was at home and heard my then Nokia phone ping, indicating the receipt of an SMS. What I had actually received was an MMS, which included a photo of 3 people at a party. I initially thought that this was cute but not much of value, at least to me. It then struck me that despite the small size of the screen and the resolution of the image, I was still able to discern a great deal of detail from the image. This experience coincided with the point in the development of my EMR at which I had built a web interface for viewing xrays. I set up a test environment and sent an xray, as a link to a web site I built, to my phone. And lo and behold, I saw the fracture that was on the film. I laughed out loud. I had read about attempts at providing doctors with a streamlined approach to viewing medical information remotely. But cellphones were relatively new, and smartphones at this time were not in use by the general public. Still, I built a new system that offered doctors, who would call me for a consult, the option to have me look at the xrays of the case, no matter where I was, and no matter if I had my laptop with me.

Amazingly, even in this “early adopter” version, I was able to see enough detail to offer my opinion of the xray in most cases. However, it was clear to me that other doctors would not be comfortable with this version of the (small) viewer. I waited patiently for the first smartphones to reach Israel and I was one of the early purchasers of a Windows phone from the HTC company that provided a full web experience and a much bigger and higher resolution screen. At this point, the quality of the image nearly matched that of my big screen at home. Over time, smartphones (with the spread of the iPhone) became much more commonplace and the perfect storm of technology had finally arrived. It was now possible to build an interface that would allow doctors in one of the clinics to easily type a question and include a link to the xrays, and/or ECG of the patient. The remote doctor could now easily view this information via his or her smartphone and type back a response. This revolutionized the way in which we provided remote oversight and assistance to the on site physicians. Over time, I expanded the service and finally allowed physicians to send photos of a suspicious skin finding or rash or injury, to the remote consultant. Once again, this offered a significant jump in the power of the remote consultant. I should note that other systems around the world were providing variations of this service to medical staff. But our complete package, which was most notable for its ease of use, was (and still is) unique amongst electronic medical records.

Along the way, I discussed this new service with senior physicians in radiology and emergency medicine. Multiple times, I was literally laughed at, and told that the images would never be of sufficient quality to make a diagnosis. At one point, I and colleagues published our experience with using smartphones for such remote viewing of xrays, but still, colleagues laughed at the service, saying that it would not be practical for a long time.

Once I had the final version of the system in place, along with all of the consultants having smartphones,. this service became an essential part of the day to day medical work in all of the clinics. It was rated as one of the most innovative and valuable services by my colleagues and by visiting physicians who specifically came to see it in use.

There is no question that the early adopter version of this service was effectively no more than proof of concept. But what it did was change a perspective such that the potential was not only realized, but eventually fully implemented. Anyone who laughed at earlier versions of this service simple lacked the vision to appreciate the potential which would be realized in just a couple of years after the first trials.

When looking at GG, specifically in the medical arena, the only criticism that should be shared is constructive. Of course, it is people’s right to say anything they wish. However, if they have sufficient vision to recognize the potential of GG in medicine, then they should be seeking to identify problems only for the sake of having these problems addressed by Google, to make versions 2 and 3 and later of GG, more effective in medicine. To be a naysayer when this is clearly an early adopter version (despite being offered to the general public), is simply shortsighted. And I would hope that doctors would have already learned never to underestimate the power and speed of improvement in the technological spheres.

A version of GG, that will be available in the coming years, will answer all of the issues that the naysayers have raised. And it will become such a valuable and critical tool, that NOT having it will impede the surgeon’s (and all physicians) ability to perform their tasks as best as possible. Before I left my previous place of employment, we already had plans for being early adopters of GG, and for integrating it into our EMR. And I can comfortably say that we would have found the way to make it a valuable tool to the physicians who were using it. Unfortunately, I assume that now, some other medical service will need to pick up the gauntlet to finally create a GG service that is deemed essential by the medical community. But to all the naysayers who will eventually be proven wrong, I hope that the experience with GG will finally demonstrate that (a) technology is always advancing and (b) it is incumbent on all physicians to have the vision to find ways to make new technologies work in medicine, in order to improve the universal quality of care.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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