July 29, 2015
Written by Special Guest Blogger Dr. Yauheni Solad, Yale New Haven Health System
We live in an exciting time. Evolution of cloud computing coupled with new ways to access and interact with cloud data via Smart Devices has created unprecedented environments. This has ignited changes in the way we practice Medicine and provide care.
In this post I’ll try to review future trends and directions where I feel wearable technologies can provide benefits in healthcare.
1) Point-of-care wearable devices
Every healthcare provider needs quick and reliable access to patients’ medical records. If you add a transcription service and a reference source with current guidelines and recommendations, you’ll probably save every provider several hours a day.
Google Glass gave us hope that a wearable point-of-care device that does not distract the practitioner from the patient is not remote science fiction. As mentioned in my previous posts, Google Glass unfortunately was not ready for primetime. The good news is that Google Glass re-ignited interest and facilitated a road to market of a whole breed of smart devices, from similar Smart Glasses to Smart Watches, Smart Lenses, etc. Therefore, maybe, a good and reliable point-of-care wearable device is not so far away after all.
Ideally, I feel that smart devices will be useful if they can provide the following capabilities:
- EMR (Electronic Medical Record) data retrieval – Sounds easy, but it is actually much more complicated than you think. EMR has a lot of information, not all of it is relevant or easily displayed on a small screen. Given that efficiency of information retrieval is expected from Smart Devices, additional efforts to transform medical records to easy consumable extracts is required. Who will do it? I don’t have an answer now, but Artificial Intelligence will likely play an important and large role. Technically remote assistants can do it also, but to me, the introduction of another human layer will just increase the risk of errors. For now, even a partial EMR data extract, like current medications, problem list, allergies, etc. will be helpful for first time responders and even Emergency Department providers. Ultimately, we should achieve full EMR access.
- Point-of-care decision support – For me, one of the most intriguing use cases. Let’s put aside that we don’t have many good, actionable, and evidence-based guidelines, which can be easily transformed into a set of rules, and imagine that available knowledge is great and completely ready for widespread adoption. How will we support the implementation of these guidelines? Currently, for example, decision support can provide you with alerts while you work on documentation, or enter orders. Unfortunately, it’s not always the optimal time for an intervention. Not all providers write notes directly after the encounter, so for example, this colonoscopy reminder may be a few hours late. Moreover, this is a relatively easy problem compared to significantly more complicated treatment algorithms. I agree it is great if you as a clinical provider can remember everything but unfortunately, it is not always possible. Naturally help from decision support, based on current evidence and guidelines especially at the point of care, will be extremely helpful (as long as it provides relevant information, not annoying and useless alerts as some of the current EMR systems do). In my opinion, Smart Devices are ideally suited for this. Gentle, context-aware reminders from EMR system to a practitioner’s smart device (Glass, Watch or something else) will play the role of well-trained assistants with a deep knowledge of patient and current treatment guidelines.
One of the most natural implementations for Smart Glasses is the ability to share your point of view. This can provide huge benefits in medical education and remote patient follow-up. One small example, when you cover nursing home patients for your group you sometimes have to make a decision based solely on a nurse’s description and available data (plus Vitals or Labs if available). Imagine if you can see the patient from the nurse’s point of view; guide her to perform the required physical exam (maybe even use a Smart Stethoscope to share heart and lungs findings). I think the latter case will make you, as a physician, much more comfortable in making informed clinical decisions.
Now, add the ability to see patients in the remote location or help doctors in training with specialty coverage after hours. Honestly, this kind of application can significantly improve the quality of care we provide.
Lastly, imagine disaster medicine application when highly trained providers from all around the World help to guide first responders to address urgent staffing shortages and needs. It would be amazing and has the potential to save many lives.
3) Remote Health Monitoring
This use is more patient-oriented. In the era of Affordable Care Organization, we are trying to extend the reach of medical care beyond the walls of hospitals and offices. To me it’s extremely clear – patients would prefer to stay at home if they can get the same level of care. It’s not always possible in a case of acute illness. For chronic care, study after study shows that patients actively engaged in their care have better overall outcomes. Soon, this will translate not only to a higher quality of care and patient satisfaction, but also to real financial benefits for health systems.
As a physician I would like to have as much relevant patient data as possible. This can help me to make better clinical decisions, adjust treatment plans earlier, and prioritize patients based on severity. Currently, we have smart bracelets, watches and other health tracking sensors. Now add sensors embedded in your bloodstream, or into everyday devices with the Internet of Things (IoT) and you will easily end up with billions of records a day. The only question is: “How to deal with all this new information in a setting of already existing informational overload?” Unfortunately, many physicians are already getting more information than they can potentially analyze. This is a growing problem, which can potentially become a legal one if you miss something, which requires emergent medical attention. This is exactly the problem we are trying to solve at CureCast (www.curecast.com ). Our goal is to provide clinical providers with a set of tools to reliably aggregate, analyze and react to the massive amount of personal health data that is becoming available.
Overall, I believe that it will not be impossible to provide high quality care in the future without remote health monitoring (via smart devices). Healthcare as a continuum, with close integration of providers and systems, is our ideal future.
4) Augmented reality devices
Several years ago, augmented reality seemed like something from science fiction. But now, with Microsoft HoloLens and multiple other Smart Glasses, it is not as remote as we initially thought. Just to make it clear, in this post I refer to augmented reality as a set of features which provide a visual overlay on top of our regular visual world. Why? Mainly because clinical application is different. As a practicing provider, I do not see Microsoft HoloLens as a point-of-care device, neither in hospital nor in outpatient settings. The whole notion of point-of-care wearable technologies implementation is to focus more on patients. It is still debatable how patients will react to a provider wearing Smart Glasses, but one thing is clear to me – a provider cannot wear a full set of sci-fi looking glasses during the encounter. Visual contact is extremely important for clinical care, and devices which obstruct direct visual contact will be a downgrade from an already broken system where you constantly engage with a monitor, not the patient.
Augmented reality uses really excite me as we truly are trying to build a new dimension. I feel medical education will be the main use in healthcare. I wish someone gave me something similar when I had my pediatric surgery training. The ability to provide context-aware step-by-step recommendations is invaluable, especially for providers who do not perform a particular procedure very often (doctors in training or even doctors in remote locations with limited support). Radiology and the overall area of medical imaging can receive a huge upgrade with augmented reality visualization capabilities. Imagine reviewing all the available images combined in a single 3D model. To me it’s truly amazing.
Also, don’t forget about the overlap with telemedicine applications we discussed earlier. I feel augmented reality devices may be a little better suited for the remote provider lead consults/supervision, especially if real-time feedback on procedure performance is required (bigger screen with real reality augmentation capabilities is just much better suited for this than a small screen on the edge of your eyesight).
Wearable technologies can have a bright future in medicine. But we should not forget that every technology is just a tool that can help to provide better care. Overall, ultimate success will depend on our ability to effectively integrate these tools in our clinical workflow. Good technologies should be invisible and at the same time indispensable. Transition will not happen overnight, but if we keep our focus on patients, I’m sure we will have better and safer healthcare coupled with happier clinical providers.
Yauheni Solad, MD, MHS is Medical Director of IT for the Yale New Haven Hospital System, a Postdoctoral Fellow in Medical Informatics at the Yale Center for Medical Informatics, and the CEO of Curecast Inc. Dr. Solad will speak at EWTS ’15, sharing his insight on the technical challenges facing enterprise adoption of wearable technology. Learn more about him here and here.