March 19, 2016
We recently sent over some questions to Dr. Peter R. Chai, an emergency medicine physician and toxicology fellow at UMass Medical School. Read his answers below, and catch him speaking at EWTS East in Atlanta this June.
BrainXchange (Q): To begin, how about you provide us with a little background on yourself and your career. What do you do at UMass Medical, and how/when did you first learn about (or encounter) wearable technology?
Dr. Peter Chai (A): I am an emergency medicine physician and fellow in medical toxicology at the University of Massachusetts Medical School. I became interested in working on wearable technology during my residency training at Brown University, where I led one of the first emergency medicine teams deploying Google Glass in the emergency department. I found that we were using outdated technology in medicine (writing paper charts, using pagers) and we really could harness the revolution in wearable devices to improve the ways in which we deliver healthcare to our patients. Given the variety and large number of wearables available, we knew that we needed to rigorously evaluate these wearable devices instead of buying into the hype.
From my research (published in JAMA Dermatology) at Brown, I continued to UMass to pursue a fellowship in toxicology because patients with substance abuse are in need of and keenly interested in technological innovations to help improve their health. I work with an amazing team of physicians and researchers at UMass who are NIH funded to solve substance abuse problems and HIV medication adherence through advanced technology. I am interested in how we can leverage advanced devices—ingestible biosensors, wearable biosensors, augmented reality and virtual reality—to improve the ways in which we deliver health, and coordinate care in difficult patient populations.
Imagine this: You work with a patient population that, because of their disease, may have social stigma that prevents them from coming to clinic appointments, or substance abuse problems that may prevent them from remembering to take medications that are desperately needed to prevent progression of their chronic disease. How do you improve their health? How can you monitor them from afar, and deliver care wherever they are? How do you integrate technology into their lives in a manner that doesn’t become a patient interacting with the technology, but just daily life? These are the things we are trying to solve.
BrainXchange (Q): When did it become apparent to you that wearable technology could benefit your work?
Dr. Peter Chai (A): I work in the emergency department. Every day, we see sick patients that may need immediate specialty consultation at the bedside. I realized quickly through working in the ED, sometimes we just wanted our consultant to be at the bedside with us in order to see the patient and make a decision together. Playing phone tag through an antiquated pager system was not ideal. When Google Glass was released, we quickly recognized that the ability to project a first-person view of a sick patient to a consultant was a perfect way to streamline and improve bedside care. Added to that, the benefits of a head-mounted wearable—unobtrusive, hands-free, and ultra-portable—were obvious. Using a simple device like Glass, we could transform any emergency department into a state-of-the-art telemedicine suite by putting on the wearable, and walking into the room.
On the other side, as a toxicologist, we frequency get phone consults on sick, poisoned patients, and wish that we could just see them at bedside in order to understand the description of the patient. That’s why we decided to use Glass at UMass- so we could improve our bedside consultations.
BrainXchange (Q): How do you use wearables in the workplace? Describe for us your experience with Google Glass.
Dr. Peter Chai (A): We currently use Google Glass, and have active research involving a digital pill that directly measures medication adherence and a wrist-mounted biosensor to discover signals of opioid overdose and tolerance. We deployed Glass at UMass starting in 2014 in our toxicology consult service. Residents who rotated through our service used Glass while evaluating patients at the bedside and as toxicologists, we were able to observe the interview, physical exam and basic vital signs remotely. We were able to interact with our residents through Glass, asking them to take photos of relevant materials related to a poisoning, or prompting them to ask additional questions that they may have forgotten. In the context of a research study, we found that we were able to improve our diagnostic accuracy using Glass, and change our projected management. These results were published in the Journal of Medical Toxicology.
BrainXchange (Q): How did you partner with Pristine to get Google Glass at UMass Memorial?
Dr. Peter Chai (A): Simple. We had an awesome idea and a willing, innovative partner. We also have very innovative, future-oriented IT staff at UMass. Pristine was able to help us establish the necessary wireless connections that would avoid interference with other medical devices, while allowing us to get high-fidelity streaming video.
BrainXchange (Q): Did you encounter any major challenges in implementing the technology? How did your colleagues, residents, and patients like smart glasses?
Dr. Peter Chai (A): There were many initial challenges deploying a novel wearable device in a hospital. Correct permissions, HIPAA compliance, fidelity of wireless reception are only a few of the issues that we had to rectify. Overcoming these difficulties required a multidisciplinary team comprised of physicians, security staff, industry leaders and information technology specialists. Ultimately, when Glass was deployed, our colleagues were intrigued and excited by its prospects. Residents on our service enjoyed using it–from an academic perspective, they were able to benefit from direct, real-time supervision by an experienced physician in an unobtrusive manner. We were using Glass in a time when there was a lot of press regarding privacy issues. Interestingly, patients loved that we were using Glass to bring a consultant virtually to their care. Instead of entering a room and being overwhelmed with obstructive technology (computers, electronic charts), we were using technology to interact with the patients. They saw us actively looking at them, aiming a head-mounted camera at important aspects of the physical exam to improve their care, and they overwhelmingly preferred it when compared to the standard phone consultation.
BrainXchange (Q): Rate your experience with Google Glass from 1-10. What was difficult? What surprised you? What worked especially well, and what needs to be improved?
Dr. Peter Chai (A): Glass was surprisingly simple to operate. Its voice commands and gesture commands are intuitive. Wireless connection and generating a seamless video stream through Glass are difficult, but can be overcome with a strong industry partner like Pristine. Improving battery life, wireless signal, CPU power will open the door to high-fidelity use of Glass, improving the current applications we have for it.
BrainXchange (Q): What are some applications for smart glasses / AR glasses that you would like to see in the future, in your own job as well as in the general medical/healthcare community?
Dr. Peter Chai (A): I think Glass and other AR devices have the potential to replace traditional methods of communication in medicine. A busy emergency physician can leverage AR to have a general view of sick patients in the ED as they are moving through other patients in the department, get notifications of sick patients coming by ambulance, and notifications of critical results. In addition, a head-mounted camera like Glass allows a physician to send video of physical exams to a consulting physician, or if needed, beam a specialist into the room (virtually) for a time-sensitive consult. For the surgeon, Glass could function as a heads-up notification of an operating room schedule, project critical imaging intraoperatively or function as a first-person view when an intra-operative consult is required. There are so many exciting applications for AR devices which will require rigorous research and evaluation to determine their true value.
BrainXchange (Q): Describe the ideal pair of smart glasses, or ideal piece of wearable technology, that would revolutionize your line of work.
Dr. Peter Chai (A): The ideal piece of advance technology that would revolutionize healthcare is probably the ability of our innovation to move beyond wearables. Creating a technology that allows us to get real-time, accurate, actionable data from patients without asking patients to do anything extra is an exciting prospect that the revolution and innovation of wearables will lead. Technology is only useful if those who have to use it—patients and physicians—will actually accept and interact with technology. So instead of a pair of smart glasses or a wearable device, my ideal piece of technology is one that I don’t even know is there, yet is working in the background, giving me the data I need to do my job.
BrainXchange (Q): Have you explored any other wearable devices? What has been your experience with those wearable technologies? Which devices can you see coming into your workplace in the near future?
Dr. Peter Chai (A): We currently work with Google Glass, the Empatica E4 (a wrist-mounted research-grade device tracking temperature, accelorometry and electrodermal activity), the eTect ID-Cap (an ingestible biosensor that can be coupled with a desired medication to create a digital pill that directly measures medication ingestion events), and a variety of other devices. We have some cool ideas up-and-coming with Sony Smart Glasses, drones, and Oculus Rift, among other devices. We’re always looking to collaborate and think about how these devices can change how we work and how patients interact with their health.
BrainXchange (Q): Do you use any personal wearables while not on the job? A fitness tracker, Apple Watch?
Dr. Peter Chai (A): No, for all the wearables researcher I am, I love the old school automatic movement watches. That’s what I wear, although I do use a Garmin Forerunner when I run. Most recently, I’ve started using the Bragi Dash, a set of completely wireless headphones that has a built-in heart rate monitor and step counter (I’m my own guinea pig trying to figure out how we could use this in our research studies). Pretty cool stuff!
BrainXchange (Q): Describe for us – or rather imagine – the future of wearable technology in emergency medicine. What’s going to happen on this front in the next year? How about in the next 5 years?
Dr. Peter Chai (A): Wearable technology is going to allow us to transition healthcare from the office, the hospital, the clinic to the patient’s home. We will advance our ability to detect disease before it occurs, predict patients who are at risk through advanced biosignatures, and manage potential complications prior to them occurring. In patients who need titration of their medications, or those who are ill and need physician evaluation, we will be able to manage at home some of the conditions that currently require patients to come to the hospital. In the next 5 years, I hope that we will continue to develop wearables until they are no long wearables or technology. Instead, they will just be a part of our life. The ultimate goal of technology should not be to showcase its use, but instead become so seamless that no one thinks of it as technology.