At Partners HealthCare's Connected Health Symposium last week, Beth Israel Deaconess CIO and SVP Dr. John Halamka led a small panel discussion about the rise of wearables in healthcare with a particular focus on the early days of Google Glass adoption by doctors. In his introductory remarks Halamka briefly laid out a vision for why data from patients' wearables will become increasingly important to healthcare providers.
"It's really because in Boston today at Beth Israel Deaconess we have $1 billion in terms of global capitated risk and contracts," he said. "Fee for service is dying. We are now reimbursed for keeping you healthy. It is far better for you never to come for a readmission to the hospital and rarely come to the emergency department. We want you to come to the right place of care at the right time. If we can treat you at your home and prevent you from becoming sick, we're looking at continuous wellness rather than episodic sickness. That's actually better aligned by our economic incentives... It is actually interesting for us from a big data perspective to look across our population and use patient generated health care data and use that in care management and care planning."
Halamka noted that the recently acquired Continue Health Alliance did not succeed -- unfortunately -- in its quest to convince home health device makers to all adopt standards that would make universal data aggregation from the devices easier. But with HealthKit, Apple may have largely succeeded where Continua couldn't:
"You cannot buy 20 devices at Walgreens and know they will all work on the same platform," he said. "So, alas, what we are left with is heterogeneity. What Apple has said, and Samsung has said and others will do, is that we'll create middleware that will gather data from all the devices in the home, put it into a normalized attribute value pair set and then, with certain patient consent controls, enable the patient to share it with apps. ... So HealthKit is simply a mechanism by which you gather all the devices you own into a single container stored on your mobile device and then enable you to share that data with apps, which could send that data to EHRs, PHRs, third party decision support systems, research or clinical trial systems, all kinds of various places."
Halamka went on to imagine how the Apple Watch might be a great companion device -- better than a smartphone since it's on the wrist -- to Proteus Digital Health's intelligent medicine system.
But as noted above the meat of the session was really a discussion of Google Glass use by healthcare providers. Halamka's panelists were Dr. Steven Horng, who is the emergency department lead for the Google Glass Project at Beth Israel, and Pelu Tran, Co-Founder and Chief Product Officer for Glass-focused company Augmedix. Halamka kicked off the discussion by suggesting that Google Glass might be an ideal device to implement Atul Gawande's famous Checklist Manifesto for doctors -- especially when a surgeon is scrubbed in and not able to touch a smartphone or tablet to review a checklist.
"For those of you familiar with work of Atul Gawande and his Checklist Manifesto: What if in the course of delivering care or a surgery the checklist via F-16 heads up display says: 'Today it is the right kidney that is being removed. That's the right kidney.'"
Halamka's colleague Dr. Steven Horng was upfront about his team's experience implementing Google Glass in the emergency department. While Glass and wearables like it have great promise in clinical settings, Horng said he's discovered some technical limitations.
"The first is processor power," he said. "This isn't a device that was meant to be worn as a heads up display that's on 24/7 that's constantly looking for voice commands. That's not what Glass was built for, it was meant for episodic use. Using it in this way drains the device like no other. Glass [when used by consumers] is meant to have a battery life that lasts for quite a while, for us it lasts maybe two hours, maybe one. If you turn on all its features, probably less. You can certainly add on a battery pack, and that's what we did, to get us to 12 to 14 hours. But then you have the processor going all the time and with external charging, this makes for a very, very hot device that is perhaps sometimes dangerous."
Horng also said the device sometimes has problem connecting to the facility's WiFi network even though hospital staff don't have problem connecting to it with other mobile devices.
"Lastly, the WiFi power on it is meant to go to a hotspot on your phone or in your home, in a enterprise situation, even though we have no coverage issues for our other devices -- like our iPhones, iPads, or workstations on wheels -- we do have some unfortunate coverage issues for Glass."
Augmedix's Pelu Tran said his customers have had a different experience from the one Horng described, but Tran noted that his company's Glass app is for ambulatory settings not emergency rooms.
"We have been able to guarantee all our customers 99 percent up time and I don't think we've had a single physician decide to not use Glass because of discomfort or any issues," Tran said. "I definitely agree that [battery life] is a major concern -- well, not major -- but a concern, and one that is surmountable. I like Dr. Halamka's analogy that Glass is currently at iPhone 1 not iPhone 6. Glass is definitely at iPhone 1."
Augmedix has deployed Glass at a commercial scale at three major health providers, including a Dignity Health clinic in LA. Augmedix says its users have seen more than 20,000 patients across 17 clinics in the past 18 months.
"I think that rumors of Glass' demise have been greatly exaggerated," Tran said.
Halamka summed it up nicely: "Google Glass is an early device that was originally designed for other uses and now we are pushing it to its engineering limits... I think our conclusion is these are early days but these are devices in real production. We are able to demonstrate real utility, although we are encountering some limitations."