monocle Smart glass for nurses
Final report - Advanced Concept Design
Jan Frielingsdorf 4542592 | TU Delft coach: Erik van Kuijk | Company coach: Dr. Elif Ozcan | Group 5B | 03-02-2017
PROJECT: NOISE FREE INTENSIVE CARE UNIT 1 2 FINAL REPORT ReportContent Structure
Introduction 4 Problem definition 5 Assignment 5 Approach 5 Solution 5 Initial design vision: Silent guidance 6 Research and relevant conclusions 8 Benchmarking: Existing and emerging solutions 9 Technology research: bone conduction 10 Benchmarking: Smart glasses 12 Monocle: Concept explanation 14 Details: Components and costs 21 Easy tilting mechanism 24 Costs 24 Evaluation: User interview and client feedback 25 References 30 Appendices 32 Appendix 1: User evaluation questions Appendix 2: Report: The use of smartglasses in healthcare
PROJECT: NOISE FREE INTENSIVE CARE UNIT 3 Introduction
4 FINAL REPORT Problem definition Approach
One of the most prominent problems of Intensive In the first half (team-based), an analysis of ICU Care Units for staff and patients (ICUs) is the technology development and hospital culture, noise caused by excessive occurrence of alarm researching multi-sensory information design sounds from machines that constantly have to followed by research into wearable devices monitor and support the patient. and emerging technologies helped to create individual design visions. The main cause for the high frequency of alarms The second half (individual) consisted of solution are false alarm rates that can be as high as benchmarking, choosing a final design concept 70% [1] and in some cases even 99% [2]. This followed by an extended technology research causes the hospital staff to become desensitized and a final user evaluation. to alarms that can be critical. This behaviour is the typical definition for a phenomenon known as alarm fatigue [3], which was the number one health technology hazard in 2015 for the fourth Solution consecutive time [4]. “Monocle” is a smart glass for nurses that provides Furthermore, hospital device manufacturers quicker access to information, transmitting any are obliged by law to equip their products with device sound only to the responsible nurse - to auditory alarms [5] - exposing everybody in an reduce the noise in ICU’s. Quicker and mobile ICU to the noise instead of only alerting the access to information prevents stress, facilitates responsible staff. work-flow and enables nurses to spend more valuable time at the patient’s bedside.
Compared to existing smart-glasses, monocle Assignment is specifically designed for the unique context of a hospital environment, taking into account Erasmus MC hospital asked for concepts for a hygiene, ergonomics, durability and useful more silent ICU by optimizing monitoring and features such as voice dictation and barcode signalling from the perspective of the nursing scanning. staff and looking at wearable technologies.
PROJECT: NOISE FREE INTENSIVE CARE UNIT 5 Initial design vision: Silent guidance
The initial vision was to create an ideal work are promising solutions but rather belong to the This device was aimed to be designed for a future environment for nurses by turning a noisy, thus field of management and IT. context where ICU equipment regulations don’t stressful, environment into a calm and relaxing require open auditory alarms anymore to give one that increases the patient’s well-being and With nurses being the main target group for this a glimpse of how a worthwhile future can look chance for recovery as well. An environment with project, one of the solutions, however, stuck out like and to trigger ideas about which steps are no auditory alarms at all - at least none that can by suggesting silent alarms that selectively notify necessary to get there. be heard by everyone. single nurses only, thus reducing the overall noise level. The initial idea was a future pager in the form A report by Philips [6] on how to tackle noisy of a head worn device which should contain a ICU`s states the main problem being the many This approach sounded reasonable and suitable component that notifies the nurse and some false alarms and also suggests a combination of for Industrial Design and was hence turned into kind of display which lists and ranks tasks and approaches as there is no single solution to this the concepts main goals: designing a nurse- alarms. issue. wearable device for silent alarms to prevent desensitization, using clearly recognizable However, many of these solutions can‘t be related and distinguishable signals. Furthermore the directly to industrial design. Staff and patient device should facilitate nurses workflow and education or filtering algorithms, for example, provide guidance after alarms are triggered.
Desensitization Alarm Fatigue NOISY CALM Stress
6 FINAL REPORT SILENT GUIDANCE
PROJECT: NOISE FREE INTENSIVE CARE UNIT 7 Research and relevant conclusions
8 FINAL REPORT Benchmarking: Existing and emerging solutions
Ascom: Unite Connect [7] Philips: alarm management solution [8] Vocera: Alarm Management System [9]
A solution designed for standard patient Designed to complement staff workflow, help Aimed to reduce alarm fatigue and integrates monitoring systems which sends alarm lower the noise level and enhance patient care. with most industry-leading patient monitoring information to several devices (wireless handsets, It optimizes all problem causing points - from systems. It enables prioritization of alarms and pagers, smart devices and text displays.) The patient sensors and monitors over IT to mobile sending only actionable alarms to the right system includes alarm filtering – categorizing solutions, offering reporting and analysis to recipient device of choice, including smartphones, and relevant conclusions and reducing the number of alert messages manage alarms and providing mobile (-phone) tablets and the Vocera Badge. The entire care being received by clinicians. Comes with a secure access to patient data. Software lists the number team can securely text each other in response messaging app and features like automatic and occurrence of alarms, the caregiver response to an event. The system comes with “native escalation and forwarding alarms if a nurse and response times. This data can be used to push technology” for reliable alert delivery and is busy, which contributes to a safer patient adjust alarm parameters, improving protocols, improved security. environment. and balancing the workload among caregivers.
Conclusions cancel out false alarms, categorize true alarms Therefore, the to-be designed nurse wearable and notify nurses on their smart devices. should improve upon these aspects. • Promising system and software solutions for reducing noise and facilitating nurses workflow • These devices, however, still produce alarm It was further decided to design the nurse exist and are on the rise but are expensive and sounds that everybody can hear, and at least wearable for and within these solutions, take time to be implemented in the rather slow smartphones require both hands to operate, implementing their features to increase their developing clinical environment. which is impractical for the physical job of efficiency. This was considered suitable since nursing. Moreover, smartphones often don’t it would likely take several years for the above • These solutions come with great features to meet the specific requirements for an ICU, such solutions to become the standard - the same as hygienic and break-proof construction. applying to the developed nurse wearable.
PROJECT: NOISE FREE INTENSIVE CARE UNIT 9 Technology research: bone conduction
Bone conduction is a rather unknown Bone conduction headphones could also be phenomenon of receiving sounds via vibration used for nurses to differentiate between non- through bones, particularly the skull. urgent notification (vibration only) and urgent alarms (vibration + sound/voice). Bone Conduction bypasses the eardrums and bone conduction devices ,instead, act as the In order to validate and test these features, the eardrum. Such devices decode sound waves and wireless bone conducting headphone “AS600SG Transmitting sound via vibration through bone mass convert them into vibrations that travel to and Trekz Titanium” by Chinese company Aftershokz and skin instead of air. can be received by the Cochlea (inner ear)[10]. was purchased and testes with several people.
Bone-conduction headphones exist but never had a successful breakthrough since their audio quality usually never matches conventional headphones. Their biggest advantage, however, lies in the possibility to hear your surroundings since the ear-canals are not covered. This feature was found to be very useful for the ICU context since nurses could be solely exposed to sounds while still being able to listen to patients and co- workers.
Furthermore, bone conduction headphones would offer a hygienic solution for swapping devices between nurse shifts. Bone conduction headphones audio quality is sufficient to transmit voices of phone calls and alarm sounds that usually never require the same high audio quality as music. AS600SG Trekz Titanium
10 FINAL REPORT Conclusions
• The audio quality was surprisingly good - music as well as phone calls could be understood easily while still listening to you surroundings, thus making it suitable for an ICU environment.
• The sound leakage was perceivable but really quiet - presumably no other staff members would be able to hear a personal alarm in an ICU.
• The vibrations were noticeable (“tickling”) but not uncomfortable - creating and ideal side effect to attract nurses attention besides the sound.
• The headphones themselves were still comfortable to wear after 5 hours but the battery housing was pressing against the skull which should be prevented in the final product.
PROJECT: NOISE FREE INTENSIVE CARE UNIT 11 Benchmarking: Smart glasses
After the concept presentation it became clear at approximately 141% in 2016-2020 and grow to combine two concepts of a bone conduction from $2.34 Billion in 2015 to $8.13 Billion by headphone and a virtual reality lens into one 2022. Just recently, at the Consumer Electronics device that could fulfil the initial main goals: Show (CES) 2017 smartglasses were one of the selectively alerting single nurses while providing main attractions and several new models were features that facilitate and speed up their shown to the world. workflow. With many new models hitting the market, the Such a combination exist in form of so called differences between them grow alike. Some Google Glass smart glasses where Google Glass is probably smartglasses use voice control and integrated the best known example. Google’s research touchpads for control while others like the Epson product uses a small display to offer a quick BT-300 uses external handsets with a trackpad, glance at information while transmitting sound through built-in bone conduction speakers. Despite its initial hype, it never became a success for consumers due to Google’s missed chance of conveying it’s usefulness, its salience and privacy concerns about the built-in camera [11].
However, its usefulness for business, especially for the healthcare sector, was never doubted and various researches have been conducted that list smart glasses many benefits for healthcare [12].
Other companies, such as Vuzix and Epson also joined the race and produced smart glasses for business but ulimately want to pierce the consumer sector. A new report by market research firm Technavio [13] has forecast that EPSON BT-300 the global market for smart glasses will grow
12 FINAL REPORT battery and computing unit. Depending on whether the battery is integrated into the glasses frame or a handset, the usage time can vary by hours.
Most of the smart glasses feature 2 lenses while Vuzix also offers single large lens devices with a rotatable casing and different mounting options, claiming that their clients wished for such ergonomic changes [14].
Conclusions Vuzix M3000 • Smart glasses offer many opportunities for the healthcare sector in general, particularly for nurses. Their features can improve education, consultation, reading and accessing data, workflow and documentation for nurses.
• A rotatable casing similar to Vuzix M3000 is good for pushing the lens out of sight if not needed, for example, during a patient or family talk.
• A large display similar to Vuzix M3000 is presumably needed if data of previously mentioned software solutions and apps are shown. Sony’s Smart Eyeglass • An external handset with a battery and a trackpad reduces the headset size, increases the usage time and offers an easier way of controlling software and apps than voice control and simple touch gestures.
PROJECT: NOISE FREE INTENSIVE CARE UNIT 13 monocle Concept explanation
14 FINAL REPORT HANDSET
Monocle consist of a headset that provides the nurse with information and tools for communication.
The cable connected handset is basically a smartphone without a screen. It is equipped HEADSET with a clamp and can be attached to the nurses clothes, at best the pants pockets.
The Handset includes the battery and acts as the computing unit, running common or hospital specific smartphone operating systems and apps similar to ascom Myco, for example [15].
It is compatible with phone and paging networks Concept explanation – depending on the hospitals preference.
Monocle is a smart glass for nurses that provides quicker access to information, transmitting any device sound only to the responsible nurse, thus reducing the noise in ICU’s. CLAMP It is meant to work together with external company solutions that reduce false alarms and provide apps and software that facilitate nurses worklfow.
PROJECT: NOISE FREE INTENSIVE CARE UNIT 15 The headset has a built-in bone conduction speaker that transmit soundwaves trough the skull – offering a hygienic solution that lets nurses still hear their surroundings.
Next to phone calls, different alarm signals can thus be transmitted to the responsible nurse only:
16 FINAL REPORT 7cm
Monocle fits all head sizes. The headband length can be altered by 7cm which was found to be the standard for headphones after measuring. The lens distance to the eye can be altered by 4cm 4cm, hence, monocle can be worn over a pair of glasses. This value was calculated by subtracting the minimum from the maximum eye-ear distance of an anthropometric study [16].
PROJECT: NOISE FREE INTENSIVE CARE UNIT 17 If more visual information is needed, the casing can seamlessly be tilted down for the display to automatically activate and show augmented reality information layered over the real world such as patient data , messaging apps, device manuals or other documents.
18 FINAL REPORT The Handset has a trackpad that lets the nurse easiest control the user interface and apps if attached to the pants pockets - the trackpad facing away from the leg. A simple double-tap, similar to contemporary smartphones, or a voice command activates the lens-display. The built-in revolutionary Soli sensor [17] allows for gesture control without actually touching the screen if preferred for hygiene reasons, for example.
This sensor also displays the nurses finger position hovering over the screen so the nurse knows where her finger is pointing.
PROJECT: NOISE FREE INTENSIVE CARE UNIT 19 Monocle comes with features that greatly Monocle also comes with a flashlight and a facilitate nurses workflow and education: voice camera that let nurses record (live) videos and dictation for hands-free composing of texts, take pictures for advice seeking or documentation voice commands for hands-free control, barcode purposes if done so in agreement with the scanning for quick access to linked data e.g. hospitals patient privacy policies. If a picture is device manuals and fast data-sharing with co- taken or a camera is being recorded a noticeable workers. yellow LED light will flash for indication.
20 FINAL REPORT Details Components and cost
PROJECT: NOISE FREE INTENSIVE CARE UNIT 21 HEADSET All white Polycarbonate parts are injection- Supports left or right eye use moulded and IP54 certified, making them dust and water resistant, thus disinfectable. Dimensions: All components and features were derived Headband 290mm from data sheets of existing products: Casing length 129mm [18,19,20,21,22]. Lens 33x50mm BC Transducer casing 25mmØ Spring steel band
PCB with: • Noise cancelling microphones (for Sliding conductor phone calls) (copper) • 3 axis gyro | 3 axis accelerometer | 3 axis mag/integrated compass DLP WVGA color • 3-degree of freedom head tracking Bone conduction transducer • Proximity sensor inward facing display unit • Proximity ALS (Ambient Light sensor) outward facing Anti-slip padding • Touch sensor for unlocking the (memory foam) tilting mechanism
Transducer padding (silicone)
Aluminium lens frame (laser cut) camera: • 13 megapixel stills • 1080p video Waveguide based see through lens: • Image stabilized auto-focus Flashlight & • Field of view (diagonal): 20 degrees, • 1D/2D barcode scanner LED indicator equivalent to 12,7cm mobile device screen seen at 35,5 cm
22 FINAL REPORT Regular smartphone PCB with latest Connected via USB 3.1 cable for fast charging Android version installed: and large data transmission • Google Soli sensor for finger tracking Clamp for easy and gesture commands mounting on pockets • Blueooth and Wi-Fi antennas • 3G Cellular with HSPA data support • 128 GB storage • GPS transceiver • Infrared tracking sensor for precise room level accuracy • Loudspeaker = alarm sound for malfunction or headset disconnection
Battery cover with snap closure for easy swapping of the battery
Volume button
5000 mAh battery for a HANDSET secure runtime of +12h Standard Android buttons Optimal for single hand use
Dimensions: 120x60x18,5 mm
PROJECT: NOISE FREE INTENSIVE CARE UNIT 23 Easymechanism tilting-muscle wire mechanism
Touch here to unlock rotation. Spring coil
Microphone vent
Muscle wire A capacitive touch sensor inside the casing recognizes if the user touches two designated points at the casing (with the thumb and index finger). Consequently, current flows trough the “sliding conductor” (see headset explosion view) to the muscle wire [23]. As a results, the wire contracts and pulls back the lever that blocks the rotating gear. As soon as the user releases the fingers from the casing the muscle wire relaxes and the coil spring pushes the lever back in the gear to fix its position . Thus, a seamless rotation of the casing is possible as soon as it is touched. Costs
Monocle consists of many components, of it has a handset with an included battery and manufacturing costs are 330€ and material costs which many are highly specialized, making it only similar components. Its retail price currently lies 110€ after Ullman [25]. possible to retrieve a price by negotiating with its at 849€. Monocle, however comes with a few producers, which exceeds the time of this project. more components such as the barcode scanner Due to initial small batch size the consumer price Therefore, similar, existing products are analysed or the bone conduction transducer. Moreover, will be high but as with many new technology to come up with a cost estimation: the display technology is more advanced than products the price goes down when demand The EPSON “Moverio BT-300” [24] was published the one BT-300 uses. Therefore the initial sales and batch numbers grow which is the case for recently and is somewhat similar to Monocle as price is generously estimated to be 990€, where smartglasses as mentioned before.
24 FINAL REPORT Evaluation User interview and client feedback
PROJECT: NOISE FREE INTENSIVE CARE UNIT 25 A user evaluation in form of an interview with two ICU nurses from the Erasmus MC hospital was conducted to get the end users opinion about the final concept and to derive useful recommendations for a theoretical continuation of the project. The interview was conducted in a staff room at the Intensive Care Unit. The final concept video, a visual summary of this report, was shown on a laptop to explain the holistic story and the final solution. Furthermore, a mockup prototype of Monocle’s handset was tested for a quick ergonomic feedback. The interview lasted about 30 minutes and was a great opportunity to confirm and rethink assumptions and ideas of the concept. The final client presentation also contained useful insights that are noted on the next page.
A mockup model of monocle’s handset was tested
26 FINAL REPORT Conclusions & Recommendations
• Monocle was thought to be useful and its • Seeing ICU device guidelines on the lens was interface ,though, and might not be comfortable features beneficial for nurses and patients in the considered useful for novice nurses. Lower long-term. This depends on the nurse uniform of future. and upper alarm limits for a patients were also course but the best position for controlling the mentioned to be useful. Moreover, remote handset would have to be tested. • It was agreed that exposing only a single controlling machine settings via the handset nurse to a relevant alarm instead of everybody, would be a nice gimmick. • The tilting function, voice dictation, barcode also by getting rid of loudspeakers, is needed. scanning and live-video recording for external The noise level inside an ICU was considered a • It was noted that users with a large amount of support was considered really useful. problem - especially for patients that sometimes hair, e.g. an afro, would probably not be able to unconsciously suffer from it. wear the headset. Furtermore, it was said to look • The client suggested to remove the hindering unstable and fall off when running. This would cable and include a battery in the headset. • It was mentioned, however, that monocle seems have to be tested and if necessary redesigned. Considering that a nurse shift can last up to highly technical,thus, being a potential hindrance 12 hours and even EPSON “Moverio BT-300”’s to older staff members that are not used to such • It was suggested to equip the handset with battery in the handset only lasts for 6h, it is technology. a screen as a back-up, in case the lens display assumed that putting a long-lasting battery in the breaks but the nurse still depends on the device. headset without making it really bulky is not on • The subjects stated that they often use their option for now. personal smartphone - next to their pagers - for • The nurse uniform overlapped the handset Removing the cable is still desired, though, and their work, for example, confirming a protocol or when attached to pants pockets a bit so it had is likely to be feasible in the future if battery searching for medication by online. Combining to be attached to the jacket pocket which would size shrinks and long-range wireless charging these two devies into one would be benefical. require a slightly angled arm to control the becomes possible.
PROJECT: NOISE FREE INTENSIVE CARE UNIT 27 Thank you for reading!
28 FINAL REPORT PROJECT: NOISE FREE INTENSIVE CARE UNIT 29 ReferencesSources referred to in the text
[1] Chambrin, M.-C. et al. (1999). Multicentric study of monitoring alarms in the adult intensive care unit (ICU): a descriptive analysis. Intensive Care Med, 25. p 1364.
[2] Atzema, C. (2006). ALARMED: Adverse events in Low-risk patients with chest pain Receiving continuous electrocardiographic Monitoring in the Emergency Department. A pilot study. American Journal of Emergency Medicine, 24. p 62.
[3] Kristensen, M. et al. (2015). Alarm fatigue in the perception of medical soundscapes. EuroNoise 2015, p 746.
[4] White, J. (2014). 10 healthcare technology hazards for 2015. [online] Healthcarebusinesstech.com. Available at: http://www.healthcarebusinesstech.com/2015-health care-technology/ [Accessed 2 Oct. 2016].
[5] Unknown. Auditory Alarm Requirements in IEC 60601-1-8 and Risk Management Considerations. (n.d.). Retrieved January 30, 2017, from http://www.med-technews. com/articles/articles/article/18/Auditory Alarm Requirements in IEC 60601-1-8 and Risk Management Considerations
[6] Unknown. Taking alarm management from concept to reality: a step by step guide. (n.d.). Retrieved January 30, 2017, from https://www.usa.philips.com/b-dam/b2bhc/ us/whitepapers/alarm-systems-management/An-action-Plan.pdf
[7] Unite connect for patient monitoring. (n.d.). Retrieved January 30, 2017, from http://www.ascom.com/ws/en/index-ws/segments-division/hospitals/solution/hospi- tal-patient-monitoring/product/unite_connect_for_patient_monitoring/solutionloader.htm
[8] Hospital alarm management solution | Philips Healthcare. (n.d.). Retrieved January 30, 2017, from http://www.usa.philips.com/healthcare/clinical-solutions/alarm-ma- nagement
[9] Alarm Management System. (2017, January 25). Retrieved January 30, 2017, from https://www.vocera.com/product/vocera-alarm-management-clinical-analytics
[10] Bone Conduction: How it Works. (n.d.). Retrieved January 31, 2017, from http://www.goldendance.co.jp/English/boneconduct/01.html
[11] http://www.business2community.com/tech-gadgets/5-reasons-google-glass-miserable-failure-01462398
[12] Natalia Wrzesińska, N. (2016, July 14). The use of smart glasses in healthcare – review ⋆ MEDtube Science. Retrieved January 31, 2017, from https://medtube.net/ science/use-smart-glasses-healthcare-review/ MEDtube Science 2015, Dec 4(3), 31-34
[13] Global Smart Glasses Market 2016-2020. (n.d.). Retrieved January 31, 2017, from http://www.technavio.com/report/global-human-machine-interface-global-smart-glas- ses-market-2016-2020
30 FINAL REPORT [14] Notebooki. (2016, March 10). Vuzix M300 Smart Glasses. Retrieved January 31, 2017, from https://www.youtube.com/watch?v=sPp2LofqoxU
[15] Ascom Myco. (n.d.). Retrieved February 1, 2017, from http://www.ascom.ch/ch-en/index-ch/products-solutions/our-solutions/product/ascom_myco/solutionloader. htm#applications
[16] Correlation between Facial Measurements and Occlusal Vertical Dimension: An Anthropometric Study in Two Ethnic Groups of Nepal. (n.d.). Retrieved February 1, Sources referred to in the text 2017, from http://pubs.sciepub.com/ijdsr/2/6/13/ [17] Project Soli. (n.d.). Retrieved February 1, 2017, from https://atap.google.com/soli/
[18] What’s Inside Google Glass? (n.d.). Retrieved February 1, 2017, from http://www.catwig.com/google-glass-teardown/
[19] T. (n.d.). Google Glass Teardown. Retrieved February 1, 2017, from http://www.techinsights.com/about-techinsights/overview/blog/google-glass-teardown/
[20] S, G. T. (2016, February 08). AfterShokz Bone Conduction Headphones Capsule Review. Retrieved February 02, 2017, from http://www.anandtech.com/show/10018/ aftershokz-bone-conduction-headphones-capsule-review
[21] M3000 Smart Glasses. (n.d.). Retrieved February 02, 2017, from https://www.vuzix.com/Products/m3000-smart-glasses
[22] MYCO. (n.d.). Retrieved February 02, 2017, from http://www.connexus.ie/wireless-solutions/myco
[23] Tech Sheets. (n.d.). Retrieved February 02, 2017, from http://www.dynalloy.com/tech_sheets.php
[24] Moverio BT-300. (n.d.). Retrieved February 02, 2017, from https://www.epson.nl/products/see-through-mobile-viewer/moverio-bt-300#specifications
[25] Ullman, D. G. (1992). The mechanical design process. New York: McGraw-Hill.
PROJECT: NOISE FREE INTENSIVE CARE UNIT 31 Appendices
32 FINAL REPORT Final user evaluation
Interview
Note: It’s important that everyone of you tells me their own, honest opinion so I can hear as many different opinions as possible. Please don’t be shy to really say what you think. Critic is important!
1. General thoughts ? a. What do you like about the concept? b. What do you not like? 2. Are ICU’s really too loud for you? What sounds does this annoying noise consist of? Ambient noise, radio or only alarm sounds? 3. Would you agree that it would be beneficial if all the devices would not have loudspeakers but would only alert the nurse in charge? 4. Do you use smartphones during your work and if yes, for what? Do they replace pagers? a. Are pagers/smartphone sounds of other nurses audible/ annoying?
Product specific:
5. Do you think you could benefit from such a product in the future? Why/not? a. Do you think it is useful to transmit sounds to only the responsible nurse? 6. What kind of information other than shown in the video could be useful for you to be displayed? a. For example device manuals? Do you know how to configure all the machines? b. Would it be useful to change settings via the handset from afar? 7. Do you like the aesthetics of the product? Can you imagine yourself wearing something like this, if it is comfortable? What would you change if you could? 8. Do you think that wearing the handset attached to your pants pockets is a good solution? a. Do you even have pants pockets? –> test prototype 9. Do you think the tilting down function of monocle is useful (for patient eye-contact etc.)? 10. Do you think features, such as barcode scanning or voice dictation for writing reports or texting are useful for your work? a. Which features are useful? b. Which ones are obsolete? 11. Is live camera recording or taking photos useful to seek advice from another person that is not in the same room? 12. Is it allowed to wear cables in an ICU? 13. Any other remarks?
31 science
Digital health is already growing exponentially, and with no doubt, the market for smart glasses in heal- thcare will grow accordingly in the very near future.
The use of smart glasses in healthcare – review
Natalia Wrzesińska
Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland
Natalia Wrzesińska, Banacha 1a, Warszawa. Phone number: +48 604 85 84 85, E-mail address: [email protected]
RUNNING TITLE Smart glasses in healthcare KEYWORDS smart glasses, google glasses, wearable technology, digital health
WORD COUNT 2 021 CONFLICT OF no conflicts of interest INTERESTS
ABSTRACT
Nowadays technical innovations appear rapidly. One of new possibilities is smart glasses – wearable compu- ting devices wore as standard glasses.
Although most smart glasses were not initially targeted at healthcare, they have been already implemented in multiple different medical applications across different specialties. In general such devices can be utilized whenever a screen or external monitor is already required. Head mounted displays can be implemented for very basic purposes such as education, simulation, live streaming of visualized data (i.e. vital signs, imaging studies, tests results, etc)., to more interactive functions such as video recording and digital photo documen- tation, for telemedicine, telementoring and many others. Ultimately smart glasses would implement artificial intelligence engines in the daily clinical practice and several other promising application for the future. Digital health is already growing exponentially, and with no doubt, the market for smart glasses in healthcare will grow accordingly in the very near future.
The aim of this paper is to analyze current possible applications of smart glasses in patient care as well as the advantages and drawbacks of this kind of devices in everyday clinical practice.
MEDtube Science Dec, 2015; Vol.III (4) 32 science
BACKGROUND DISCUSSION
mart glasses are wearable computing devices Numerous of studies and surveys have been conduc- that are web-connected and enable to transmit ted on smart glasses in healthcare. The majority of Smultiple types of data and project it in field of them review the most popular head-mounted display vision. Smart glasses can be used in many ways. – Google Glass. They offer most functions of a standard computer but in this case, head - mounted displays can react on Smart glasses can give the clinician information voice comments, eye movements, gestures or simple such as patients’ data, vital signs or imaging studies tactile commands. In general, a hands-free system results within their field of vision so the clinician can can be particularly useful in medical practice where use it simultaneously with performing other tasks oftentimes practitioners are hands busy, someti- or procedures. This can be very helpful in all kinds mes even in the sterile field. Smart glasses provide of interventions when doctor or nurse needs to be augmented or virtual reality in addition to wearers’ focused on the procedure. It helps to avoid looking at environment. They can be used for recording, stre- different screens or stepping away from the patient in aming video, teleconferences, data transmission, te- order to look for test results. lementoring and in education process, among others. O.J. Muensterer researched Google Glass in Child- Glass by Google has been one of the most widely ren’s Hospital. [3] He was wearing the device for 4 known types of smart glasses since it was released executive weeks constantly and used it in different si- to a selected market in 2013. It has high wearability, tuations in a typical clinical day many times for with- a wireless platform, and runs in a well-established drawal of patient data. He kept a diary on advantages android system. It is almost non obtrusive in human and drawbacks of it. The battery life, ergonomics, -to- human interaction. Other devices such as Epson audiovisual quality and other aspects were assessed. Moverio BT-200 or Atheer Lab DEV kit have yet In this study wearing Glass was well tolerated by the limited applicability in clinical settings because of law user. Also patients and their families had positive wearability (cables), lack of friendly operative system, response to it. big sized front-end, obstructive human-to-human interaction and even cost. The advantage of Google Vorraber et al. tested Google Glasses during in- Glass over other head-mounted display is also sim- terventional radiology procedures – 3 angioplasties. ple learning curve. All of the glasses provide virtual or They collected opinions on the device from participa- augmented reality (VR/AR) in see-through screen as ting radiologists. [4] The authors formulated hypothe- an addition to real milieu. sis that projection of patient data and consolidation of all kinds of parameters in the monitor within the ra- New on the market device called HoloLens by Mi- diologist/surgeon field of vision results in a reduction crosoft holds much promise for future applications. It of number of head movements to look at different is one of the first holographic computer using ho- screens, improvement of efficiency and awareness lographs appearing “in front” of the user to provide of the physician performing the procedure. In their virtual or augmented reality in real-time. Holographs study interventionists completed a survey in which are integrated with the real world. The device is head they told that they fully relied on Glasses and did not -mounted display wore like helmet/glasses. need to look at different monitors to check the vitals. The opinion of users was that Glasses improved Smart glasses were not primarily targeted at heal- concentration and supported multi-tasking. Huang et thcare but doctors and health providers around the al. came to the similar conclusion concerning spatial world are finding new exciting possibilities in weara- awareness of a smart glasses user. [5] There is no ble technology. They believe that wearable technolo- evidence that it might have negative impact on it. gy can improve clinical outcome and patient care. The concept of imaging tests results projecting onto Soreon Research predicts that smart wearables in smart glasses screen during the procedure was used healthcare market will grow from USD 2 billion in by Wu et al in the study of ultrasound-guided cen- 2014 to 41 billion in 2020 with annual growth rate of tral venous access with the use of Google Glass. [6] 65 %. [1] The results of the study was that Google Glass user comparing to person performing standard procedure Yu et al. published results of the survey among glass had less head movements but it took longer to gain users in healthcare. Majority of them were male, as- the access. It might be attributable to the fact that sistant professors in United States but other markets majority of users were not familiar with the technolo- grow very fast. [2] gy before.
In the literature there are several examples of current Google Glass can be used during surgery not only implementation of smart glasses in medical practice for data visualization or video recording. Another as well as in education and various possibilities for interesting and very helpful application is using smart the future. glasses for surgical safety checklist. At Doctors 2.0 & You 2014 Conference dr. Homero Rivas from Stan-
MEDtube Science Dec, 2015; Vol.III (4) 33 science ford University presented his experience with surgical paring to paper version or standard picture they were safety checklist prior to operation with the use of Go- pleased with the concept. This paper shows new ogle Glasses. In his study surgeons were 74% less application for Google Glass but also how it needs likely to skip life-saving steps using the checklist. It improvement. Similar study showed that Google showed that Google Glasses can improve efficiency Glass is sufficient tool for interpretation of coronary of surgical safety checklist. angiograms recorded by it which supports telemedi- cine. [13] There is great interest in impact of smart technolo- gy on education. Smart glasses can be widely used Google Glass can also help to share information in teaching whether it is constant telementoring for concerning patient whether it is asking for a consult example through the procedure or using virtual reality in one center or consulting specialists around the for learning. world. [14]
Newly introduced HoloLens by Microsoft can help The device can put clinicians together in a telecon- medical students to learn anatomy in 3 dimensions ference to discuss live case, take and send photos using holographic images. [7] The pilot study was or videos, help to retrieve medical information in no conducted in Case Western Reserve University and disruptive manner. Preliminary assessment of those Cleveland Clinic. The device enables students not functions was conducted by Widmer et al. [15] The only see the anatomical structures in 3D but also research team tested sending and retrieving visual work on holographic mannequins and interact with medical records such as pictures of the skin as well them. That provides better understanding of human as CT and MRI images to define whether Google anatomy than learning from two dimension graphics Glass can affect the accuracy of results. As they in a book. The students had very positive response to showed despite some minor disadvantages Google this method of education. Glass can potentially help in decision making and improve patient care. Mentioned earlier, Dr. Homero Rivas from Stanford University was one of the first surgeons implementing Authors from Yale University were trying to asses if augmented reality in surgical lab for teaching purpo- Google Glass and teleconferencing can be helpful for se. In his experiment surgeon could see the procedu- healthcare providers performing triage during mass re he was about to perform step by step projecting in accidents and emergencies. [16] In their study the his field of vision. [8] team of paramedics communicated with an off-site emergency medicine specialist using Google Glass. Dickey et al. developed application for Google Glas- They found out that still there are some obstacles. ses helping to train urology residents using augmen- Using Google Glass took longer than standard triage ted reality during surgery (in this case inflatable penile but the device did not decrease performance. It can prosthesis placement). [9] Google Glass presented be helpful in the future with some technical develop- the procedure step by step and also provides inte- ment. raction between trainee and specialist. The residents had overall very good experience with the technology The concept of smart glasses can empower patients and were likely to use it in the future. It shows that in sense of interaction between them and the clinic smart glasses can be successfully used in training or other patients, telemedicine, simplifying hospital or process. outpatient visits among many other functions. [17] Virtual Reality displayed on glasses screen can also Telementoring – another interesting application directly help in patient treatment for example in pain for smart glasses, allows students or residents to management. Maani et al. in their study randomized perform some procedures on a patient by them- burn victims (wounded soldiers) to receive standard selves while being constantly monitored by senior pain medications during debridement of the wound doctor. There is an example of study with using or get distracted by virtual reality during the procedu- Google Glass in cardiology residents and fellows re. [18] Then Graphic Rating Pain Score was measu- during training in different possible cardiac scenarios. red. Patients reported significant less pain during [10] It can help trainees to gain independence and wound cleaning while distracted by VR. self – confidence. This method can also be used to record students’ actions and their evaluation as some Researchers are also trying to evaluate possible studies showed. [11] advantages of using smart glasses by patients with chronic diseases. For example applications allowing Jeroudi et al. investigated the accuracy of electrocar- patients with Parkinson’s disease to motion tracking, diogram interpretation with the use of Google Glas- voice and visual clues or recognition of objects. In ses. [12] They compared interpretation of 10 ECGs the Netherlands patients with Parkinson’s disease by viewing it on Google Glass screen, photograph answered online survey in which they were very taken by Google Glass, paper ECG and its picture enthusiastic about this technology helping them with taken by camera. Although in their study users were everyday activities. [19] dissatisfied of an image of electrocardiogram com-
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There is also possible use for wearable technology in TAB. 1. CURRENT APPLICATIONS OF SMART GLASSES IN pharmacy for example for drug delivery tracking or HEALTHCARE checking medications prior to delivering them to the Area of application Examples patient which can increase safety and also in educa- tion and in medication preparing process. [20] Reading data Vital signs, test results Although smart glasses can be very helpful and have great potential for the future use there are some Telementoring Education, consultations drawbacks and aspects that need to be worked out in the future. Life streaming of procedure, telecon- Video recording ferences, video records for digital There are some technical aspects that can lower the documentation performance and usability such as poor camera ima- Digital patient history, consultations, Workflow, documentation ge preventing from wider use in telemedicine, short emergencies, drug delivery tracking battery life, memory limits, wearability and others. Used in chronic diseases, telemedi- Patients empowerment There is also major concern over patient confidentia- cine, patient connection lity. The important issue that could inhibit progress Augmented reality, telementoring, and innovation is sensitive data storage and trans- Education mission problem. Glasses explorers and e-health trainees evaluation specialists around the world are debating how to improve security of this type of wearables. Other Safety checklists
The Glass Development Kit for Google glasses ena- BIBLIOGRAPHY bles the device to work in local network (for example 1. Daugirdas, John T. Handbook of Dialysis 5th Edition, Wolters hospital network) rather than via internet which can Kluwer 2014 help to protect sensitive data such as patients digital 2. Prystacki T, Kloda K, Safranow K, Dziedziejko V, Domanski L. documentation. Modern Management of Dialysis Center has an impact on pa- tients’ blood pressure and calcium-phosphorus metabolism. MEDtube Science Dec 2013; 1(1), 19-21. Other thing preventing from general use of smart 3. Tsirpanlis G, Boufidou F, Zoga M, Triantafyllis G, Fatourou A, glasses are legal regulations. In developed countries Nicolaou C. Low cholesterol along with inflammation predicts it is necessarily to consider use of the device in treat- morbidity and mortality in hemodialysis patient. Hemodial Int. ment or diagnostic process (FDA approval, CE mark). 2009 Apr;13(2):197-204. 4. Al Aly Z, Edwards JC. Vascular biology in uremia: insights into It is widely known that development and innovations novel mechanisms of vascular injuryAdv Chronic Kidney Dis. come first, than applications and legal regulations. 2004 Jul;11(3):310-8. Review. With rapid technical growth and many new devices 5. Wszola M, Kwiatkowski A, Nosek R et al. Chlamydia pneumo- on the market (not necessarily targeted in medicine niae infection and ischemic heart disease in hemodialysis patients. Transplant Proc. 2006 Jan-Feb;38(1):31-4. and healthcare only) legal process of approval needs 6. Stenvinkel P, Heimburger O, Paultre F, Diczfalusy U, Wang T, to be more effective. Berglund L, Jogestrand T: Strong association between mal- nutrition, inflammation, and atherosclerosis in chronic renal CONCLUSIONS failure. Kidney Int 1999;55:1899-1911. 7. Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C: It seems that wearable technology such as smart Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 1999;55:648-658. glasses have potential to improve effectiveness of 8. Gupta J, Mitra N, Kanetsky PA, Devaney J, Wing MR, Reilly healthcare and education. Improvements of devi- M, Shah VO, Balakrishnan VS, Guzman NJ, Girndt M, Periera ces as well as new specific applications will allow BG, Feldman HI, Kusek JW, Joffe MM, Raj DS: Association for smart glasses to be used in different aspects of between albuminuria, kidney function, and inflammatory biomarker profile in CKD in CRIC. Clin J Am Soc Nephrol patient care. 2012;7:1938-1946. 9. Schindler R, Beck W, Deppisch R, Aussieker M, Wilde A, Although medical practitioners are evaluating smart Göhl H, Frei U. Short bacterial DNA fragments: detection in glasses benefits in various situations still some more dialysate and induction of cytokines. J Am Soc Nephrol. 2004 studies need to be conducted and legal regulations Dec;15(12):3207-14. established. Also numerous technical obstacles have to be eliminated to make smart glasses more efficient in everyday practice.
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