With a toxin coursing through their veins, patients, who come in for poison treatment, are often in an altered mental state, even incoherent perhaps. And the physician on duty may not be an expert in poisons. What happens next?
For most physicians evaluating a potentially poisoned patient, the only solution is a discussion over the phone with a regional poison control center, says Peter Chai, a fellow in medical toxicology at the University of Massachusetts Medical School in Worcester. Almost daily, he says, he and his colleagues are confronted with cases that make them think: “If only we could actually see the patient.”
Traditional telemedicine is expensive. Google Glass, the wearable computer with the built-in camera, could allow a toxicology specialist to virtually visit the patient’s bedside and help with the diagnosis, Chai and his colleagues report in the latest edition of the Journal of Medical Toxicology, published online on August 6.
Glass, which is increasingly being used as a platform for innovations in healthcare to benefit patients, physicians, and medical personnel, has already entered clinical practice. At the Beth Israel Deaconess Medical Center, doctors use it pull up patient files for reference. Elsewhere, physicians use it to create health care records for patients. Surgeons use Glass to broadcast procedures to others in their field who can watch and learn. Specialists can be beamed in for consults in the operating room.
“Although Glass has been studied in a variety of disciplines, we are the first in the United States – and the world – to explore Glass as a platform for toxicology consults,” says Chai. He mentions that there are only around five hundred toxicologists in all of United States. A tool that allows virtual bedside toxicology consult services could be a welcome innovation.
For the feasibility study, resident physicians at the UMass Medical School wore Glass while evaluating poisoned patients in the emergency room. An on-campus toxicology expert, watching the real-time video of the event, offered guidance via text messages. Of eighteen cases, the virtual exam changed the course of treatment in more than half of them; in six cases experts suggested an antidote.
The modified Glass, loaded with customized software from Pristine Eyesight, can securely transmit images, but it will not store the video or share the information with Google. The setup is compliant with the Health Insurance Portability and Accountability Act, or HIPAA, meaning it is designed to protect the patient’s privacy.
This study is important, not only within our specialty, but also across medicine, says Aaron Skolnik, Assistant Medical Director of the Banner Poison & Drug Information Center in Arizona. “Wearable and ultra-portable devices will be tremendously helpful to rural and critical care hospitals that are often unable to invest large amounts in a telemedicine infrastructure, but still need emergent access to sub-specialist care,” he says.
From a technical perspective, nothing prevents the implementation of Google Glass for remote toxicology consults, says Dr. Edward Boyer, the paper’s co-author, who holds dual appointments at Boston Children’s Hospital and UMass Medical Center, the only places in Massachusetts to offer bedside toxicology consult services. “The main stumbling block is whether treatment areas – emergency departments, clinics, and so on—have a W-Fi system that allows seamless transmission of high-quality images,” Boyer said.
In the future, the researchers hope to be able to provide care for poisoned patients at remote locations not just in their own ER. The headmounted device, they said, could obviate the need for a helicopter ride to get the toxicologist’s verdict.