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Research Letter |

Feasibility and Acceptability of Google Glass for Emergency Department Dermatology Consultations FREE

Peter R. Chai, MD, MMS1; Roger Y. Wu, MD, MBA2; Megan L. Ranney, MD, MPH2; Jayne Bird, MD3; Sandy Chai, MD3; Brian Zink, MD2; Paul S. Porter, MD, MBA2
[+] Author Affiliations
1Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts School of Medicine, Worcester
2Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence
3Department of Dermatology, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence
JAMA Dermatol. 2015;151(7):794-796. doi:10.1001/jamadermatol.2015.0248.
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Published online

Emergency department (ED)–based teledermatology has become more common in recent years because patients who present to the ED with skin concerns often require prompt diagnosis and treatment. Skin concerns make up 3.3% of ED visits; most of these patients wait months to see a dermatologist.1 Recent studies have demonstrated the feasibility of using mobile telephones for ED teledermatology.2

Google Glass, a pair of eyeglasses with a computer, camera, and microphone built into the frame, is a wearable form of mobile video communication introduced in 2012.3 Despite significant media attention related to the use of Glass in health care settings, its value for patients and physicians has not been established.4 This study aimed to assess the feasibility and acceptability of Glass as a communication tool for ED dermatology consultations.

This was a prospective cohort study of patients who presented to our urban academic ED with a chief concern of rash from March 1, 2014, through July 4, 2014. Patients were eligible for participation if they were aged between 18 and 89 years, spoke English, were able to provide consent, and presented with a dermatosis that required a dermatology consultation. The protocol was approved by Lifespan–Rhode Island Hospital Institutional Review Board.

Study investigators obtained written informed consent. Participants had an initial standard dermatology consultation (a telephone call and, when necessary, a static photograph of the rash) with the dermatology consultation resident. Patients were then evaluated by a separate teledermatologist (the dermatology chief resident) through a real-time video link using Glass and running a third-party, Health Insurance Portability and Accountability Act–compliant video platform (Pristine IO; Pristine). The video link was sent to the teledermatologist through a Google Nexus 7 tablet (Google). After completing the 2 consultations, patients completed a brief survey on attitudes and beliefs regarding this teledermatology experience.

A total of 348 patients presented to the ED with a chief concern of a rash during the study; 41 patients required a dermatology consultation (Figure). Thirty-nine patients were eligible for the study and 31 patients consented. Most participants (18 of 31 [58%]) had never seen a dermatologist. Most participants (28 of 31 [90.3%]) did not have a dermatologist with whom they could follow up.

Place holder to copy figure label and caption
Figure.
Study Flowchart

Flow diagram describing the participants included and excluded in the study. ED indicates emergency department; dermatology unavailable, teledermatologists (S.C. and J.B.) were unavailable.

Graphic Jump Location

Thirty-one of 34 (91%) attempted connections were completed and considered successful. All participants (n = 31) who completed a Glass teleconsultation also completed the survey (Table).

Table Graphic Jump LocationTable.  Acceptability of the Google Glass Dermatology Consultation

This study demonstrates that Glass is a feasible and acceptable platform for real-time ED teledermatology. Participants overwhelmingly believed that their privacy was protected while using the modified Health Insurance Portability and Accountability Act–compliant version of Glass. While patients prefer face-to-face visits, when a dermatologist is not immediately available for an in-person evaluation—as is typical in the ED setting—participants preferred the Glass video consultation to the standard telephone consultation.5

Because of the interactive nature of Glass, the teledermatologist was able to appreciate both the gestalt of nonspecific skin eruptions and specific dermatoses. The teledermatologist could also expand the medical history and physical examination by directing the ED physician to ask specific questions or examine additional locations.

This study has several limitations. First, as a single-center study, feasibility results may not be generalizable to other institutions, especially given significant variability among hospital information technology infrastructures. Second, this study did not address the accuracy of diagnosis using Glass. Third, this study did not address the effect of the device on revenues, costs, or workflow. Future studies should examine the diagnostic accuracy, costs, and workflow implications and physician satisfaction related to using wearables such as Glass for ED dermatology consultations.

Accepted for Publication: January 28, 2015.

Corresponding Author: Paul S. Porter, MD, MBA, 55 Claverick St, Providence, RI 02903 (pporter@lifespan.org).

Published Online: April 15, 2015. doi:10.1001/jamadermatol.2015.0248.

Author Contributions: Drs P. R. Chai and Wu had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs P. R. Chai and Wu share first authorship.

Study concept and design: P. R. Chai, Wu, Ranney, Zink, Porter.

Acquisition, analysis, or interpretation of data: P. R. Chai, Wu, Ranney, Bird, S. Chai, Porter.

Drafting of the manuscript: P. R. Chai, Wu, Ranney, Zink, Porter.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Wu, Ranney, Porter.

Obtained funding: Porter.

Administrative, technical, or material support: P. R. Chai, Ranney, S. Chai, Porter.

Study supervision: P. R. Chai, Zink, Porter.

Funding/Support: This study was supported by the University Emergency Medicine Foundation for the purchase and use of Google Glass.

Role of the Funder/Sponsor: The University Emergency Medicine Foundation had a role in the design and conduct of the study, but not in the collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Derek Merck, PhD, The Warren Alpert Medical School of Brown University and School of Engineering, Brown University, provided information technology, network, and cybersecurity advice, implementation assistance, and technical support; Ignacio Santana, MS2, The Warren Alpert Medical School of Brown University, provided assistance with patient recruitment, data collection, and Glass technical support; and John Kawaoka, MD, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, contributed medical and research advice along with allocation of resident priority. None were financially compensated.

Correction: This article was corrected on June 9, 2015, to fix the Figure.

Baibergenova  A, Shear  NH.  Skin conditions that bring patients to emergency departments. Arch Dermatol. 2011;147(1):118-120.
PubMed   |  Link to Article
Duong  TA, Cordoliani  F, Julliard  C,  et al.  Emergency department diagnosis and management of skin diseases with real-time teledermatologic expertise. JAMA Dermatol. 2014;150(7):743-747.
PubMed   |  Link to Article
Google I/O 2012. Google website. https://developers.google.com/events/io/2012/. Accessed August 30, 2014.
Chai  PR, Wu  RY, Ranney  ML, Porter  PS, Babu  KM, Boyer  EW.  The virtual toxicology service: wearable head-mounted devices for medical toxicology. J Med Toxicol. 2014;10(4):382-387.
PubMed   |  Link to Article
Grillo  E, Vañó-Galván  S, Jiménez-Gómez  N, Ballester  A, Muñoz-Zato  E, Jaén  P.  Dermatologic emergencies: descriptive analysis of 861 patients in a tertiary care teaching hospital. Actas Dermosifiliogr. 2013;104(4):316-324.
PubMed   |  Link to Article

Figures

Place holder to copy figure label and caption
Figure.
Study Flowchart

Flow diagram describing the participants included and excluded in the study. ED indicates emergency department; dermatology unavailable, teledermatologists (S.C. and J.B.) were unavailable.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable.  Acceptability of the Google Glass Dermatology Consultation

References

Baibergenova  A, Shear  NH.  Skin conditions that bring patients to emergency departments. Arch Dermatol. 2011;147(1):118-120.
PubMed   |  Link to Article
Duong  TA, Cordoliani  F, Julliard  C,  et al.  Emergency department diagnosis and management of skin diseases with real-time teledermatologic expertise. JAMA Dermatol. 2014;150(7):743-747.
PubMed   |  Link to Article
Google I/O 2012. Google website. https://developers.google.com/events/io/2012/. Accessed August 30, 2014.
Chai  PR, Wu  RY, Ranney  ML, Porter  PS, Babu  KM, Boyer  EW.  The virtual toxicology service: wearable head-mounted devices for medical toxicology. J Med Toxicol. 2014;10(4):382-387.
PubMed   |  Link to Article
Grillo  E, Vañó-Galván  S, Jiménez-Gómez  N, Ballester  A, Muñoz-Zato  E, Jaén  P.  Dermatologic emergencies: descriptive analysis of 861 patients in a tertiary care teaching hospital. Actas Dermosifiliogr. 2013;104(4):316-324.
PubMed   |  Link to Article

Correspondence

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