AUSTIN – October 23, 2015 – Seton Healthcare Family stroke researchers led by Lone Star Stroke Consortium leader, Steven Warach, M.D., Ph.D., were granted $150,000 from Genentech last October to study the use of Google Glass in telestroke programs geared for rural environments.

The goal of the research was to discover if smart glasses like Google Glass  and similar smart glasses (Vuzix) could be used instead of telemedicine carts for improving availability, timing, and effectiveness of stroke evaluation, diagnosis, and eventual treatment while maintaining quality and confidentiality of care.

Why Telemedicine for Stroke?

Vascular neurologists, interventional neurologists, device specialists, and neuroradiologists tend to be available on-site at most comprehensive medical centers but are usually not available to patients in rural areas with smaller hospitals. The need to connect specialists with outlying patients has been an ongoing challenge. Physicians used to rely on telephone consultations for patients requiring off-site expert opinions. But in the last 10-15 years, telemedicine has become commonplace for stroke assessments. Telemedicine carts are used for telestroke assessments and conducted by an expert who can see and interact with a patient remotely, and subsequently can provide an informed decision on treatment or transfer steps.

Telemedicine Carts Improve Patient Care and Physician Satisfaction

“Being able to use a telestroke cart from home drastically improves patient care,” said Johanna L. Morton, M.D., a Lone Star Stroke Consortium Principal Investigator and Telestroke Medical Director at Seton Medical Center-Hays (SMCH), where telemedicine carts are used for stroke assessments.

Dr. Morton lives more than twenty-five miles from SMCH and says the ability to evaluate and treat a patient while at home is helpful for her, because it eliminates a forty-minute commute while still allowing her to assess the patient with her own eyes.

“With the frequency of stroke mimics that present, I was confident in my decision-making using telemedicine carts, more so than I would have been if I had relied on a telephone discussion with the on-site ED physician,” said Dr. Morton.

The Problem with Telemedicine Carts and Considering a Smart Glasses Alternative

Telemedicine carts are superior to a phone call for stroke assessment. However, they can be clunky and inconvenient for hospital workers. Imagine the headache of having to track down a telemedicine cart and wheel it across the hospital for a patient who is staying on the critical care unit for a heart problem and has a stroke warranting an expert telemedicine consult. In the ED, telemedicine carts can probably be found easily, but if one is needed elsewhere in the hospital, locating, moving and preparing for use, demands time and resources.

Now imagine every emergency physician using a device with the portability of a mobile phone or smart glasses like Google Glass for telestroke assessments. The glasses not only stream video and audio from the wearer, but also allow experts to give instructions and pass along checklists through the glasses remotely.

Can Google Glass Live up to the Hype?

A study examining Google Glass technology as a unique approach to telemedicine for stroke consultations needed to be approached cautiously. The veil of hype surrounding the device needed to be pulled back. The portability, reliability, cost-effectiveness, and many other pros and cons would need to be assessed before Google Glass could be considered a better standard than telemedicine carts.

“Our view of new technology is that it’s great, but you don’t just accept it as better because it’s new. You have to assess it,” explained Dr. Warach.

Dr. Warach partnered with Truman J. Milling Jr., M.D., Deputy Director of the Seton/UTSW Clinical Research Institute, and Bob Harding, Jr., D.O., Medical Director, Emergency Department, Seton Highland Lakes Hospital, to see if reality would match the Google Glass hype and could be compared against telemedicine carts right away. This was the premise of the Genentech study. Ideally, confirming improved technology would mean spreading it throughout the Lone Star Stroke Research consortium sites, and expanding the novel practice method throughout the state of Texas.

Conclusion: Neither Pristine nor Third Eye can Compare to Telemedicine Carts…Yet.

 After contacting the few companies that offered a wearable telestroke solution, two promising contenders were selected for the evaluation: Pristine and Third Eye. While acknowledging both companies’ responsive tech support services and undeniable potential of the solution, the research team decided the technology wasn’t ready yet.

“We found the first generation of the technology had potential but we wouldn’t want to use it in the real world,” reported Dr. Warach.

In fact, connectivity issues caused so great a roadblock that before the smart glasses solution could be scrutinized against telemedicine carts, researchers would have to determine which (if either) of the two Google Glass telemedicine providers was most reliable. In mock exams using both Pristine and Third Eye products, it was not uncommon for Dr. Milling to be wearing smart glasses with Dr. Warach viewing remotely, and the broadcast to suddenly stop, leaving both physicians with nothing but dead air. Often, Dr. Warach could not pick up the audio from the patient being examined by Dr. Milling, which was far from ideal.

Connectivity was not the only problem. The hardware itself needed improvements. Glasses would often start to overheat after 15 minutes of use, resulting in discomfort for the wearer.

After months of tests, researchers concluded Pristine’s product was superior to Third Eye’s but neither’s performance could compare to telemedicine carts. The Genentech study conclusion and details of the mock trial frustrations were reported in a Assessment of the Feasibility of Wearable Tech as Tool for Telestroke – Google Glass Poster at the European Stroke Organisation Conference in April, 2015.

Study Phase II with Next-Generation Smart Glasses Technology

 Since the Google Glass hardware underperformed, Pristine developers suggested a different solution on which their program could also run called Vuzix.

“We were pleased to learn that Pristine offered a device-agnostic solution that would allow us to evaluate comparable hardwares because it meant we would no longer be limited to just one device. We could pick and choose the best device for our use case,” said Kristin Chandler, MPH and Project Administrator from Seton’s Innovation and Commercialization Team who coordinated the telestroke technology evaluation.

Dr. Warach and Seton’s telemedicine support team continued working with Pristine using Vuzix, which provided a higher resolution picture, experienced fewer signal interruptions, and yet was a bit bulkier than Google Glass.

In early 2015, Google announced a late 2015 market release of a new and improved hardware, Glass II. Pristine received a demo version of Glass II, which Dr. Warach had the opportunity to briefly examine. During the demo, he was encouraged to see the new device provided a much better picture and he could now clearly hear the patients on the other end. While awaiting the official release of Glass II, Dr. Warach and the team are designing a new study to evaluate the improved Glass II, and compare the updated technology to the telemedicine carts as originally intended.

By: Whitney Power, Lone Star Stroke News Editor