On any given shift as an emergency physician, I see a myriad of drug overdoses and toxic exposures. One important resource I use is expert guidance from the poison control center. This service is organized into regional call centers around the country to provide a 24/7 reference for the general public and medical providers.
Poison centers are typically staffed by pharmacists and physicians specialized in toxicology. They use telephone calls to collect information for their medical recommendations. This is free of charge, because of federal funding, and is one of the few medical specialties that do not bill for services. Advances in wearable technology may change the landscape for medical specialties that perform consults like toxicology.
The article “Teletoxicology: Patient Assessment Using Wearable Audiovisual Streaming Technology” in The Journal of Medical Toxicology is an interesting study on the accuracy of remote consultants using Google Glass ® to evaluate patients.
We’ve covered a number of medical apps focused on managing toxic exposures including the webPOISONCONTROL Poison app from a group of poison control center. The American College of Emergency Physicians also has a Toxicology app that we favorably reviewed as well as a quick reference app for the top 25 most ingested toxins.
The medical field has been interested in wearables for some time. As telemedicine has matured into the age of wearable technology, remote monitoring and seamless communication of data has become feasible and cost effective. Telemedicine is already being used for remote consultations in very specific situations like stroke care. Wearables can facilitate the integration of health information and fitness activity for patients. Google Glass ® was a potential medical wearable that has seen waning interest from the general public. Production was discontinued in 2015, but the medical field has carried on with projects.
This is one of the first papers to study the accuracy of wearable technology for toxicology consultations. There have been similar studies on surgical specialties using Google Glass ® for consults, but the papers focused mainly on feasibility and subjective measures. This paper was a prospective observational cohort study to test the accuracy of 50 patient evaluations. Toxicology fellows wore Google Glass ® during their evaluations. Remote toxicology providers also evaluated the patient by viewing the audio video stream. Pictures of EKGs were taken to allow for remote providers to view them in greater detail. Reliability kappa scores were calculated for 11 of the 17 categories on patient evaluation. Categories relating to the eye exam had slight to fair agreement scores, while the others had substantial agreement. Both evaluators also filled out a subjective questionnaire on the acceptability and reliability of using Google Glass ®. The conclusion was that Google Glass ® consults had good agreement on the evaluation except for eye tests.
I am interested in the idea of using wearables for consults because I rely on specialty consultations on a daily basis. There are many barriers before wearables can make its debut into the standard of care. Privacy, consultant liability, reimbursement, and information security are just a few issues that need to be addressed if wearables are to become the standard. Medicine still relies on a paging system and telephone communication for consultations. I cannot even begin to describe how cumbersome and antiquated this system is. Having consultants be able to evaluate patients with me and give faster recommendations would be immensely helpful. Extending the reach and efficiency of specialists would help in rural settings where specialists are not available. It is heartening to see that the medical field continues to study Google Glass ® despite the decline in consumer interest. Tech innovation in medicine is still driven by the consumer market. While organizations like the American Medical Association have taken steps to initiate physician leadership, it is still a long ways before medical providers are the main drivers of innovation. Until then, more research is needed to determine if wearables are a viable solution to the traditional medical evaluation.
