Wednesday, April 2, 2014

Healthcare: A promising vertical for Google Glass?

Last month, I spotted a very interesting blog post about Google Glass by John Halamka, M.D., the CIO of one of Boston's largest research hospitals. Google Glass, a virtual reality system embedded in a pair of eyeglasses, has been given a bad rap in the media by a series of minor controversies involving whether people are recording or photographing things that they shouldn't. But the usage of Glass that Halamka describes is one of the few examples that I've seen of the technology providing a measurable improvement over older technologies -- in this case, emergency room systems used to present patient information to doctors and other staff.

Dr. Halamka is one of those rare CIOs who truly embraces the cutting edge of information technology -- ten years ago he had an RFID chip containing his medical information embedded in his arm. He is very interested in promoting discussions around new technologies and what they can do to improve healthcare. Working with Emergency Room staff at Beth Israel Deaconess Hospital, he developed a prototype system for doctors to retrieve certain types of information through Google Glass. In a blog post titled Wearable Computing at BIDMC (since removed from the Web), he described how it worked, as well as some of the issues around usage of the technology:
When a clinician walks into an emergency department room, he or she looks at bar code (a QR or Quick Response code) placed on the wall.  Google Glass immediately recognizes the room and then the ED Dashboard sends information about the patient in that room to the glasses, appearing in the clinician’s field of vision. The clinician can speak with the patient, examine the patient, and perform procedures while seeing problems, vital signs, lab results and other data.

Beyond the technical challenges of bringing wearable computers to BIDMC, we had other concerns—protecting security, evaluating patient reaction, and ensuring clinician usability.

Here’s what we’ve learned thus far:

Patients have been intrigued by Google Glass, but no one has expressed a concern about them. Boston is home to many techies and a few patients asked detailed questions about the technology. Our initial pilots were done with the bright orange frames—about as subtle as a neon hunter's vest, so it was hard to miss.

Staff has definitely noticed them and responded with a mixture of intrigue and skepticism. Those who tried them on briefly did seem impressed.

We have fully integrated with the ED Dashboard using a custom application to ensure secure communication and the same privacy safeguards as our existing web interface. We replaced all the Google components on the devices so that no data travels over Google servers. All data stays within the BIDMC firewall.

We have designed a custom user interface to take advantage of the Glass’ unique features such as gestures (single tap, double tap, 1 and 2 finger swipes, etc.), scrolling by looking up/down, camera to use QR codes, and voice commands. Information displays also needed to be simplified and re-organized.

We implemented real-time voice dictation of pages to staff members to facilitate communication among clinicians.

Google Glass does not appear to be a replacement for desktop or iPad—it is a new medium best suited for retrieval of limited or summarized information. Real-time updates and notifications is where Google Glass really differentiates itself. Paired with location services, the device can truly deliver actionable information to clinicians in real time.

Here’s a real BIDMC experience described by Dr. Steve Horng

"Over the past 3 months, I have been using Google Glass clinically while working in the Emergency Department. This user experience has been fundamentally different than our previous experiences with Tablets and Smartphones. As a wearable device that is always on and ready, it has remarkably streamlined clinical workflows that involve information gathering.

For example, I was paged emergently to one of our resuscitation bays to take care of a patient who was having a massive brain bleed. One of the management priorities for brain bleeds is to quickly control blood pressure to slow down progression of the bleed. All he could tell us was that he had severe allergic reactions to blood pressure medications, but couldn’t remember their names, but that it was all in the computer. Unfortunately, this scenario is not unusual. Patients in extremis are often overwhelmed and unable to provide information as they normally would. We must often assess and mitigate life threats before having fully reviewed a patient’s previous history. Google glass enabled me to view this patient’s allergy information and current medication regimen without having to excuse myself to login to a computer, or even loose eye contact. It turned out that he was also on blood thinners that needed to be emergently reversed. By having this information readily available at the bedside, we were able to quickly start both antihypertensive therapy and reversal medications for his blood thinners, treatments that if delayed could lead to permanent disability and even death. I believe the ability to access and confirm clinical information at the bedside is one of the strongest features of Google Glass. "

We have been live clinically with Google Glass for a limited set of four emergency physicians serving as beta users since 12/17/13. Since then, we have been working on improving stability and adding features to improve usability. Some of these modifications include the addition of an external battery pack, increasing the wireless transmission power, pairing the headset with our clinical iPhones, using head tilt to control vertical scrolling, revamping our QRcode reader to improve application stability, adding an android status bar to show wireless connection strength and battery power.

In addition to our four beta users, we've also had impromptu testing with at least 10 other staff members since 1/24/14 to get feedback to refine the user experience.

As a device being used in clinical care, we needed to rigorously test our setup to ensure that the application is not only reliable and intuitive, but improved the workflow of clinicians rather than impede it.

I believe wearable computing will replace tablet-based computing for many clinicians who need their hands free and instant access to information.
Google Glass healthcare experiment Halamka BIDMC
Dr. Halamka indicated that the pilot was a success, and said a full roll-out was anticipated in the coming weeks.

It should be interesting to see if this learning experiences of this experiment can be applied to other medical settings, not just at BIDMC but also other hospitals and clinics. Of course, besides improving the interface and other aspects of the data being delivered to caregivers, developers need to consider how the technology may impact other aspects of running a hospital and interacting with patients. VR may be a large chasm for patients and some staff to cross, and there is also the issue of whether the usage of such technologies requires FDA input.



Tuesday, March 11, 2014

What does # mean in twitter? (Or, all about hashtags)

(Excerpted from my Twitter guide, Twitter In 30 Minutes.) You may notice that some words in tweets have the hashtag or pound symbol (#) added to the front. Occasionally, there will be a hashtagged phrase or acronym with all of the spaces and periods removed, like #thingsthatbotherme. What does # mean in Twitter? The blog post below explains how to use them, as well as some hashtag no-nos.

Hashtags are a Twitter convention that lets people easily find tweets about the same topic. By adding a hashtag to the front of a word or phrase, it turns it into link that is hooked up to Twitter’s search engine. Click the link, and the most recent tweets that include the same hashtag are displayed. Here’s what shows up when I click on #Bulls:

Twitter hashtag example: #Bulls

Hashtags serve other useful functions as well. They alert other Twitter followers to the fact that the tweet is about a certain topic that may otherwise not be apparent. Let’s say you’re watching the Oscars on TV, and you see someone wearing a beautiful dress glide by the camera. You could ask your Twitter followers:

Twitter example clothing

Many people may not know what you are talking about. But they will if you add:

Twitter example Oscars #oscars

By adding #oscars, it’s clear you are talking about the awards ceremony, and not something else. Moreover, if any follower clicks the #oscars link, they’ll see all of the other tweets tagged “#oscars”.

Sometimes people create funny hashtags. The television host Jimmy Fallon and his writing team are especially skilled at this. They ask their viewing audience a funny question and then tell them to use a hashtag to let the writing team (and other viewers) see the answers. Here’s are some of the responses to his hashtag #WorstCarIEverHad:

Twitter Jimmy Fallon hashtag example

Hashtags are also used to tag sporting events (for instance, #olympics), political races (#election2016), conferences (#ces2014), and practically any other event you can think of.
Some new Twitter users make the mistake of turning every word in their tweets into hashtags. Here’s an example:


It’s irritating and unnecessary. They tweets are hard to read. In addition, hashtagging common nouns, verbs and other words doesn’t add any value if people click on the hashtags.

Another mistake involves using the wrong hashtag. For instance, followers of the Boston Red Sox generally use #redsox to talk about their team, not #bostonredsox or #sox.

Mistakes can also happen when a single hashtag is used by two different groups of people. Check out #gastro, which is used by people who like gourmet food as well as doctors and scientists who are interested in discussing gastrointestinal diseases:

Bottom line: Choose your hashtags carefully. If I am interested in using a particular hashtag in a tweet, I often search Twitter first to make sure it’s the appropriate one to use.

Wednesday, November 27, 2013

23andMe's CEO letter and the FDA crisis

I just received this email from the 23andMe's CEO:

Dear 23andMe Customers,

I wanted to reach out to you about the FDA letter that was sent to 23andMe last Friday.

It is absolutely critical that our consumers get high quality genetic data that they can trust. We have worked extensively with our lab partner to make sure that the results we return are accurate. We stand behind the data that we return to customers - but we recognize that the FDA needs to be convinced of the quality of our data as well.

23andMe has been working with the FDA to navigate the correct regulatory path for direct-to-consumer genetic tests. This is new territory, not just for 23andMe, but for the FDA as well. The FDA is an important partner for 23andMe and we will be working hard to move forward with them.

I apologize for the limited response to the questions many of you have raised regarding the letter and its implications for the service. We don't have the answers to all of those questions yet, but as we learn more we will update you.

I am committed to providing each of you with a trusted consumer product rooted in high quality data that adheres to the best scientific standards. All of us at 23andMe believe that genetic information can lead to healthier lives.

Thank you for your loyalty to 23andMe. Please refer to our 23andMe blog for updates on this process.

Anne Wojcicki
Co-founder and CEO, 23andMe

I am a 23andMe customer. I was attracted to the genetic testing service because the results can be used for genealogical research, but have since grown to appreciate the health insights. In fact, family members have ordered kits based on the reports that they saw were available. We have already received the results for one relative, but two others are awaiting testing.

The other valuable service provided by 23andMe is the community. There are a lot of online discussions about genealogical and health results, and even more importantly, it's possible to reach out to people who share some common genes that indicate relative status.

I think the FDA should be concerned about the accuracy of the testing, and the potential for false positives. But remember that 23andMe is also focused on data quality. In addition, 23andMe is very careful to provide peer-reviewed research and other vetted data to users of its service, when it comes into providing health insights. It also states that health-related concerns should be discussed with doctors and other health professionals.

In other words, 23andMe is not a DIY diagnosis service. It shows risks based on genetic profiles and public research, and advises people to seek out professional medical advice.

Sunday, October 6, 2013

Another In 30 Minutes title released, and an update

What is Twitter?
The latest In 30 Minutes title, a guide that explains what is Twitter and how to get the most out of the social networking service, was released to the wild on the first of this month. Like all members of the In 30 Minutes family, Twitter In 30 Minutes covers the basics, including:

  • Registering for Twitter on a phone or online
  • Customizing a Twitter profile
  • Figuring out who to follow (and who to block)
  • Tips to make great tweets

Obviously, this appeals to people who are new to Twitter, but I have also identified a significant audience of people who have created accounts in the past but dropped off after a few tweets. This guide is for them, too, as it explains how to make Twitter a more rewarding experience and also gets into some of the more advanced features and conventions. If you want to learn more about Twitter In 30 Minutes or show your support, please visit the official Twitter In 30 Minutes website.

I also wanted to give an update about blogging. It's been some time since I updated Digital Media Machine. On one level, that bothers me because I live and breathe digital media, and certainly have a lot to say.

On the other hand, the lack of content on this blog (and my other online spaces, ranging from product blogs to YouTube) reflects the reality that I simply do not have the bandwidth to regularly contribute content to Digital Media Machine and elsewhere.

What's taking up my time? In 30 Minutes guides are part of it, but the other aspect relates to my consulting activities. I work with a small number of startup clients on marketing and business administration. I started doing this about a year ago, because our family income had suffered greatly (referenced in an earlier blog post about failure) and I didn't want to take a salary from In 30 Minutes guides. Over time, the consulting has grown from about 10 hours per week to 25 or more, and I just don't have the added hours to blog regularly. The exception: Digital content associated with new releases. For Twitter In 30 Minutes, that includes this blog post, as well as a short series of basic Twitter videos I posted on YouTube and on the companion website.

As I don't see my hours freeing up anytime soon, don't expect too many posts on Digital Media Machine. The best way to keep up with my activities is on @ilamont, and @in30minutes. It's much easier to make 140-character updates than it is to write full-fledged blog posts.

Saturday, July 6, 2013

My brief review of the biography of Steve Jobs

Over the weekend I finished Walter Isaacson's biography of Steve Jobs. As the book has been reviewed extensively by other people, I am going to try to limit my own review to insights that were  largely absent in the earlier discussions about the book.

My first observation concerns the amount of research that went into the book. Isaacson conducted  hundreds of interviews with Jobs and the people close to him, yet only a relatively small number of quotes made it into the book. As I read the biography, I kept wondering how many quotes and facts ended up on the cutting-room floor. There was probably enough material to create another bio of Jobs, plus assorted studies of specific products or the people around him. To that end, I would be very interested to see a book about the relationship between Jobs and Ive, as well as Jobs and Lasseter (the creative genius at Pixar).

Speaking of Pixar, I was very excited to see the sections about Jobs' history at Pixar, and how he helped grow the company. The sections about Jobs and Eisner, as well as the tale of the Disney acquisition, were absolutely fascinating. As a technology journalist from the late 1990s until 2010, I really felt that the Jobs/Pixar story was neglected by the media in favor of Jobs/Apple, but Isaacson really helped shed some light into the Pixar connection.

However, I also have some criticism concerning Isaacson's coverage of Apple products from 1997 until his death. I felt it was uneven. For instance, the author dove into the iTunes/iPod/music industry story, but barely scratched the surface of the App Store and its impact. There were also a slew of Apple hardware products that were notable but were barely mentioned. I'm not just talking about Xserve or rare product flops, either. For instance, the MacBook Air marked a milestone in laptop design, but it was not called out in the book.

Nevertheless, these issues are relatively minor, considering the magnitude of Isaacson's accomplishment. He had to write about an incredibly difficult topic, and the result is an extensive, honest portrait of a complex and troubled man.

Sunday, May 19, 2013

Toyota dealerships have an image problem. Can new ads help?

Toyota is currently running a series of dealership-focused television ads in our part of the country (I suspect the campaign is national, as the ads have high production value). The ads always show target consumers (usually families with young kids, or a college-aged child) walking into the dealership, where they go to a reception counter that features a seated woman (the same lady shown in the clip below). The customer initiates the conversation. The employee helpfully shows the car that's the perfect match.

It seems as if Toyota is trying to portray dealerships and their employees as being harmless and passive. The customer is in control (starting the conversation, standing over the dealership employee). The employee is a woman, and does not use high-pressure sales tactics, hover over potential customers, etc.

I believe Toyota (and perhaps the dealerships themselves) understand they have an image problem, and the ads are designed to fight this. The question is: Is it enough? The bad tactics over the years have made most people wary of dealerships. It's not clear if a bunch of new TV spots can make much of a difference.



Monday, April 22, 2013

Mainstream media botched parts of Boston Bombers story, too

There's a lot of criticism right now of how Reddit, Twitter, and other social media platforms were responsible for spreading false information about the hunt for the bombers responsible for the Boston Marathon terrorist attack. I would like to use this post to remind people that the mainstream media had their own credibility problems during this affair.

On the afternoon of April 17, around the time AP, CNN, The Boston Globe and other professional news outlets were claiming suspects had been arrested or were about to be, I took note of what the anchors on local Boston-area TV stations were saying:

WCVB: "I'm seeing the same tweets you're seeing"

WBZ anchor Jack Williams: "We want to clarify so people understand: We're quoting sources, who are quoting sources."

Williams: "Let me speculate out loud as we try to figure out what in the world is happening here."

Williams: "If you don't mind, let me speculate a little more, Paula"

Williams: "We haven't confirmed everything yet. But something has happened."

On Friday, when the city was effectively locked down, speculation and misinformation was joined by over-reporting of operational details. I saw one of the local stations showing a street address in Watertown that police were investigating, while the studio anchor quizzed the on-scene reporter about the position of snipers. This was after the Boston and State police had requested media not to divulge details that might endanger the lives of officers:



Is it any wonder that people have a tough time trusting professional news organizations?

Boston bombing TV coverage criticism