Smart Glasses for Supporting Distributed Care Work: Systematic Review.

BACKGROUND: Over the past 2 decades, various desktop and mobile telemedicine systems have been developed to support communication and care coordination among distributed medical teams. However, in the hands-busy care environment, such technologies could become cumbersome because they require medical professionals to manually operate them. Smart glasses have been gaining momentum because of their advantages in enabling hands-free operation and see-what-I-see video-based consultation. Previous research has tested this novel technology in different health care settings. OBJECTIVE: The aim of this study was to review how smart glasses were designed, used, and evaluated as a telemedicine tool to support distributed care coordination and communication, as well as highlight the potential benefits and limitations regarding medical professionals' use of smart glasses in practice. METHODS: We conducted a literature search in 6 databases that cover research within both health care and computer science domains. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to review articles. A total of 5865 articles were retrieved and screened by 3 researchers, with 21 (0.36%) articles included for in-depth analysis. RESULTS: All of the reviewed articles (21/21, 100%) used off-the-shelf smart glass device and videoconferencing software, which had a high level of technology readiness for real-world use and deployment in care settings. The common system features used and evaluated in these studies included video and audio streaming, annotation, augmented reality, and hands-free interactions. These studies focused on evaluating the technical feasibility, effectiveness, and user experience of smart glasses. Although the smart glass technology has demonstrated numerous benefits and high levels of user acceptance, the reviewed studies noted a variety of barriers to successful adoption of this novel technology in actual care settings, including technical limitations, human factors and ergonomics, privacy and security issues, and organizational challenges. CONCLUSIONS: User-centered system design, improved hardware performance, and software reliability are needed to realize the potential of smart glasses. More research is needed to examine and evaluate medical professionals' needs, preferences, and perceptions, as well as elucidate how smart glasses affect the clinical workflow in complex care environments. Our findings inform the design, implementation, and evaluation of smart glasses that will improve organizational and patient outcomes.

Experiences and Perceptions of Distinct Telehealth Delivery Models for Remote Patient Monitoring among Older Adults in the Community.

Three major telehealth delivery models-home-based, community-based, and telephone-based-have been adopted to enable remote patient monitoring of older adults to improve patient experience and reduce healthcare costs. Even though prior work has evaluated each of these delivery models, we know less about the perceptions and user experiences across these telehealth delivery models for older adults. In the present work, we addressed this research gap by interviewing 16 older adults who had experience using all these telehealth delivery models. We found that the community-based telehealth model with in-person interactions was perceived as the most preferred and useful program, followed by home-based and telephone-based models. Persistent needs reported by participants included ease of access to their historical physiological data, useful educational information for health self-management, and additional health status tracking. Our findings will inform the design and deployment of telehealth technology for vulnerable aging populations.

Information Seeking and Sensemaking in Emergency Medical Service through Simulation Video Review.

Emergency medical services (EMS) providers often face significant challenges in their work, including collecting, integrating, and making sense of a variety of information. Despite their criticality, EMS work is one of the very few medical domains with limited technical support. To design and implement effective decision support, it is essential to examine and gain a holistic understanding of the fine-grained process of sensemaking in the field. To that end, we reviewed 25 video recordings of EMS simulations to understand the nuances of EMS sensemaking work, including 1) the types of information and situation that are collected and made sense of in the field; 2) the work practices and temporal patterns of EMS sensemaking work; and 3) the challenges in EMS sensemaking and decision-making process. Based on the results, we discuss implications for technology opportunities to support rapid information acquisition and sensemaking in time-critical, high-risk medical settings such as EMS.

Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study.

BACKGROUND: Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. OBJECTIVE: The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. METHODS: We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users' perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Interviews were transcribed verbatim and analyzed using the open coding technique. RESULTS: We identified four potential application areas for smart glasses in EMS: enhancing teleconsultation between distributed prehospital and hospital providers, semiautomating patient data collection and documentation in real time, supporting decision-making and situation awareness, and augmenting quality assurance and training. Compared with the built-in touch pad, voice commands and hand gestures were indicated as the most preferred and suitable interaction mechanisms. EMS providers expressed positive attitudes toward using smart glasses during prehospital encounters. However, several potential barriers and user concerns need to be considered and addressed before implementing and deploying smart glasses in EMS practice. They are related to hardware limitations, human factors, reliability, workflow, interoperability, and privacy. CONCLUSIONS: Smart glasses can be a suitable technological means for supporting EMS work. We conclude this paper by discussing several design considerations for realizing the full potential of this hands-free technology.

User Needs and Challenges in Information Sharing between Pre-Hospital and Hospital Emergency Care Providers.

Effective communication between pre-hospital and hospital providers is a critical first step towards ensuring efficient patient care. Despite many efforts in improving the communication process, inefficiencies persist. It is critical to understand user needs, work practices, and existing barriers to inform technology design for supporting pre-hospital communication. However, existing research examining the ways in which patient information is collected and shared by pre-hospital providers in the field has been limited. We conducted a series of ethnographic studies with both prehospital and hospital care providers to examine 1) the types of information that are commonly collected and shared by the pre-hospital providers in the field; 2) the types of pre-hospital information that are needed by hospital-based teams for ensuring appropriate preparation; and 3) the challenges in the pre-hospital communication process. We conclude by discussing technology opportunities for facilitating real-time information sharing in the field.

Prevalence and incidence of hypoparathyroidism in the United States using a large claims database.

Hypoparathyroidism is a rare endocrine disorder whose incidence and prevalence have not been well defined. This study aimed to 1) estimate the number of insured adult patients with hypoparathyroidism in the United States and 2) obtain physician assessment of disease severity and chronicity. Prevalence was estimated through calculation of diagnoses of hypoparathyroidism in a large proprietary health plan claims database over a 12-month period from October 2007 through September 2008 and projected to the US insured population. Incidence was also calculated from the same database by determining the proportion of total neck surgeries resulting in either transient (≤6 months) or chronic (>6 months) hypoparathyroidism. A physician primary market research study was conducted to assess disease severity and determine the percentage of new nonsurgical patients with hypoparathyroidism. Incidence data were entered into an epidemiologic model to derive an estimate of prevalence. The diagnosis-based prevalence approach estimated 58,793 insured patients with chronic hypoparathyroidism in the United States. The surgical-based incidence approach yielded 117,342 relevant surgeries resulting in 8901 cases over 12 months. Overall, 7.6% of surgeries resulted in hypoparathyroidism (75% transient, 25% chronic). The prevalence of chronic hypoparathyroidism among insured patients included in the surgical database was estimated to be 58,625. The physician survey found that 75% of cases treated over the past 12 months were reported due to surgery and, among all thyroidectomies and parathyroidectomies and neck dissections performed in a year, 26% resulted in transient hypoparathyroidism and 5% progressed to a chronic state. In conclusion, the two claims-based methods yielded similar estimates of the number of insured patients with chronic hypoparathyroidism in the United States (~58,700). The physician survey was consistent with those calculations and confirmed the burden imposed by hypoparathyroidism.

Employee health and frequency of workers' compensation and disability claims.

OBJECTIVE: To assess the relationship between self-assessed employee health risk status and future workers' compensation (WC) and short-term disability (STD) claims. METHODS: A historical cohort study linking Health Risk Assessment (HRA) survey data with subsequent WC and STD claims. HRA participants who developed a WC or STD claim in the subsequent 12 months were identified as cases and compared with HRA participants who did not develop a claim in the subsequent 12 months. RESULTS: High-risk participants had higher odds of filing a WC claim, when compared with low-risk participants (OR: 2.99, 95% CI: 1.22 to 7.32) despite adjustment for demographic factors including job type. Medium-risk participants had 1.5 times higher odds, when compared with low-risk participants to file for STD (OR: 1.45, 95% CI: 1.15 to 1.82). Other relationships trended similarly but did not reach statistical significance. CONCLUSION: Self-assessed personal health risk does impact future lost productivity in WC and STD claims even after adjustment for demographic, health factors, and job type (WC only). Employers wishing to reduce the impact of lost productivity should consider a worker's personal health risks as predictors of future lost productivity and may want to address this in broad risk reduction programs.