Over the past 50 years, computers have evolved dramatically. In the 1950s, most computers were the size of a room. By the late 1970s, a computer could fit on a desk. By the late 1990s, laptops could fit in a normal-sized bag. By the late 2000s, a computer could fit in one’s pocket. And now in 2014, a computer can now rest comfortably on one’s face: see Google Glass.
Clinicians are highly mobile workers. They are on their feet for most of the day walking many miles. When they sit down to interact with patients, they want to direct their undivided attention to the patient.
Before the advent of meaningful use and the rise of EMRs, clinicians could look at patients and hold a clipboard in hand to document findings. Templates were dense but highly functional. The input mechanism – the pen – offered superb granularity, control, and flexibility (though at the expense of legibility and reportability).
Then federal government instituted the Meaningful Use program, which has forced computers on physicians, many of whom didn’t want to switch from their paper-based documentation styles. Although computers solve some problems that paper-based solutions could never accommodate, they have created problems pertaining to usability, flexibility, and lack of physician-patient interaction.
Why have physicians come to resent desktop computers and EMRs so much? Desktop computers were designed for white-collar, stationary workers. The primary input mechanisms – the keyboard and mouse – are robust and granular, but extremely inflexible in terms of physical human-computer interaction. The desktop was never designed to accommodate the ergonomic needs of mobile healthcare workers.
Tablets… The Dream That Never Was
When the iPad was announced in April 2010, many saw an opportunity to rectify all of the wrong-doings of the desktop. The iPad looked and felt like a digital clipboard. It could be held the same way and was approximately the same size. Many heralded the iPad as the tool that would save medicine from desktop hell.
A few years later, we’ve learned that the iPad is not an adequate desktop or clipboard replacement. Although it holds immense promise at first glance, it simply isn’t robust enough:
- Typing on the software keyboard is woefully inadequate for complex narratives.
- Structured fields that require date/number/list pickers are cumbersome and slow.
- The human finger isn’t nearly as precise as a mouse, and as such, digital forms can’t be as dense as paper based forms.
Will healthcare providers be slaves to desktops forever? I think not.
Enter Smart Glasses
Google Glass is by far the most widely recognized set of smart glasses that’s commercially available. But there are many others: ODG, Vuzix, Atheer. Samsung, Sony and others are also rumored to be building smart glasses.
Glass was designed for the mobile worker. It’s handsfree and omnipresent. It knows when it’s being worn so it doesn’t require the user to authenticate (type in a password) upon each use. It is transparent and out of the way. Rather than force awkward manipulation and ergonomics, Glasses finally free physicians to focus on the patient at hand and maintain sterility.
Although the screen is still small and the user input mechanisms limited, the form factor holds great potential. In the next few years, we’ll see massive innovation in optical technologies that will accommodate massive screens and granular hand-tracking technologies for precise data manipulation and selection. Coupled with ever-improving voice-recognition and natural language processing technologies, Glasses will come to be an integral part of the physician workflows.
Indeed, Google Glass is already being adopted by many of the top US hospitals: UC Irvine, UCSF, Stanford, Dignity Health, University of Washington, Beth Israel Deaconess, Sutter Health, Brown, Brigham and Women’s, UCLA, Banner Health, and more. Although none of these institutions have deployed full-blown EMRs on Glass, they are inching towards it.
Of course, the evolution and deployment of Glasses will be slower than desired. Although the hardware is quickly evolving, it will take several years before EMR vendors redesign EMRs around the new form factor. Some will be slower than others, and many will make horrible design decisions as they adopt desktop and mobile design conventions to Glasses rather than Glasses-native design conventions.
But even still, the potential is exciting. Most new form factors are met with great resistance. Almost nobody outside of Apple recognized the potential of the iPhone at launch and indeed it was highly criticized for its lack of traditional smartphone features. Many thought the iPad was doomed to fail because it was just an oversized iPod Touch.
Similarly, many don’t yet see the massive potential that Google Glasses offer, but as hardware and applications evolve, the value will become clearer and the potential realized.
Doctors, you won’t be slaves to your desktops forever.
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