Five Questions With: Dr. Paul Porter

"Google Glass will assist dermatologic patients by allowing a two-way interaction. In our early patient interviews, we found that it gives the dermatologist a chance to ask questions and the patient a chance to respond to them rather than just sending pictures or having the physicians out of the room on a phone call."

Dr. Paul S. Porter is an attending physician in the department of emergency medicine at Rhode Island, The Miriam and Hasbro Children’s hospitals. He earned his bachelor’s and medical degrees, as well as a master of business administration, from the University of Pennsylvania; and completed his residencies at Morristown Memorial Hospital in Morristown, N.J.; and Dartmouth Hitchcock Medical Center in Hanover, N.H. He is a member of the US Army Medical Corp, and maintains status as an attending physician at Walter Reed National Medical Center.
Porter is overseeing the first use of Google Glass in an emergency department in the nation at Rhode Island Hospital; the technology is being used in dermatology.

PBN: Do you have a long-standing interest in technology? Is this use of Google Glass something that represents a fruition of some kind?
PORTER:
I have a long-standing interest in developing lower cost, higher-quality healthcare. Technology is part of that solution. I developed the Special Projects program at University Emergency Medicine Foundation and first started with low-tech, developing a system that coordinated primary care physicians with the emergency department at Rhode Island Hospital, resulting in significant reductions in hospital days and expenses. Technology and Google Glass is the next step in care coordination.
I became interested in telemedicine when I was running an emergency department in Baghdad, Iraq, transporting injured soldiers either back to the United States or around Iraq, which was both dangerous and expensive. I began sending images back to the Walter Reed Hospital for specialist consultations and it proved to be very effective. We have been looking for a chance to do it locally ever since, and I have had a couple of experiments in telemedicine.

PBN: What led to the decision to innovate using Google Glass specifically for dermatology in an Emergency Department setting?
PORTER:
The decision to choose dermatology was three-fold: (a) Dermatology is the most visual of specialtie; (b) It is a relatively low-risk specialty for technology disruption in that you generally have some time to make and treat the diagnosis; (c) Google Glass was an inexpensive platform for developing a Telemedicine Program. The unit cost compares very favorably with a full telemedicine cart which could cost up to $150,000.

PBN: What are some of the ways that Google Glass will assist dermatological patients – are burn victims some of the people who might benefit from the use of the technology?
PORTER:
Google Glass will assist dermatologic patients by allowing a two-way interaction. In our early patient interviews, we found that it gives the dermatologist a chance to ask questions and the patient a chance to respond to them rather than just sending pictures or having the physicians out of the room on a phone call. For example, our dermatologist recently suggested a treatment to the patient and the patient was able to respond in real time that they had already tried that treatment and it didn’t work in a very comfortable way and then we moved to a second treatment and felt the patient was very satisfied.

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Burn victims are not generally treated by our dermatologists but rather are treated by our trauma surgeons who are present in house 24/7. The burn patient may benefit later on from follow-up visits that could be performed by tele-communication but it’s a different setting and in the acute setting they most often must receive care much more urgently than other patients. Where we can see burn patients benefiting from a Google Glass program would at community facilities without easy access to specialists and it would help determine whether a patient would need a referral.

PBN: If this trial goes as well as expected, or even better than expected, what would be a logical next step for a branch of emergency medicine that could benefit from Google Glass?
PORTER:
If our trial goes well, the specialties that might benefit the most are those for whom time-to-care is very sensitive. For example, beginning stroke care or the care following a heart attack in the field with the paramedics on the truck where you could find the patient with a neurologic deficiency or somebody having heart attack symptoms and a positive EKG; where you could rapidly decrease the door-to-needle or door-to-balloon time as it’s called in the field.
On another front, we could see where having access for mental health issues; access to a psychiatrist who might be out of the facility in that they will be able to see the patient and ask questions over Google Glass.

PBN: What were some of the privacy hurdles that you had to overcome before you felt comfortable using Google Glass with patients, and what steps did you take to get past those hurdles?
PORTER:
We take privacy very seriously and the privacy hurdles we had to overcome were to insure that we wouldn’t photograph a patient’s protected information and that our data would be encrypted form the starting point to the ending point. Our data is heavily encrypted over our modified version of Google Glass all the way through and no images are ever stored so that it is just actively streamed.
We did a full security audit with our chief information officer and heavily analyzed the encryption. There are also additional protections and measures within the Lifespan IT department to ensure patient privacy is maintained at all times.

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