Charles Webster, MD, Contributing Writer
Charles Webster, MD blogs about healthcare IT for Future Care and on his website,

Google Glass and the future of healthcare

sites/ shot 2013-07-09 at 4.13.36 PM_0.pngFlickr/Creative Commons photo by Antonio Zugaldia.
July 9, 2013 AT 8:14 PM

I’ve had Google Glass for three weeks. I’ve used it. I’ve demoed it. I’ve programmed it. During that time there have been many news articles and blog posts full of ideas for Glass in healthcare. Pundits on the next disruptive and transformative tech have weighed in. Now it is my turn to predict the future. Successfully or unsuccessfully, only time will tell. I’m going out on a limb here…


Can (and will) Glass empower patients? Will third-party apps be there to help do so?


There’s lots of interest in Glass use by surgeons, EMTs, and nurses, for hands-free and real-time access to critical information. It’s justified. But there’s also been negative speculation about threats to patient privacy. What will patients think when they see their physician wearing Glass. In my opinion, it will become just another tool they associate with healthcare workers (less obtrusive than the head mirror that used to be a symbol of the medical profession). The bigger question should be, what will physicians and others think when they see a patient wearing Glass?


Glass won’t disrupt and transform healthcare unless patients, not just providers, begin to use it (I told you I was going out on a limb! I know lots who’d disagree!). I look forward (well, sort of) to Glass telling me how many calories are in that second slice of cheesecake, that 65 percent of my followers forgo it – in real-time, while I’m reaching for it. When a busy specialist lists alternatives and contraindications heading out the exam room door, I want to review the video, including automatically inserted links. God forbid, someday, when I am (hopefully temporarily) too weak to lift a mouse or smartphone, let alone a tablet, I want to stay in touch with relatives, friends, and colleagues. Soon, if it hasn’t already happened, someone will emerge from surgery and his or her first words will be, “Where’s my Glass? Could you put it on me? OK Glass…” And, if someone doesn’t happen to own Glass, give them one when admitted, to help navigate from place to place, to access educational material, and to, generally, pass the time in a more interactive way than staring at the hospital room TV.


The largest unanswered question is whether apps, called Glassware, will be there to propel Glass adoption. Don Norman, the father of Human- or User-Centered Design, who is well known in the health IT usability community, says “Google glassses are well done. I've worn them. Beautiful, but are they functional? The developer community will find out.” So it’s worth taking a peak under Glass’s hood to understand how Glass is programmed.


First of all you need to understand that Glass is not a video monitor constantly between you and the world. It’s a small rectangle that occasionally appears, at your bidding, to float above the fray in front of you. You hear a “ding!” (no one else can hear) and you can tap your temple or (my favorite) just tilt your head back slightly to see whatever multimedia “card” just appeared on your “timeline.” A single card may be just a bit of static info pushed to you, or it can interact with you via touchpad or voice command. Collections of related cards, called “bundles” can also appear and disappear, or, if you “pin” them, be constantly available.


A bundle of cards is a simple workflow, a sequence of steps, consuming resources (your attention) to achieve a goal. For example, to put Glass into Guest mode for demoing, I navigate forward to Settings, which has a little dog-eared triangle symbol in the upper right. This means you can drill down to a set of cards you swipe past until you get to the card you can tap to turn Guest mode on or off.


Where do cards come from? Glass comes with some sources of cards, such as email and Twitter, plus news from New York Times and CNN. If they were the sum total of Glass’s functionality, it would be a bust. Fortunately Glass is a platform for third-party apps, called Glassware. Will Glass have the third-party software necessary to make people – the people who need to stay fit and watch their weight, record medical conversations and access patient education, and navigate complicated hospital environments ­ want Glass? To me that is the billion-dollar question. For it will be non-healthcare Glassware that’ll drive adoption of the Glass platform, just as consumer electronics and digital entertainment drives so much outside and inside of healthcare.


There are two kinds of Glass apps. The first are the cards I’ve already talked about. They’re creating using the Mirror API (application programming interface). They’re miniature HTML webpages. Some hardcore Java Android programmers dismiss the Mirror API as being too limiting. From their point of view this may be true. Eventually there will be a software development kit (SDK) to allow Java programmers (about ten million worldwide) to create apps for Glass using similar tools as currently used for smartphones. While the GDK has not yet been officially released, I’ve heard of some remarkable non-Mirror Glassware in the works, some for healthcare.


The Glass user interface is very different from smartphones. Google warns not to simply port smartphone apps to Glass.


  • Design for Glass

  • Don't get in the way

  • Keep it timely

  • Avoid the unexpected

By the way, these quite resemble my five principles of usable EHR workflow I described almost 10 years ago.


While the cards/timeline may seem limiting to “real” programmers, I’m excited by cards/timeline because I’m reminded of Apple Macintosh’s HyperCard. Back then, non-programmers composed stacks. Soon, non-programmers, using graphical tools, will create bundles of Glassware cards, connect them up to various services in the cloud, and publish their own Glass apps. I think, and hope, there is going to be an explosion of third-party content for Glass, content (cards) and workflows (sequences and collections of cards). This is the true brilliance of Google Glass’s two-level programming architecture. It will be easy to create simple apps, but still possible to create sophisticated apps.


So, yes, I predict Google Glass will have a big impact, used by clinicians, on healthcare. But it’ll have an even bigger impact on healthcare if it is wildly successful outside healthcare. And this will only be possible if there’s an explosion of third-party Glassware apps, both healthcare and non-healthcare. Finally, I predict the tools will be there, for both programmers and non-programmers, to create compelling healthy and healthcare content and highly usable workflows.


Why am I willing to go so far out on a limb and make such spectacular predictions? Let’s just say I’d like patients and physicians to meet eye-to-eye, so to speak.  

I just wrapped up a video

I just wrapped up a video project for a few of the Presidential Innovation Fellows at HHS/ONC showcasing the integration of Blue Button Plus data and Google Glass. It's meant to explore the doctors perspective - . Thought it might be an interesting add-on to this article.