“Historically, a lot of the technology we've asked physicians to adopt seems to have created inefficiencies along with the benefits," says Davin Lundquist, MD, CMIO of Dignity Health in San Francisco.
That hasn't been the case with Google Glass and an integrated app from startup Augmedix. "I don't think you could pry it off the doctors who are using it," he says.
Since mid-January, the technology has allowed three Glass-wearing Dignity Health physicians to have more natural conversations with their patients. During patient encounters, audio and visual information is streamed through the physicians’ Glass to the Augmedix software. Then, a combination of automated and human-assisted transcription on the Augmedix end sends patients’ histories, vitals and other information directly to the patients’ electronic medical record, meaning the physicians’ eyes are on their patients, not a computer screen.
Dignity Health had been working with Augmedix for months before the technology was introduced in the clinic setting, says Dr. Lundquist, to ensure privacy and security standards were met, and to help the physicians feel comfortable wearing the Glass and integrating the new technology their workflow. After a couple weeks of dry runs, three physicians — Dr. Lundquist, an internal medicine specialist and one of the group's most popular family medicine physicians — began wearing Google Glass with Augmedix for every patient encounter.
And they haven’t taken them off.
"I still carry my iPad or laptop with EMR access [into patient encounters], but now I don't have to interact with those tools because I'm confident that as I have a conversation with the patient about what their symptoms are and as we discuss a treatment plan, everything that's happening is going into the progress note," says Dr. Lundquist.
The physicians review all the Augmedix EMR entries at the end of the day for accuracy, but Dr. Lundquist says any changes that need to be made are often very minor. This workflow change — from manually entering complete notes into the EMR to just reviewing the Augmedix entry — has been a significant time-saver. The physicians were spending 10 to 11 hours a day at the clinic between patient visits, documentation and other related tasks; now they're spending eight or nine.
"For me personally, at the end of a clinic day when I saw 15 to 20 patients, it was taking me two to three hours to finish charting all those visits," says Dr. Lundquist. "Now, it takes me 10 to 15 minutes."
As a result, the new technology has dramatically improved the physicians' work-life balance. Not wanting to cut down on time spent with patients at the clinic, the physicians would take their work home and continue completing charts well into the evening. With Google Glass and Augmedix, "we feel like we've gotten our lives back," says Dr. Lundquist.
He says patients have appreciated the change as well. While he expected at least some patients to be uncomfortable being in front of Google Glass’ camera, he says a large percentage of patients don't even notice he's wearing the high-tech glasses. "When patients come in, they're concerned, they're not feeling well," he says. "Mostly, they're just grateful I'm there, meeting their eyes and listening."
Those that do recognize the technology are often impressed, Dr. Lundquist says. Far from being uncomfortable, these patients often equate advanced technology with advanced clinical knowledge and expertise, and often end up trusting him more. Throughout the four-month trial, less than 1 percent of the patients asked Dr. Lundquist or one of the other physicians to remove Google Glass, he says.
Dr. Lundquist and his team are currently in discussions to expand the use of the technology to more Dignity Health clinics. If trials continue to go well, he expects Google Glass and Augmedix to be adopted more widely throughout the Dignity Health system.
The limiting factor in the expansion will be cost. Dignity Health, like all other healthcare providers across the country, is under increasing pressure to justify every additional line in the budget. Dr. Lundquist plans to begin a more focused exploration into the return on investment of the technology, comparing the cost of Google Glass and Augmedix with the quantifiable benefits — time saved, additional patients seen. Preliminary analyses suggest Google Glass and Augmedix will be at least comparable to other time-saving strategies like medical scribes, he says.
"Of course, if you asked doctors if getting two hours of their day back was worth the cost, they'd obviously say 'yes,'" he says.
Dr. Lundquist is thankful, however, that the decision to expand may not come down solely to money. "I've been with Dignity Health for a couple of years now, and one of the things that has impressed me is how they make the patient the priority," he says. He sees this application of Google Glass as aligned with Dignity Health's goal of keeping compassion at the center of care delivery by allowing for a real, personal connection between patients and physicians.
"Ironically, being technology, it's really harnessing the human side of medicine," he says.
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