Health Tech: Google Glass Enters Health Care

New technologies for human-computer interaction are being developed at an exponentially accelerated pace: the time to transition from laptops to smartphones was much shorter than the time to transition from desktop computers to laptops. And now, only a few years after smartphones debuted, we are already anticipating the rise of wearable tech—chief among which is the Google Glass device. Being curious about how Google Glass could be applied to health care, we seized the opportunity to speak with Kyle Samani, the CEO and founder of, a company that aims to do just that.

How exactly is Pristine applying Glass to health care?

We’ve built two HIPAA-compliant apps for Google Glass: Pristine Checklists and Pristine EyeSight. Pristine CheckLists are just that—checklists—and Pristine EyeSight is a first-person video streaming solution. We support one-to-one, one-to-many, and many-to-one streams to and from any authorized Glass, iPhone, iPod Touch, iPad, PC, or Android device.

Checklists are straightforward. Nurses are using them from pre-op to pre-anesthesia. We’re also testing Pristine CheckLists for scope processing and cleaning. In scope processing, hospital staff are going through 30 to 50 steps to clean instruments, and those steps vary by manufacturer and model. I haven’t been to a hospital that’s implemented real process control around checklists because the cleaning staff can’t use their hands. Broadly speaking, checklists are about process control. We’re delivering process control solutions for environments in which the cost of being wrong is high, and in which the people cannot use their hands. I have no doubt we’ll discover more use cases for Pristine CheckLists over time.

First-person video streaming will be used in dozens of ways that we don’t even know about yet. We solve the problem of “Can you come over here and look at this?” Or if you want to think about it the other way around, we also solve the problem of “What are you doing?” In many large hospitals, the answer to first question is “no”—because the other person is a 10-minute walk away—and the answer to the second question has been unactionable since the other person is usually a 10-minute walk away.

Some of the key use cases we’ve identified in which the surgeon wears Glass:

  • Teaching/training for the surgeon
  • Intra-OR remote consults
  • Tele-surgery

Some use cases in which nurses or other mid-level staff wear Glass:

  • Ensuring nurses get the right piece of equipment from the equipment room during a procedure
  • Remote monitoring and management for anesthesia (putting Glass on their certified registered nurse anesthetists)
  • Remote monitoring and management for OR managers (same stream that anesthesia is receiving)
  • Remote monitoring and management for ED doctors (putting Glass on ED nurses)
  • Remote monitoring and management for ICU doctors (putting Glass on ICU nurses)

Fundamentally, we break the assumption that you need to be in room X to provide value in room X—for every room of the hospital. That’s an extremely powerful concept, and one that will take years to be fully understood and realized. We’re really at the tip of the iceberg with discovering where and how Pristine EyeSight can be used.

How did you come up with the idea for Pristine?

I’ve been programming since I was about 10 years old. Although I grew up in Austin, I went off to New York University to study finance, thinking that I wanted to be an investment banker until I learned what investment banking was all about. After I realized that investment banking wasn’t right for me, I got into health care IT by joining an EMR company, VersaSuite, back home in Austin. VersaSuite caters to rural hospitals (50 beds and under). I literally taught people that a mouse isn’t a rodent, but a click device. I spent 3 years there (1 year running an engineering team, 1 year as the lead technical salesman, and 1 year as the product manager for all clinical applications).

Earlier this year, Google announced the #ifihadglass competition. My eyes immediately lit up. I’ve always been enamored with novel forms of human-computer interaction (HCI) and new toys, and Glass is obviously the most ridiculous new toy around. From the moment I saw Glass, it was clear to me that Glass will change medicine. I recruited my cofounder, Patrick Kolencherry, and we both quit our jobs. We started working on what would eventually become Pristine in April, though we didn’t create a legal entity until May 15th.

My first big idea for Glass was to help blind people. I was so jaded by health IT I just wanted to get out. About a week later, we decided that we weren’t qualified to enter that market. When Patrick joined, we began developing apps to extend the EMR onto Glass. We threw that away a couple of weeks later.

Our first investor found me through HIStalk. He was an anesthesiologist who saw the potential for Glass in the operating room. He really opened our eyes to the opportunities for Glass in and around that setting. Since then, our vision has grown.

You write prolifically about Google Glass. What use cases in medicine make the most sense?

To effectively answer this question, I need to step back a bit. Let’s call Glass a computer on your face. Let’s call a smartphone a computer in your pocket. Let’s call a laptop a computer on your desk.

What did smartphones do that laptops couldn’t? What was their marginal value? Mobility, camera, GPS, always-connected Internet, and touch. As such, successful smartphone apps take advantage of these distinct characteristics of the device.

So, the real question is, what can Glass do that smartphones cannot? What is the marginal value of Google Glass? As it turns out, I’ve written several blog posts addressing that very question. To sum those posts up, there are six fundamentally unique characteristics of Glass:

  • Hands are free
  • Heads-up display
  • Friction-free (it’s always there)
  • First-person camera
  • Head tracking
  • One-way audio

On the other hand, Glass is an extremely limited platform. The two biggest limitations are the small screen and lack of robust input options. The screen can hold ~40 words of text, though I wouldn’t recommend putting even that much text on the screen. The device is simply unusable if typing is required, and although voice can be a substitute, voice quickly breaks as a reliable input method when discussing people’s names and complex clinical terms such as drugs, procedures, and labs.

The best Glass apps need to heavily take advantage of at least two or three of the marginal value traits, if not more. If a Glass app doesn’t take advantage of them, it probably shouldn’t exist on Glass.

Which of these characteristics is useful in medicine? Pretty much all of them except head tracking. There are some interesting opportunities for head tracking in the long term, but there’s much more low-hanging fruit to be had by taking advantage of the other five characteristics.

We can turn those five characteristics into a job description: Glass can provide immense value for people who are running around all day, using their hands, and who need to quickly access and share information. Glass’ value is even more pronounced if that information is sensitive and should only be shared selectively.

Pretty much every health care professional has that job description: surgeons, surgical techs, doctors in most medical disciplines, most types of nurses, pharmacists, lab technicians, phlebotomists, EMTs, etc. I honestly struggle to think of a single class of health care professional that doesn’t have that job description.

In 5 years, I expect 80% or more of health care professionals in the country will wear an eyeware computer. That sounds like a bold claim, but recall that the iOS App Store turned 5 earlier this year, and smartphone adoption at the point of care is between 70–90% depending on who you ask. In the short term, I suspect we’ll see Glass adoption driven by high-dollar, high-value use cases: surgery, ICU, and emergency care.

I know Pristine has been growing rapidly over the past few weeks. What are your key goals for this year and next year?

By the end of the year, we’d like to have a commercially viable product that hospitals will pay for. We were the first to deploy and test HIPAA-compliant Glass apps in live patient care environments, and in surgery and the ICU of all places. We will be testing and refining for the next few months. Given how personal Glass is—remember that it rests on your face—the user experience has to be extremely polished. Although our apps are usable today, they’re not quite yet ready for prime time.

It’s honestly too difficult to clearly lay out a goal for the end of 2014. We are still learning so much about how our product will be used in clinical environments that it’s nearly impossible to lay out goals for next year. We know that we’re getting interest from the ER and ICU, even though the apps we built are targeted for surgery. We’ll see what adoption and reception look like in the OR and other areas, and make some judgment calls early next year to crystallize goals for the end of 2014.

Shiv Gaglani is an MD/MBA candidate at the Johns Hopkins School of Medicine and Harvard Business School. He writes about trends in medicine and technology and has had his work published in Medgadget, The Atlantic, and Emergency Physicians Monthly.

Keywords: Judgment, Patient Care, Health Insurance Portability and Accountability Act, Investments, Job Description, Checklist

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