Google Glass Presents Opportunities, Challenges for Otolaryngologists

Legal Concerns

Nicolas Terry, a professor of law at Indiana University Robert H. McKinney School of Law in Indianapolis, is familiar with the legal issues surrounding wearable technology and pointed out some concerns about the use of Google Glass.

Surgeons can have data displayed within their field of vision as they perform a procedure, using it as a kind of checklist so that they don’t have to turn away and consult a book or other document. “If we start putting new things within the field of vision of a surgeon, to what extent could there be an argument that the surgeon is being distracted?” Terry asked. He has heard reports of technology leading to mistakes, such as a resident using a smartphone app to update a prescription, then getting a text message in the middle of doing so, which led to a mistake and patient injury.

Recording and transmitting data can assist with medical training. Traditionally, when surgeons are performing a surgery, it is impossible for a resident to have the same vantage point unless the surgeon steps out of the way. Given the nature of head and neck surgery, with its small, dark fields, this can be a hindrance to education. But with Glass, the surgery can be streamed real-time to another monitor for a resident, who can watch, provide input, and ask questions.

Terry noted the “strict ethical rules” surrounding the recording of a patient, even for such beneficial uses as education and training. “There are lots of ethical areas that people doing this are going to have to be very careful of, and they typically rotate around quite detailed consent that is required from the patient,” he said.

Then there is the storing and processing of data, which requires complying with the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules, Terry said. “A lot of what is likely going on with Glass at the moment causes real problems with regard to privacy and security,” he said. Hospitals where Glass is used for storing and processing should enter into business associate agreements with vendors that assure HIPAA compliance. Google itself does not offer such agreements, because it is not HIPAA-compliant. Outside vendors essentially have to adapt the technology to make it so, and their products can be pricey.

“When you see a bunch of physicians really interested in a new technology like this, I think it’s cause for celebration,” Terry added, “but then after that first cheer goes up, it’s important that you say, ‘We want to use this—what are the ways we can minimize risk?’”