We sought to investigate the accuracy of remote electrocardiogram (ECG) interpretation using Google Glass (Google, Mountain View, California). Google Glass is an optical head mounted display device with growing applications in medicine. We compared interpretation of 10 ECGs with 21 clinically important findings by faculty and fellow cardiologists by (1) viewing the electrocardiographic image at the Google Glass screen; (2) viewing a photograph of the ECG taken using Google Glass and interpreted on a mobile device; (3) viewing the original paper ECG; and (4) viewing a photograph of the ECG taken with a high-resolution camera and interpreted on a mobile device. One point was given for identification of each correct finding. Subjective rating of the user experience was also recorded. Twelve physicians (4 faculty and 8 fellow cardiologists) participated. The average electrocardiographic interpretation score (maximum 21 points) as viewed through the Google Glass, Google Glass photograph on a mobile device, on paper, and high-resolution photograph on a mobile device was 13.5 ± 1.8, 16.1 ± 2.6, 18.3 ± 1.7, and 18.6 ± 1.5, respectively (p = 0.0005 between Google Glass and mobile device, p = 0.0005 between Google Glass and paper, and p = 0.002 between mobile device and paper). Of the 12 physicians, 9 (75%) were dissatisfied with ECGs viewing on the prism display of Google Glass. In conclusion, further improvements are needed before Google Glass can be reliably used for remote electrocardiographic analysis.
Google Glass (Google, Mountain View, California) is an innovative device with optical head mounted display technology designed to function in a smartphone-like, hands-free format. It is an interactive device with a display (640 × 360 resolution Himax HX7309 liquid crystal on silicone display module that provides the equivalent of a 25-inch high-definition screen from 8 feet away), natural language voice command, Bluetooth and Wi-Fi connectivity, and 5-megapixel camera capable of capturing photographs and videos. Early attempts to use Google Glass in medicine showed promising results. The technology has been used in the operating theater as well as the catheterization laboratory to broadcast procedures both for medical education and for consultation with specialists. Google Glass is being introduced into medical school curriculums to enhance education. The ability to remotely transmit and review electrocardiograms (ECGs) for diagnostic purposes using Google Glass could be important, especially in cases of emergency; however, the accuracy of interpretation has received limited study. We sought to evaluate use of Google Glass for remote electrocardiographic interpretation.
Methods
We selected 10 ECGs from “The Complete Guide to ECGs” (O’Keefe Jr, Hammill, Freed, Pogwizd, Physicians’ Press, Birmingham, Michigan, 1997) that illustrated electrocardiographic findings requiring prompt recognition in the emergency medicine setting. Twenty-one key findings (1 to 3 per ECG) were identified and each was assigned 1 point ( Table 1 ). Scoring emphasized identification of the key electrocardiographic feature(s) rather than minor secondary findings. A point was given for correct identification of each key finding, but no points were deducted for incorrect responses.
| Electrocardiogram Reading | Possible Points | Points Earned | P | ||||
|---|---|---|---|---|---|---|---|
| Glass Prism | Glass Image | Paper Electrocardiogram | Prism vs Image | Prism vs Paper | Image vs Paper | ||
| Ischemia/Morphology | |||||||
| Anteroseptal/Inferior myocardial infarction | 3 | 2.8 ± 0.5 | 2.9 ± 0.3 | 3.0 ± 0.0 | 0.50 | 0.25 | 1.00 |
| Anterior myocardial infarction | 3 | 2.4 ± 0.7 | 2.5 ± 0.5 | 2.5 ± 0.7 | 1.00 | 1.00 | 1.00 |
| Complete left bundle branch block | 2 | 0.5 ± 0.9 | 1.1 ± 0.9 | 1.7 ± 0.5 | 0.06 | 0.004 ∗ | 0.09 |
| Pericarditis | 3 | 1.5 ± 0.5 | 1.8 ± 0.5 | 1.8 ± 0.6 | 0.25 | 0.13 | 1.00 |
| Prior inferior myocardial infarction | 2 | 1.3 ± 0.5 | 1.7 ± 0.5 | 2.0 ± 0.0 | 0.22 | 0.01 ∗ | 0.13 |
| Ischemia/Morphology Total | 13 | 8.5 ± 1.8 | 9.9 ± 1.8 | 11.0 ± 1.3 | 0.01 ∗ | 0.001 ∗ | 0.03 ∗ |
| Rhythm | |||||||
| Mobitz type I | 2 | 1.3 ± 0.9 | 1.8 ± 0.4 | 2.0 ± 0.0 | 0.03 ∗ | 0.03 ∗ | 0.50 |
| Paroxysmal supraventricular tachycardia | 2 | 1.4 ± 0.7 | 1.6 ± 0.5 | 1.8 ± 0.5 | 0.75 | 0.31 | 0.50 |
| Ventricular tachycardia | 1 | 0.8 ± 0.4 | 0.9 ± 0.3 | 1.0 ± 0.0 | 1.00 | 0.50 | 1.00 |
| Ventricular fibrillation | 1 | 0.6 ± 0.5 | 0.7 ± 0.5 | 0.8 ± 0.5 | 1.00 | 0.63 | 1.00 |
| Atrial flutter | 2 | 0.9 ± 1.0 | 1.2 ± 0.9 | 1.8 ± 0.6 | 0.50 | 0.03 ∗ | 0.06 |
| Rhythm Total | 8 | 5.0 ± 1.3 | 6.2 ± 1.3 | 7.3 ± 1.0 | 0.02 ∗ | 0.001 ∗ | 0.002 ∗ |
| Total points | 21 | 13.5 ± 1.8 | 16.1 ± 2.6 | 18.3 ± 1.7 | 0.0005 ∗ | 0.0005 ∗ | 0.002 ∗ |
| Min – Max Score | 9 – 16 | 10 – 19 | 15 – 21 | ||||
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