title: Teletoxicology: Patient Assessment Using Wearable Audiovisual Streaming Technology.
abstract: Audiovisual streaming technologies allow detailed remote patient assessment and have been suggested to change management and enhance triage. The advent of wearable, head-mounted devices (HMDs) permits advanced teletoxicology at a relatively low cost. A previously published pilot study supports the feasibility of using the HMD Google Glass® (Google Inc.; Mountain View, CA) for teletoxicology consultation. This study examines the reliability, accuracy, and precision of the poisoned patient assessment when performed remotely via Google Glass®.
  
  
  
  A prospective observational cohort study was performed on 50 patients admitted to a tertiary care center inpatient toxicology service. Toxicology fellows wore Google Glass® and transmitted secure, real-time video and audio of the initial physical examination to a remote investigator not involved in the subject's care. High-resolution still photos of electrocardiograms (ECGs) were transmitted to the remote investigator. On-site and remote investigators recorded physical examination findings and ECG interpretation. Both investigators completed a brief survey about the acceptability and reliability of the streaming technology for each encounter. Kappa scores and simple agreement were calculated for each examination finding and electrocardiogram parameter. Reliability scores and reliability difference were calculated and compared for each encounter.
  
  
  
  Data were available for analysis of 17 categories of examination and ECG findings. Simple agreement between on-site and remote investigators ranged from 68 to 100 % (median = 94 %, IQR = 10.5). Kappa scores could be calculated for 11/17 parameters and demonstrated slight to fair agreement for two parameters and moderate to almost perfect agreement for nine parameters (median = 0.653; substantial agreement). The lowest Kappa scores were for pupil size and response to light. On a 100-mm visual analog scale (VAS), mean comfort level was 93 and mean reliability rating was 89 for on-site investigators. For remote users, the mean comfort and reliability ratings were 99 and 86, respectively. The average difference in reliability scores between on-site and remote investigators was 2.6, with the difference increasing as reliability scores decreased.
  
  
  
  Remote evaluation of poisoned patients via Google Glass® is possible with a high degree of agreement on examination findings and ECG interpretation. Evaluation of pupil size and response to light is limited, likely by the quality of streaming video. Users of Google Glass® for teletoxicology reported high levels of comfort with the technology and found it reliable, though as reported reliability decreased, remote users were most affected. Further study should compare patient-centered outcomes when using HMDs for consultation to those resulting from telephone consultation.
authors.affiliation: Department of Medical Toxicology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA. abskolnik@gmail.com.|Department of Emergency Medicine, Center for Toxicology and Pharmacology Education and Research, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. abskolnik@gmail.com.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Skolnik
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Chai
authors.affiliation: Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Dameff
authors.affiliation: Department of Medical Toxicology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA.|Department of Emergency Medicine, Center for Toxicology and Pharmacology Education and Research, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Gerkin
authors.affiliation: Department of Emergency Medicine, Banner - University Medical Center Phoenix, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Monas
authors.affiliation: Department of Medical Toxicology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Padilla-Jones
authors.affiliation: Department of Medical Toxicology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA.|Department of Emergency Medicine, Center for Toxicology and Pharmacology Education and Research, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Curry
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D011041:Poisoning / Q000175:diagnosis* / Q000628:therapy; D011446:Prospective Studies; D019114:Remote Consultation / Q000191:economics / Q000379:methods*; D015203:Reproducibility of Results; D062606:Tertiary Care Centers; D014218:Triage; D014741:Video Recording / Q000295:instrumentation*; D000076251:Wearable Electronic Devices
keywords: Google glass; Telehealth; Telemedicine; Toxicology; Wearable devices