Journal of Medical Toxicology

, Volume 12, Issue 4, pp 358–364 | Cite as

Teletoxicology: Patient Assessment Using Wearable Audiovisual Streaming Technology

  • Aaron B. Skolnik
  • Peter R. Chai
  • Christian Dameff
  • Richard Gerkin
  • Jessica Monas
  • Angela Padilla-Jones
  • Steven Curry
Original Article



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.


Telemedicine Google glass Toxicology Wearable devices Telehealth 



The authors wish to especially thank Angela Padilla-Jones, RN, BSN, for her efforts in coordinating this research.

Compliance with Ethical Standards

This observational cohort study was reviewed and approved by our institutional review board and complied with our center’s best practices for human subject research. A waiver of consent was granted after demonstration of minimal potential harm to patients and strict compliance with information confidentiality practices.

Conflict of Interest

The authors declare that they have no competing interests.

Sources of Funding

Funding was provided by Banner Health and the Banner – University Medical Center Phoenix, Department of Graduate Medical Education.

Previous Presentation(s) of Data


Supplementary material

13181_2016_567_MOESM1_ESM.docx (76 kb)
ESM 1 (DOCX 75 kb)
13181_2016_567_MOESM2_ESM.docx (52 kb)
ESM 2 (DOCX 52 kb)
13181_2016_567_MOESM3_ESM.docx (14 kb)
ESM 3 (DOCX 14 kb)


  1. 1.
    Curry SC, Brooks DE, Skolnik AB, Gerkin RD, Glenn S. Effect of a medical toxicology admitting service on length of stay, cost, and mortality among inpatients discharged with poisoning-related diagnoses. J Med Toxicol. 2015;11(1):65–72. doi: 10.1007/s13181-014-0418-z.CrossRefPubMedGoogle Scholar
  2. 2.
    Blizzard JC, Michels JE, Richardson WH, Reeder CE, Schulz RM, Holstege CP. Cost-benefit analysis of a regional poison center. Clin Toxicol (Phila). 2008;46(5):450–6.CrossRefGoogle Scholar
  3. 3.
    LoVecchio F, Curry S, Waszolek K, Klemens J, Hovseth K, Glogan D. Poison control centers decrease emergency healthcare utilization costs. J Med Toxicol. 2008;4(4):221–4.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Miller TR, Lestina DC. Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis. Ann Emerg Med. 1997;29(2):239–45.CrossRefPubMedGoogle Scholar
  5. 5.
    Zaloshnja E, Miller T, Jones P, et al. The potential impact of poison control centers on rural hospitalization rates for poisoning. Pediatrics. 2006;118(5):2094–100.CrossRefPubMedGoogle Scholar
  6. 6.
    Zaloshnja E, Miller T, Jones P, et al. The impact of poison control centers on poisoning-related visits to EDs—United States, 2003. Am J Emerg Med. 2008;26(3):310–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Prosser JM, Smith SW, Rhim ES, Olsen D, Nelson LS, Hoffman RS. Inaccuracy of ECG interpretations reported to the poison center. Ann Emerg Med. 2011;57(2):122–7. doi: 10.1016/j.annemergmed.2010.09.019.CrossRefPubMedGoogle Scholar
  8. 8.
    Chai PR, Babu KM, Boyer EW. The feasibility and acceptability of Google Glass for teletoxicology consults. J Med Toxicol. 2015;11(3):283–7. doi: 10.1007/s13181-015-0495-7.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Chai PR, Wu RY, Ranney ML, et al. Feasibility and acceptability of Google Glass for emergency department dermatology consultations. JAMA Dermatol. 2015;151(7):794–6. doi: 10.1001/jamadermatol.2015.0248.CrossRefPubMedGoogle Scholar
  11. 11.
    Walker T. Google Glass: tech giant to halt sales of headset in current form—but vows to look to future. 2015. In: Accessed 23 Dec 2015.
  12. 12.
    Paul F. Heads up: Google Glass may be coming back. 2015. Accessed 23 Dec 2015.
  13. 13.
    He J, Choi W, McCarley JS, Chaparro BS, Wang C. Texting while driving using Google Glass: promising but not distraction-free. Accid Anal Prev. 2015;81:218–29. doi: 10.1016/j.aap.2015.03.033.CrossRefPubMedGoogle Scholar
  14. 14.
    Lewis J, Neider M. Through the looking (Google) glass: attentional costs in distracted visual search. J Vis. 2015;15(12):1360. doi: 10.1167/15.12.1360.CrossRefGoogle Scholar

Copyright information

© American College of Medical Toxicology 2016

Authors and Affiliations

  • Aaron B. Skolnik
    • 1
    • 2
  • Peter R. Chai
    • 3
  • Christian Dameff
    • 4
  • Richard Gerkin
    • 1
    • 2
  • Jessica Monas
    • 5
  • Angela Padilla-Jones
    • 1
  • Steven Curry
    • 1
    • 2
  1. 1.Department of Medical ToxicologyBanner – University Medical Center PhoenixPhoenixUSA
  2. 2.Department of Emergency Medicine, Center for Toxicology and Pharmacology Education and ResearchUniversity of Arizona College of Medicine – PhoenixPhoenixUSA
  3. 3.Division of Medical Toxicology, Department of Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  4. 4.Department of Emergency MedicineMaricopa Medical CenterPhoenixUSA
  5. 5.Department of Emergency Medicine, Banner – University Medical Center PhoenixUniversity of Arizona College of Medicine – PhoenixPhoenixUSA

Personalised recommendations