Design Thinking Health: Telepresence for Remote Teams with Mobile Augmented Reality

Part of the Understanding Innovation book series (UNDINNO)


This research examines the capabilities and boundaries of a hands-free mobile augmented reality (AR) system for distributed healthcare. We use a developer version of the Google Glass™ head-mounted display to develop software applications to enable remote connectivity in the healthcare field; characterize system usage, data integration, and data visualization capabilities; and conduct a series of pilot studies involving medical scenarios. This book chapter discusses the need for a AR head-mounted display to improve chronic wound care photography and to facilitate surgical interventions. We provide an overview of the system architecture used in this research, and highlight future applications of AR systems for improved clinical care.

In the broader context of distributed collaboration for improved healthcare delivery, this research provides a foundation for: (i) examining the use of technology for complex distributed problem solving through interdisciplinary collaboration; (ii) gaining an improved understanding of the benefits of human augmentation through enhanced visualization and auditory capabilities, on healthcare team performance; and (iii) exploring an AR system’s ability to influence behavior change in situations requiring acute decision-making through interaction between centralized experts and point-of-impact delivery personnel. Moreover, this chapter provides insight into the need for future IT systems engineering projects aimed at enhancing healthcare connectivity and distributed care.


Augmented Reality Pressure Ulcer Inertial Measurement Unit Augmented Reality System Mobile Augmented Reality 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Augmented reality


Centers for medicare and medicaid services


Digital single-lens reflex


Electronic medical record


Head-mounted display


Hospital-acquired pressure ulcers


Intensive care unit


Internal measurement unit


Medical record number


Mobile wound analyzer


National pressure ulcer advisory panel




Virtual nurse


  1. Ahn C, Salcido RS (2008) Advances in wound photography and assessment methods. Adv Skin Wound Care 21:85–93CrossRefGoogle Scholar
  2. Albrecht UV, von Jan U, Kübler J, Zoeller C et al (2014) Google glass for documentation of medical findings: evaluation in forensic medicine. J Med Internet Res 16(2), e53CrossRefGoogle Scholar
  3. Aldaz G, Shluzas LA, Pickham D, Eris O, Sadler J, Joshi S, et al. (2015) Hands-Free Image Capture, Data Tagging and Transfer Using Google Glass: A Pilot Study for Improved Wound Care Management. PLoS ONE 10(4):e0121179. doi:  10.1371/journal.pone.0121179 Google Scholar
  4. Beard HR, Hamid KS (2014) Worth a thousand words: integrating clinical photographs into an electronic medical record. Healthcare 2(1):22–25CrossRefGoogle Scholar
  5. Bickmore TW, Pfiefer LM, Jack BW (2009) Taking time to care: empowering low health literacy hospital patients with virtual nurse agents. In: Proceedings of the CHI 2009. ACM PressGoogle Scholar
  6. Bizzotto N, Sandri A, Lavini F, Dall’oca C, Regis D (2013) Video in operating room: GoPro HERO3 camera on surgeon’s head to film operations—a test. Surg Innov. doi:  10.1177/1553350613513514 Google Scholar
  7. Craig AB (2013) Understanding augmented reality: concepts and applications. Elsevier, Boston, MAGoogle Scholar
  8. Dixon BJ, Daly MJ, Chan H, Vescan AD, Witterick IJ, Irish JC (2013) Surgeons blinded by enhanced navigation: the effect of augmented reality on attention. Surg Endosc 27:454–461CrossRefGoogle Scholar
  9. Doherty A, Williamson W, Hillsdon M, Hodges S, Foster C, Kelly P (2013) Influencing health-related behaviour with wearable cameras: strategies & ethical considerations. In: Proceedings of the 4th International SenseCam & Pervasive imaging conference. ACM, New York, NY, pp 60–67Google Scholar
  10. Epic Systems. Accessed 10 Jan 2014
  11. Glauser W (2013) Doctors among early adopters of Google Glass. Can Med Assoc J 185:1385CrossRefGoogle Scholar
  12. Gonzales D, Pickett R (2011) Too much pressure. Stanford Nurse 31(1):12–13Google Scholar
  13. Google + Glass Update. Accessed 21 Jan 2014
  14. Google Glass. Accessed 5 Aug 2013
  15. Goran SF (2010) A second set of eyes: an introduction to Tele-ICU. Crit Care Nurse 30(4):46–55CrossRefGoogle Scholar
  16. Graves N, Birrell F, Whitby M (2005) Effect of pressure ulcers on length of hospital stay. Infect Control Hosp Epidemiol 26:293–297CrossRefGoogle Scholar
  17. Hayes S, Dodds S (2003) Digital photography in wound care. Nurs Times 99(42):1–3Google Scholar
  18. Ishimaru S, Weppner J, Kunze K, Kise K, Dengel A, Lukowicz P, Bulling A (2014) In the blink of an eye: combining head motion and eye blink frequency for activity recognition with Google Glass. In: Proceedings of the 5th augmented human international conference. pp 150–153Google Scholar
  19. Krouskop TA, Baker R, Wilson MS (2002) A noncontact wound measurement system. J Rehabil Res Dev 39:337–345Google Scholar
  20. Lutz BJ, Kwan N (2014) Chicago surgeon to use Google Glass in operating room. Accessed 2 Feb 2014
  21. Lyder CH, Wang Y, Metersky ML et al (2012) Hospital-acquired pressure ulcers: results from the national medicare patient safety monitoring system study. J Am Geriatr Soc 60:1603–1608CrossRefGoogle Scholar
  22. Magnusson L, Hanson E, Borg M (2004) A literature review study of information and communication technology as a support for frail older people living at home and their family carers. Technol Disabil 16:223–235Google Scholar
  23. Mattke S, Klautzer L, Mengistu T, Garnett J, Hu J, Wu H (2010) Health and well-being in the home: a global analysis of needs, expectations, and priorities for home health care technology. RAND Corporation, Santa Monica, CAGoogle Scholar
  24. Medical Xpress. First US surgery transmitted live via Google Glass (with video Accessed 13 Oct 2013
  25. Mobile Wound Analyzer. Accessed 6 Apr 2014
  26. Muensterer OJ, Lacher M, Zoeller C, Bronstein M, Kübler J (2014) Google Glass in pediatric surgery: an exploratory study. Int J Surg 12:281–289CrossRefGoogle Scholar
  27. National Pressure Ulcer Advisory Council (2014) FAQ: photography for pressure ulcer documentation. Accessed 16 Mar 2014
  28. Sen CK et al (2009) Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen 17:763–771CrossRefGoogle Scholar
  29. Shluzas LA, Aldaz G, Sadler J, Joshi SS, Leifer L (2014a) Mobile augmented reality for distributed healthcare: point-of-view sharing during surgery. In: Proceedings of the fourth international conference on ambient computing, applications, services and technology (Ambient 2014), IARIA, pp 34–38Google Scholar
  30. Shluzas LA et al (2014b) A wearable computer with a head mounted display for hands-free image capture and bi-directional communication with external sensors. US Provisional Patent No. 61968857, Mar 2014Google Scholar
  31. Starner T, Mann S, Rhodes B, Levine J, Healey J, Kirsch D, Picard R, Pentland A (1997) Augmented reality through wearable computing. Presence 6(4):386–398Google Scholar
  32. van Krevelan DWF, Poelman R (2010) A survey of augmented reality technologies, applications, and limitations. Int J Virtual Real 9(2):1–20Google Scholar
  33. Wagner P, Bartl K, Gunthner W, Schneider E, Brandt T, Ulbrich H (2006) A pivotal head mounted camera that is aligned by three dimensional eye movements. In: Proceedings of the 2006 symposium on eye tracking research & applications. ACM, New York, NY, pp 117–124Google Scholar
  34. Wu L, Cirimele J, Card S, Klemmer S, Chu L, Harrison K (2011) Interactive cognitive aids: maintaining shared mental models in anesthesia crisis care with nurse tablet input and large-screen displays. UIST’11, ACMGoogle Scholar
  35. ZBar barcode reader. Accessed 12 Feb 2014
  36. Zhou F, Duh HBL, Billinghurst M (2008) Trends in augmented reality tracking, interaction and display: a review of ten years of ISMAR. In: Proceedings of the 7th IEEE/ACM international symposium on mixed and augmented reality. ISMAR, pp 193–202Google Scholar
  37. Zhu E, Hadadgar A, Masiello I, Zary N (2014) Augmented reality in healthcare education: an integrative review. doi: 10.7287/peerj.preprints.335v1

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Center for Design ResearchStanfordUSA

Personalised recommendations