Merritt Brown, MD, is one of our finalists in the MedTech Boston Google Challenge with his “Management of Acute Stroke with Wearable Technology.” His backstory is especially inspiring. Unfortunately, he is one of the few finalists who will not be presenting in person as he is currently teaching students and treating patients in Zambia.
Through the use of non-invasive, hands-free wearables, the patient data can be pushed to the neurologist instead of a page announcing simply the room and name of the Code Stroke. The data can be updated as vitals are obtained, medications (especially blood thinning products) recorded, and past history (especially any bleeding disorder, abnormal heart beat, or cardiovascular risk factors such as high blood pressure, high cholesterol, or diabetes) updated. The NIH Stroke Scale score can be called out to “Ok Glass” at each step of the examination (with cues for scoring for training residents to aid in accurate reporting). With all this information in hand, the neurologist can then “ok glass” orders such as administering tPA or send a page with the information collected to the appropriate physician for surgical intervention. Obtaining consent for either medical or surgical management can then be handled directly with video/audio functions of the device (saving the time to obtain written consent, gather appropriate forms, etc).
In terms of some of my past history, I really did not follow the usual course by any stretch of the imagination. Despite being interested in medicine at a very young age, I was dissuaded from entering the profession by a number of family friends who were physicians due to the high cost of education as well as the bureaucratic nightmares and lowered reimbursement from HMOs which were gaining traction in the early 1990s. As an 18 year old, the idea of paying loans off until I was in my 50s was unthinkable; so, I decided to try my hand at business upon graduation from the University of Pennsylvania in 1998. I spent the next nine years as an IT consultant, financial management consultant, and strategy consultant in a variety of industries including federal, aerospace, financial, and healthcare. I had the opportunity to work for exceptional companies including Accenture and Deloitte which allowed me to start my own limited venture purchasing real estate and equities. However, throughout my late 20’s I kept imagining what it would have been like to work as a physician.
I finally returned to complete the pre-medical requisites at Penn after “winning a bet”, and was accepted to Jefferson Medical College as a member of the class of 2011. With the acceptance in hand I retired from the consulting world, and began a long journey which led me through medical school classes, rotations, and ultimately internship at Thomas Jefferson University Hospital and the Wilmington VA Hospital. During this time, I performed research at Children’s Hospital of Philadelphia in using neurophysiologic studies as predictors of epileptic onset, and wrote case studies on unique patient cases. I left Philadelphia for Boston in 2012 for Neurology Residency at Beth Israel Deaconess Medical Center where I was exposed for a second time to acute stroke management (the first was while working as an internal medicine intern at Jefferson on the Neurology service, and on the ED service).
Beth Israel Deaconess Medical Center in Boston has a number of innovations which aided my concept of using wearables for acute stroke management. Residents have used iPads to enter orders from bedside, show patients the images, and results of their radiologic images, and have access to up to date laboratory information for decision making. However, during my first “code stroke” the page call to Neurology and Radiology CT for patients who have strong concern for stroke, I realized that much of the information necessary for a clinical decision must be sought from multiple locations. Additional time by the Neurology resident was required to compile the necessary vitals, CT results, lab studies, etc., and furthermore would need to be detailed to the vascular fellow or attending in piecemeal order. I realized that having this information in a push capacity (ideally in a HUD format) would cut down significantly on the time to decision; ultimately offering definitive treatment for the stroke in the form of either clot-busting medication, or interventional clot retrieval by Neurosurgery.
I have long been fascinated by the idea of Google Glass and its utility in medicine. Having a hands-free, heads up display seemed to be an ideal system for a profession where most of the practitioners use their hands for so many other reasons. I even reached out to Marshall Schram in the Google Apps division to try to investigate programs for medical management which were not available at the time of our email conversation. Unfortunately, I could not join the Google Glass Explorer Program when offered due to the financial constraints of being a resident; however, I was thrilled to see the opportunity to make my vision of wearable technology in health care practice a reality.
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