Augmented reality (AR) and virtual reality (VR) are technologies whose terms are often used interchangeably and thought of strictly as enhancements for entertainment or equipment maintenance. However, they are getting new attention in healthcare across a range of use cases, most often as tools for treating patients and training doctors. AR is showing early promise in treating PTSD (post-traumatic stress disorder) and substance abuse disorders. VR is also showing similar spark for a range of training and assistance use cases, just as it has in manufacturing, where it is a key assistant in training and performing machine maintenance.
In the 451 Research report 'Augmented and Virtual Reality: User Interfaces for IoT
,' VR is defined as a 'completely immersive replication of the user's world.' The ability to create a controlled immersive environment makes it possible to design new kinds of therapies for patients, ranging from those battling substance abuse and serious injury as well as chronic pain to those suffering from PTSD and aging. Albert Rizzo, director for medical virtual reality at the University of Southern California's Institute for Creative Technologies, called the use of VR in treating PTSD among soldiers "hard medicine for a hard problem." As part of its effort to treat PTSD, the university's Bravemind project is applying VR technology to re-immerse soldiers in battlefield situations then provide them with immediate therapy.
The 451 Take
The use of AR and VR technologies in healthcare is still nascent. But there is potential for the technologies, used individually or in combinations, to transform the traditional ways patients are treated, particularly for pain, paralysis and psychological trauma. When applied in clinical trials, AR technology has shown positive results in enhancing some treatments, such as for PTSD; replacing some others, such as opioids for chronic pain; and in creating certain new therapies, such as achieving some level of mobility for victims of paralysis. The collective results show that AR holds promise for new ways of treating patients, while VR shows promise in training and assisting doctors. Despite initial progress, a wide range of additional clinical trials and government approvals are needed to secure the technology's place in approved methods of treatment within patient care plans. As with most applications of technology in directly treating patients in healthcare, testing will take time and vendors must show both clinical success and provide a return on investment without forcing clinicians to become IT experts. That testing, along with approvals by regulatory bodies such as the US Food and Drug Administration (FDA), will take years and cost millions. Vendors are already getting started through a broad range of partnerships with healthcare providers and payers.
Clinicians generally see promise in using AR and VR, sometimes together, in reinventing how patients are treated, particularly for pain and psychological trauma. The use cases for AR and/or VR in healthcare generally fall into three buckets. First is the creation of new treatments for chronic conditions and mental health problems, such as post-traumatic stress, which favor AR. Second are training and assistance, especially for complicated procedures, which favor VR. Third is the augmentation of existing medical treatment procedures for alleviating physical injuries that result in chronic pain or paralysis and assist aging patients in managing cognitive decline. These are mainly focused on AR but can use elements of both technologies. The challenge for clinicians is in proving the clinical impact of these technologies so they can be considered viable replacements for traditional treatments, such as prescribing opioids for pain.
Whether AR-focused, VR-focused or using some combination, putting these technologies to work for patients requires close partnerships between technology vendors and clinicians. Many such partnerships are underway; for example, Dell Technologies
working with the USC Institute for Creative Technologies and supporting its Bravemind program and Samsung working with appliedVR
and Cedars-Sinai for pain management. The vendors are supporting these efforts with a range of assets from providing hardware and software as well as platforms to
providing technical assistance and funding. Dell pledged a $100,000 grant to Bravemind in May.
Although costly to prove as a means of treatment, there is much potential opportunity for AR and VR vendors. The technology is applicable across treatments provided by the spectrum of healthcare institutions including outpatient clinics, long-term care facilities and hospitals, while addressing the range of patient populations from young and relatively healthy to the chronically ill and aging.
Vendors are pursuing AR and VR adoption through continued product development and providing support for applicable medical content, plus investment in supporting a broad range of clinical trials that test AR and VR across the range of treatments previously described in this report. Samsung, for one, has supported several medical studies using its Gear VR device for pain management, treating paralysis, diagnosing macular degeneration and even diagnosing and treating concussions.
The following are examples of several AR and VR vendors applying the technologies to a range of healthcare use cases.
VR for treatment
Samsung Electronics has partnered broadly and is one of the most active VR providers in healthcare. In one partnership, with appliedVR and Cedars-Sinai, the company is supporting the study of VR for pain management and opioid replacement. In the Cedars-Sinai study, acute pain patients who viewed therapeutic content via the Gear headset reported more than 50% less pain, compared with others who watched the same content on television, supporting the idea that an immersive experience has clinical benefit, according to Samsung. Additional clinical trials include one in which Samsung is working with Stanford University and startup SyncThink to study VR use in establishing concussion severity by measuring patients' eye movements. Samsung is also working with startup IrisVision Global to help diagnose and treat macular degeneration. The studies use Samsung's Gear VR headset, created in collaboration with Oculus.
In another treatment example, Limbix VR enables therapists to provide a guided VR experience for mental health, addressing problems such as phobias. By placing a patient in a realistic but controlled VR environment built of images and videos, clinicians can gradually expose patients to situations that cause distress while maintaining safety. Limbix was founded in 2016 to leverage VR to treat mental illness and substance abuse disorders through cognitive behavioral therapy. The Limbix VR functions on Google Daydream-ready VR phones, coupled with a Google Daydream View headset.
Oculus VR, known for going from Kickstarter to a $2bn acquisition by Facebook, is using its Oculus Rift VR headset in a range of applications outside its partnership with Samsung. They include Stanford University School of Medicine, which combined software developed by its Virtual Human Interaction Lab with Oculus Rift to investigate treatments for conversion disorder, in which mental stresses are converted into physical symptoms. Oculus VR's many other partners include UK-based AI and VR specialists AiSolve along with BioflightVR for both AR and VR.
AR for medical training
Surgical Theater, of Mayfield, Ohio, says it applies fighter jet simulation technology to neurosurgery. The company's Precision VR merges 2-D brain scans to create patient-specific VR reconstructions that help surgeons better study and treat neurological problems. These reconstructions, accessible via Oculus Rift or HTC Vive headsets, are leveraged by a range of Surgical Theater offerings. The company's surgical platform, called SNAP, integrates with existing surgical navigation tools to use Precision VR to assist during surgeries by presenting each planned step of a procedure to surgeons to better orchestrate their movements. Surgical Theater's clients include UCLA, New York University, UCSF Benioff Children's Hospital Oakland, Mayo Clinic, Mount Sinai and Stanford University.
Medical offers an AR approach to phlebotomy training, by using its headset to depict a patient's vascular system
to offer digitally mediated support for those less skilled in the practice or save time for those who are. The company, which has developed its own AR equipment, supports a range of applications in anesthesia, emergency medicine, intensive care and oncology as well as assisting in operating rooms and IV setup.
Oculus VR is also pursuing medical training use cases, including partnering with Children's Hospital Los Angeles in 2017 to build a VR simulation for medical training. The simulation places medical students in emergency pediatric trauma situations where they must manage patients, along with nurses, paramedics and distraught parents. Another true-to-life training use case involves Plextek creating military battlefield training scenarios for the UK government's Defense Science and Technology Laboratory.
Benefits to providers and patients
The increasing use of AR and VR technologies in treatment, especially, and training follows a general trend toward applying information technology
and IoT technology-enhanced treatments, specifically, to address healthcare market trends
. Providers and payers are looking to lower costs and also treat larger numbers of patients by making treatments more readily available via telemedicine and remote monitoring. This trend has healthcare providers and payers collaborating to move along the path to proactive outpatient-based treatment and monitoring, performed remotely, for a larger population. In theory, the shift toward proactive outpatient care, away from a reactive inpatient treatment model, can reduce costs for payers and patients by focusing on leveraging technology to monitor and treat patients at home.
This keeps patients at home for longer, reducing hospital admissions or readmissions, driving down costs. At the same time, increasing the number of patients that can be monitored or evaluated by a given clinician in a given day has potential to bolster revenue for providers by allowing them to follow, treat and thus bill for more patients. AR and VR technologies would become part of these processes.