|06.11.20| Immersive experiences' role in future patient care; Integrating telemedicine into med school curriculums

The future of digital health could be a move from 2-D remote care to immersive 3-D experiences, according panelist at Bio Digital.

“When it comes to immersive technologies, we need to think about the whole range of technologies … from augmented reality to virtual reality. That is the first thing that comes to mind, but it really is anything that is spatial computing – meaning that it is located in a space, not constricted in a screen in front of you, but you walk around this digital content,” Mar Gonzalez-Franco, a Microsoft researcher, said during the panel.

Over the last few months, offices have emptied and the working-from-home lifestyle has surged as a result of the coronavirus outbreak. This has given rise to the adoption of video-conferencing platforms and, in the medical community, telehealth. However, that digital lifestyle can also cause a lot of strain.

“A few of the changes we were going to see in the next 20 years we are seeing in months,” Gonzalez-Franco said. “We are working from home, we’re seeing exponential growth of tech for communications. There is the gap in these technologies that are not immersive and make you very tired at the end of the day.”

But Gonzalez-Franco pitches immersive reality as a way to curb this fatigue especially in healthcare, noting it’s a different experience for users.

“When you are in a virtual system that is not the case. It gives you a strong presence of illusion and plausibility illusion, the illusion that you are there and the things that are happening are real, which means the other people are also there represented by avatars, and that can help bridge the gap of this solitary confinement … This is important for many reasons. One it can bring all these patients closer to their loved ones, even during a hard situation, but it also can help clinicians assist someone without having to go there and expose themselves.”

Today provider organizations are implementing immersive technologies as a way to help educate both patients and providers.

“When I was introduced to immersive medicine I was very curious to see if this was a platform that we can not only educate our patients about medical information, but to empathize with them while also explaining the nuances of their treatment option and their legal rights to a clinical trial,” Dr. Frank Tsai, an oncologist at Honor Health Research Institute in Scottsdale, said during the panel.

His health system has teamed up with Microsoft to create an avatar tool used to aid patient education. Tasi said that by patients may be more relaxed in their home and have a different interaction with the healthcare system.

“When you are in the doctor’s clinic at a major cancer center it is a very scary place, and also a very powerful place. You are talking to some people who are in some way in a position of power,” he said. “Imagine you can embed this patient in a virtual environment where they can be their true selves… and ask the questions they want to ask, and perhaps we have the opportunity to not just better inform them, but to guide the behavior that can guide their health.”

An immersive virtual experience can also help contextualize different information, according to the panelist. For example, patients and clinicians have a lot of data streaming in from multiple platforms.

“The idea that you have all this data now and can connect it from wearables and home devices, [there is] a risk you will only interact with the data,” Gonzalez-Franco said. “If you have spatial computing as the door to enter and interact, you can see the data in context. That is a way that people should be seeing VR."

While special technologies are already making their way into the clinical realm, there is still a long way to go – but tapping the next generation of researchers and clinicians might be the key.

“There was a time when basic scientists would work in silos from clinicians, and you have to appreciate that that gap has created a high barrier to bring novel treatments into the clinics. Since that time there is this term called 'translation scientists for clinicians,' who can translate and do research that brings benchwork into a clinic. I believe, in the technology world, we need the translational technologists to bridge that gap,” Tsai said. “I think the key is to engage young clinicians at an early stage and find those that are passionate about medicine and technology.”

As telehealth consultations and other remote-care capabilities continue to spread throughout healthcare, these technologies are more and more likely to play a significant role in regular care delivery for tomorrow's doctors, nurses, pharmacists and other healthcare staff.

Medical students aren't the only ones who could benefit from guided exposure to telehealth tools and best practices. In a recent HIMSS Digital presentation , Medical University of South Carolina (MUSC) professors explained that these educational programs can be integrated into a range of healthcare curriculums and colleges, and can benefit everyone from undergraduates to practicing medical providers.

"Telehealth is definitely an evolving area of science and application," Ragan Dubose-Morris, associate professor and director of the Center for Telehealth at MUSC, said during the webinar. "It is important that the education domain keep up with that, not only to help inform current practice, but also to inform providers where they can get updated information for future practice. So there's a baseline of continuing education that we know we need to instill for those providers."

These types of programs have been part of the clinical, research and administrative-services ecosystems for well over a decade, Dubose-Morris said. The programs within MUSC have been embedded within a handful of different educational facilities – such as its College of Nursing, its College of Pharmacy, College of Dental Medicine and others – and comprise of a handful of education modalities. Some of these include in-person roundtables, demos and facility tours; "synchronous" remote-education through videoconferences and case presentations; and "asynchronous" materials like recorded educational programs, online education modules and even mobile app-based content.

The variety of available modalities and resources provides some flexibility to programs looking to incorporate telehealth content. It can also help to manage the initial investment an organization needs to commit when it's looking to train its staff or students.

"It's really a low-stakes investment when you think about education," Dubose-Morris said. "There's quite a few platforms and programs that allow you to share information between providers and with patients in ways that are value-added, and can also reduce overall healthcare expenditures."

Those enrolled in the integrated-telehealth curriculums also see the value in these courses, Dubose-Morris continued. In a survey of 45 MUSC telehealth program participants from the last five years, roughly 86% considered their ability to utilize telehealth as part of their current or future practice to be above average or better, compared to about 12% prior to enrollment. They reported similar changes in their confidence for other related areas of personal telehealth expertise, such as their ability to explain the use of multiple telehealth tools to their peers.

"When they start from a pre-test assessment to a post-test assessment, we are definitely seeing significant knowledge gain, clear growth, and they're confident," she said. "They really do start off at a level of non-inclusive or limited information, and at the end of the semesters they are mostly greater than the average healthcare provider in being able to understand telehealth. They gain comfort demonstrating and explaining the tools of telehealth."

The curriculum participants' open-ended responses to the survey also suggested takeaways from the program beyond their technical skills with the technologies. For instance, Dubose-Morris highlighted responses in which participants said that the focus on remote consultation technologies increased their awareness in cross-disciplinary or cross-practice collaboration, while others said that it increased their awareness of new career opportunities.

"It looks to me that one of the biggest areas of learning from the individual students has been that ongoing learning: How can they learn from each other, and how can they improve their knowledge and ability?" Dubose-Morris said. "They're really thinking about, from a reflective perspective, what they learned, but [also] how they are going to take this forward. They really see value in connecting patients and healthcare members in sort of an encircled ring of care. This is something that allows for a collaborative and realistically practiced activity to occur."