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Augmented & Virtual Reality Can Finally Impact Healthcare Access and Outcomes-The HSB Blog 4/12/21

Event: The introduction of augmented reality (AR) and virtual reality (VR) into healthcare has tremendous potential to improve access, lower costs, and give patients a better understanding of their health. Over time it should help to improve overall long-term health outcomes. Previously, AR, VR, and spatial computing have been used in healthcare on a limited basis, but the broad rollout of 5G communications bandwidth and technologies will allow providers to integrate these technologies more broadly into the delivery network. As the pandemic continues, many providers are looking to virtual and augmented reality tools to enhance/expand the scope of procedures offered, facilitate medical training for difficult procedures, build better connections with patients both on and off-site, and support more personalized care. This is especially true in scenarios where the geographical distance or lack of specialized clinicians may limit available services. The inclusion of these technologies can introduce a different perspective of healthcare that will benefit the populations for generations to come.

Description: Augmented reality (AR) is a technology that combines real-world and virtual elements. The implementation of this tool in a healthcare setting is useful when trying to get patients to become more engaged with prototypes and for helping them understand a key component to their care. Virtual reality (VR) is a computer-generated simulation where people can interact within an artificial three-dimensional environment using electronic devices. It stimulates vision and hearing, causing the user to feel like they are actually sensing and feeling the simulated reality firsthand. This includes the use of a specialized headset with a built-in screen as well as gloves fitted with sensors. Although both use the same types of technology to create an enhanced experience, AR is more accessible through mobile devices, laptops, smartphones, and tablet computing devices and VR is usually delivered through a head-mounted or handheld controller. During COVID-19, many countries faced challenges due to a shortage of doctors, excessive workload, and less access to in-person doctor’s visits. Although other telemedicine options were given, the use of AR significantly improved patient’s experience. According to a study entitled “Combating COVID-19—How Can AR Telemedicine Help Doctors More Effectively Implement Clinical Work” AR telemedicine could be put on smartphones and tablets that were easy to navigate for consultations, instructions, and demonstrations from their providers, and for self-monitoring purposes as well. For example, the shortage of primary care physicians during this era has resulted in many newer physicians with little respiratory care experience coming into practice. Using AR video fusion and labeling function, respiratory experts were able to conduct real-time remote guidance and training in respiratory medicine. This is especially important in rural areas, where physician shortages, accessibility, and travel costs have always been barriers to care, particularly for the disadvantaged and those in underserved areas. In addition, through AR/VR technology, experts were able to conduct remote ultrasound guidance, emergency remote rescue, remote surgical guidance, as well as guide clinicians remotely in many other procedures. They were also able to blend computer-generated images and data from MRI and CT scans with real world views to allow doctors to visualize the patient’s bones, muscles, and internal organs without having to perform surgery. The images and findings could then be shared with other healthcare professionals to be further analyzed, decreasing the likelihood of misdiagnosis. According to an article from the Borgen Project, “5 Technologies Improving Healthcare in Rural Areas”. Purdue University created an AR technology that allowed more experienced medical professionals to assist inexperienced doctors and surgeons with fewer tools and materials yet complete certain procedures, ultimately maximizing the patient’s outcome. Additionally, the introduction of 5G, the fifth generation of cellular wireless data has helped to further enhance healthcare professional’s ability to deliver innovative, less invasive procedures. According to an article from Health Europa,”Why 5G Enabled Healthcare Is Important for Patients and Spatial Computing”, this technology offers better connectivity and broadband speeds that are required for streaming during remote surgical procedures. With the broader development of the technology, AR/VR development is also getting easier and cheaper as 5G is now becoming more accessible on cellular devices, enabling faster downloads and streaming on devices that many people already own or can more easily afford. Moreover, more powerful and affordable headsets are increasingly coming onto the market empowering more widespread consumer access and use, particularly in healthcare applications.

Implications: The introduction of AR and VR into healthcare settings has significantly impacted health disparities and access to health issues as it gives alternative options for patients to access resources they need using this technology. With the shift to greater use of telehealth, as well as improvements in technology and communications there’s been an increase in more affordable equipment for patients as well as healthcare providers. While there was improved access to telemedicine visits and increased insurance coverage during COVID due to a relaxation of regulations and waivers, it will be incumbent on healthcare organizations and regulators to find a way to adopt the use of these technologies as a standard of care. Incorporating AR and VR technologies into certain visits and treatment will ensure a better patient experience and optimal outcomes. Moreover, these technologies facilitate improvements in training, guidance, and collaboration among physicians, especially those in rural areas with fewer resources, allowing providers to better assess ailments, perform difficult surgeries, and disintegrate existing barriers to care amongst vulnerable populations. As AR and VR continue to become more broadly used and accepted in healthcare they can continue to make care more efficient, increase access, improve patient outcomes and solidity provider/patient relationships.

Dr. Google Actually Improves Diagnostic Accuracy

Event: A recent article in MobiHealthNews discussed a new study published in JAMA, which examined the association between an internet search for health information (often referred to as checking with Dr. Google) by nonphysicians and improved accuracy in diagnosis and triage. The study concluded that an association exists and online investigations for self-diagnosis lead to slightly more accurate diagnoses.

Description: This study comprised survey results of 5,000 adults asked to assess validated case vignettes of common illnesses like viral infections to severe conditions like heart attacks. Participants spent an average of 12 minutes researching the symptoms before concluding their diagnosis. They were asked to relay their diagnosis, triage, and anxiety regarding one of these cases before searching the internet for health information. The study found that 49.8% of participants correctly guessed the health condition being described prior to the internet search, and that result improved to 54% following the search. Improvements in diagnostic accuracy occurred across all forms of triage categories provided: emergent (3.1%), same day (3.5%), same week (6.4%), and self-care (3.7%). Finding useful information was difficult for participants, but they said the most helpful online resources were search engines (48.2%) and health specialty sites (42,9%). Researchers explained that performing an internet search was associated with an improved diagnosis.

Implications: Checking symptoms online is common among adults even though most patients are generally advised not to self-diagnose themselves. This is generally because clinicians fear that self-diagnosis using the internet can lead to inaccurate diagnosis, incorrect treatment, or increased anxiety about the seriousness of the illness. Between 2012 and 2013, 72% of people used the internet to look up health information, and 35% were classified as “online diagnosers.” Websites such as WebMD have taken steps to make their symptom-checkers more accurate, and there are numerous other apps on the market that can help people diagnose and triage symptoms. These sources provide a convenient way to pinpoint what condition a person’s symptoms may indicate. A 2018 review of direct-to-consumer self-diagnostic apps found that apps vary widely in functionality, accuracy, safety, effectiveness. While the generally accepted advice has been to instruct patients not to diagnose themselves the results of this study may indicate that a better approach may be to help guide patients to improve their diagnosis. This would include assisting them in what questions to ask, simple signs that may help them distinguish the severity of conditions, and when self-diagnosis may simply be impossible given the range of symptoms.

Population Health Platform, IBH To Acquire Digital Mental Health Company, Uprise

Event: A recent article in MobiHealthNews reported that IBH, a tech-enabled population health platform, recently completed its acquisition of digital mental health company Uprise. The acquisition will give IBH access to the Uprise platform which provides self-guided mental health tools delivered via self-guided modules, live coaching, and in-person therapy. The acquisition will also allow the two companies to merge large data sets, which can be used to gain insights into members' needs.

Description: Both companies, IBH and Uprise, work in the employer health space and focus on behavioral health. According to the press release, IBH, “offers digitally-enabled employee assistance programs bolstered with personalized coaching, chronic condition management, managed behavioral health, data analytics, and opioid assessment and treatment solutions.” IBH focuses on behavioral health, substance abuse monitoring, maternity management, and both population and occupational health. Uprise’s platform also allows employees to complete a well-being checklist and those who are “designated at risk get a call within 24 hours of their assessment and are then triaged to appropriate services.” The company offers telehealth services as part of its employee assistance and managed behavioral health programs.

Implications: Behavioral health issues are common in the U.S., and employers focus on employee mental health has become a significant objective of employers around the world. IBH's acquisition of Uprise should help them gain scale in the Employee Assistance Program (EAP) space and leverage the advantages of larger data sets to population health in the field of behavioral health. This is especially important during COVID as, according to the CDC, 11.2% of adults report feeling worried, anxious, or nervous, while another 4.7% report regularly feeling depressed. In addition, the American Psychiatric Association reported that depression is the leading cause of disability worldwide and costs the U.S. economy roughly $210 billion a year due to absenteeism, reduced productivity, and medical costs. Many digital health companies like IBH and Uprise have begun focusing on the employer mental health space. Other companies like Modern Health, a mental health and wellness platform, have also been looking to grow with Modern Health recently raising $74 million in February and Unmind in the U.K securing $10 million in funding for its workplace mental health platform in February of 2020.

Surgical Specialty Pre-Op and Post-Op Telehealth Visits Slow After June 2020

Event: Healthcare IT News reported on a study conducted by JAMA on the use of telehealth by surgical specialties during the COVID pandemic. The Michigan-based surgical specialties found 58.8% of the 4,405 active surgeons used telehealth during the peak of the pandemic. The conversion rates- defined as the rate of weekly new patient telehealth visits divided by the mean weekly number of total new patient visits in 2019 showed 109,610 surgical new outpatient visits from March through September 2020. Of those, 6.1% (6,634) were telehealth visits compared with 8 telehealth visits (<0.1%) during the same time in 2019

Description: The field of surgery readily adopted telehealth during the pandemic and was a major modality of health care delivery. Prior to the pandemic, the Surgical field was using telehealth for the preoperative and postoperative follow-up visits though the numbers were significantly less. Among surgery, the highest utilization of telehealth was seen among neurosurgery and urology and the lowest was seen in the orthopedics and ear, nose, and throat (ENT) departments. In addition, the Kane and Gillis cross-sectional study also reported that surgical specialties’ use of telehealth was 11.4%, the lowest among service lines. For example, telehealth utilization ranged from 12.7% in primary care to 39.5% in radiology. Surgical telehealth adoption prior to the pandemic was difficult to adopt which resulted in a decline in the surgery telehealth services when in-person clinics started to reopen. This was due to patient reservations who had initially postponed appointments as they preferred in-person visits as well as hesitancy among surgeons. With the policy-level barriers, surgeons found it concerning investing time and resources to update clinical workflows to learn new patient engagement through telehealth which they perceived would likely be an added burden. In addition, there were also patient barriers that prevented the use of telehealth which included: lack of private space, poor connectivity, no device on which to contact clinicians, and digital literacy.

Implications: During the pandemic, telehealth was one of the best modalities to reach patients given the lack of in-person visits and the need to protect patients from exposure to COVID infection. Nevertheless, the adoption of telehealth by surgical specialties remained particularly difficult when compared with other specialties. Not only were there reservations from patients, but there were also reservations from clinicians. For physicians, the main concern was about the inability to perform physical examinations properly or not being trained on proper methods to conduct physical examinations via this platform. As physical examinations are used to diagnose and determine treatment plans, enrolling surgeons in training initiatives on how to properly engage and evaluate patients via telehealth platforms would encourage both surgeons and patients to utilize this platform. In addition, adding training via residency and fellowship curriculums would also boost the use of telehealth in specialties that are still hesitant to use this platform. In addition, clinicians should also be mindful of technological barriers to access such as availability of technology and broadband communication services which may prevent patients from utilizing telehealth. Bearing these in mind, these factors should be discussed and addressed by patients and clinicians, for the broadest group of those seeking care to realize the benefits of telehealth.


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