The picture of U.S. health care isn’t a pretty one.
According to leading policy think tanks like the Organization for Economic Cooperation and Development and the Commonwealth Fund, most industrialized nations are facing an escalating cost curve that makes health care, as it’s currently organized, unsustainable.
The proportion of populations aged 65 and up is increasing, meaning that the number of elderly who are retiring and exiting taxpayer rolls right as they start drawing on public care programs, like Medicare, and right as their healthcare needs quadruple in costliness is increasing. Even more people are pulled out of the economy as they simultaneously care for their children and their parents—the so-called “sandwich generation.”
The fractured systems that make up U.S. health care are particularly challenged. The U.S. spends about 16 percent of its GDP on health care. This is nearly double the OECD median of 8.7 percent, and over 40 percent more than France, who spend the second-largest share at 11.2 percent.
U.S. health systems are notoriously dysfunctional, with misaligned incentives between insurers, infrastructure providers (vendors are contracted for everything from hospital operating rooms to electronic medical records), and health care providers. The way we pay the caring professions, fund hospitals, and train doctors, often produces outcomes that are too expensive and not of high enough quality.
If the health care system doesn’t change, and change radically, patients will face worsening health and higher costs.
One possible solution is a change in emphasis from acute care—in other words, the treatment you receive when something goes wrong and needs fixing, which tends to be expensive—to preventative care, or keeping you healthy in the first place, which doesn’t always need expensive doctors so much as a gentle nudging.
For decades, this nudging took place over the telephone or by mail. Nurses or case managers would call up their patients one at a time and ask if they’ve taken their medication, stopped smoking, stuck to a diet plan, or exercised. Even a few dozen of these kinds of calls tends to cost far less than a double-bypass and a couple of knee replacements due to obesity.
Preventative care has the added benefit of making patients feel more empowered, because there’s more that they can do to manage their health. Companies across the country have started disseminating wearables, health coaches, and data visualization to nudge patients to make healthy lifestyle choices.
How might an affordable VR headset further enhance these reforms?
an essential part of the solution
You could say that virtual reality has been employed in medical education for as long as trainees have used cadavers. Simulation has long been a hallmark in professions where individuals apprentice before they become masters. Even residency, in which someone with a medical degree apprentices, is designed to simulate and provide feedback on what it will be like when the resident becomes a full-fledged, independent practitioner.
But the first applications of what we currently understand as VR—a totally immersive environment that seeks to simulate reality as closely as possible—took place in the 1990s, when medical trainers used colonoscopy and upper GI tract endoscopy simulation. These types of simulations tended to be expensive and impractical, and very application specific. A colonoscopy simulator is not very good at simulating anything but colonoscopies. And so, outside of a few exclusive teaching hospitals, VR simulation never took off.
But an affordable VR headset could solve this issue. Not only are these becoming accessible, and technology-agnostic, or “plug and play,” but simulations across the dozens of medical specialties can be uploaded. The VR headset could do for medical education what the iPhone did for interacting with your doctor remotely, or for managing your health via mobile health applications.
These headsets would allow medical trainees to actually walk through body parts, like the colon, and see how they are constructed. Without the constrictions of scale, VR makes it possible to create 3D visualizations of diseases themselves: how they are formed, how they interact with human systems, and what a human system in the process of breakdown looks like. Surgical Theater, for example, allows surgeons to step inside a 3D model of their patient’s brain before surgery begins.
Another model that might make its way to medical practice are “cave installations,” in which projections appear on the walls, floor, and ceiling of a room to provide complete visual immersion. This has the added bonus of allowing groups of people to stand inside the same simulation, which would enable, for example, simulation of operating theater dynamics.
The problems faced by VR in the medical space are not unlike those in most gaming applications: the degree of fidelity made possible by the technology. The texture and material properties of soft tissues don’t just have to look similar. In medical training, the resemblance must be exact. Large and complex procedures involving multiple systems of the human body are difficult to simulate, both in terms of potential complications, but also in terms of appearance. There’s little room for creative interpretation.
Less of an issue, perhaps, is the potential of VR to connect health care providers and patients over distances.
One common complaint among doctors is that, ever since they started using electronic medical records, they now sit facing a computer instead of the patient. In health care, where ‘bedside manner’ is an important aspect of the patient feeling cared for, this can make the experience feel disconnected and unsafe. VR would be one way for the doctor to have access to an overlay of information while doctor and patient avatars face each other in real time.
from game-based motion training for rehabilitation, to occupational therapy
Another emerging trend in the evolving health system is the need for different kinds of health care providers—doctors, nurses, pharmacists, and so on—to collaborate in patient care teams. This enables a group with different skillsets and expertise to design a care plan with the patient at the center, as opposed to a more traditional arrangement where one kind of professional, usually a doctor, calls the shots.
Interprofessional care teams are often expensive and unwieldy. Having them organized in one location as opposed to dispersed across a care network means that patients have to work around when the team is available to be assembled in one space. What VR enables is an environment in which different providers in different physical spaces—even different time zones—can meet, along with the patient, to discuss their care, and all with the feeling of a face-to-face interaction.
VR is also helping care providers to think outside the box of traditional therapies. Simulation is being explored for everything from game-based motion training for rehabilitation, to occupational therapy where a patient can re-learn a lost ability, to neurocognitive assessment.
Projects like Bravemind use immersion as exposure therapy, recreating traumatic conditions to assess whether a person has post-traumatic stress disorder. This overcomes the natural avoidance tendencies of individuals with PTSD in safe, controlled environments. In fact, the Institute for Creative Technologies at the University of Southern California has an array of projects associated with medical virtual reality. Meanwhile, a software platform called Phobos is used to treat extreme phobias by re-creating triggers in a place where the patient can be observed, cared for, and trained to use tools when they feel panic setting in.
For the first time, truly immersive technology isn’t being associated with a few very rich healthcare research institutions. Small groups of health managers can send a VR headset to remote or homebound patients and port them into a discussion thousands of miles away.
The U.S. health system is going to need all the help it can get. VR is quickly gaining acceptance as an essential part of the solution.