EDITORS CHOICE 15.11.17

The bleeding-edge of AV in healthcare

ipad with heart on it

Medical schools and hospitals are increasing their use of AV such as using simulation to minimise errors. Tim Kridel explores how and why.

People go to the doctor to get better, not worse. But an estimated 1,000 UK hospital patients die each month from medical errors (according to a report from London School of Hygiene and Tropical Medicine), which are chronically high in many other countries, too.

That problem is a major reason why medical schools worldwide are investing heavily in AV technologies such as virtual reality and visualisation. Those sophisticated systems are why ‘heavily’ isn’t an overstatement. One integrator—speaking privately because the contract hasn’t been finalised—cited an upcoming hospital AV project with a budget of nearly €18 million.

Another example is the Interprofessional Experiential Center for Enduring Learning (iEXCEL) under construction at the University of Nebraska Medical Center (UNMC) in the US.  “The whole purpose is to transform health professions’ education, training and research,” says Pamela J. Boyers, UNMC associate vice chancellor for clinical simulation. “Medical errors are now the third leading cause of death in the US (according to figures compiled by the Centers for Disease Control and Prevention). So there’s a realisation that we need to change the way we teach doctors and nurses by using simulation and visualisation just like aviation and other high-reliability organisations have before us.”
“We need to change the way we teach doctors and nurses by using simulation and visualisation just like aviation and other high-reliability organisations have before us.”

AVI-SPL is the integrator for iEXCEL, “Back in the late ’70s and early ’80s, when airline crashes were at an all-time high, there was a movement to put pilots through simulator training,” says Jim Angelillo, AVI-SPL vice president, business development, for advanced visualisation. “Today, we rarely hear about a plane crashing or an accident. When we do, it’s almost never because of pilot error. So we believe this can be successful in the healthcare world, too.”

iEXCEL’s four levels will include a variety of immersive and simulation technologies.  “We believe the iEXCEL Visualisation and Virtual Reality Level will be one of the first and most comprehensive visualisation labs in healthcare,” Boyers says. “It will include extraordinary 2D, 3D and virtual and augmented reality technologies that will be used to create new ways of teaching, learning and research. This includes a 5-sided, laser VR environment, a large circular 2D, 3D collaboration space that we call the iEXCEL Helix, as well as 3D CAD and interactive digital walls.” 

Long-term market 


For simulation, another driver comes from professional bodies.  “The medical simulation environment is staring to evolve to a point that the governing bodies like the American Medical Association are starting to define a mandated number of hours that healthcare professionals need to go through simulation,” says Bill Nattress, Biamp Systems director of channel strategy – paging.

doctor with vr gogglesSimulation is a popular application for several reasons, starting with how it’s obviously less risky to practice on hardware rather than humans. Another reason is that simulation can cover a wider range of potential scenarios that physicians will encounter in the real world, including ones where medical errors are particularly high. That’s why iEXCEL’s advanced interprofessional simulation centre will have two simulated hospital units to mimic any patient care scenario, as well as prebriefing and debriefing rooms.

“It’s purposefully designed to teach the transfer of any patient from one level of healthcare to the next, including from home to hospital and back,” Boyers says. “That ability to practice the transfer of care is critical due to the fact it is considered a point where most medical errors occur.

“Simulation and visualisation in healthcare has been shown to, for example, reduce infection rates and improve outcomes by saving lives. So ultimately it is all about improving the quality and safety of the patient experience through providing the best training possible.”

AV also can help patients. For example, a VR headset could enable a patient to go inside a heart valve to understand exactly what the surgeon will do, step by step.

The doctor will see you now


Reducing medical errors isn’t the only way that AV could fundamentally change healthcare. For example, seeing a specialist today often means travelling hundreds of kilometers because there are only so many—and then typically only in major cities. 

Med students who train today using simulation are also increasingly using VR in their personal lives. Together, these professional and personal experiences condition them to be comfortable operating - literally - in the virtual world tomorrow. This dovetails with the trend toward using robotic surgical systems, such as da Vinci, that currently are controlled by a human on site. 

Put those two trends together, and tomorrow those robotic surgical systems could be controlled by a surgeon a county, country or continent away. That would enable more patients to receive specialised care by eliminating the cost and danger of traveling to where those surgeons practice. 

Far-fetched? Hardly. Sricharan Chalikonda, a surgeon at the Cleveland Clinic in the US, recently told The Economist, “I can totally see myself sitting here at my desk, guiding three operations in three different locations.”

Familiar challenges


Healthcare has a variety of requirements not found in other verticals. For AV pros, understanding those is as important as knowing IT security and networking fundamentals in other verticals.  For example, hard surfaces abound in healthcare facilities because they’re easier to disinfect. Flush surfaces also are preferred because anything that sticks out enough for dust to settle means germs can collect there, too. If it can’t be flush, then it has to be capable of withstanding frequent cleaning with disinfectants. 

Another unique consideration is financial. For example, although telemedicine technology has been widely available for over a decade, many private and public insurance providers have been slow to update their reimbursement policies to reflect this new type of care. That’s changing, which—along with the declining cost of telemedicine technology—should spur wider adoption.

But many healthcare AV systems are strikingly similar to those used in other verticals. For example, one level of UNMC’s iEXCEL facility has AV systems like those found in houses of worship and universities that need to share live video across multiple sites.   “There will be 20 operating bays on that floor and a command centre so that our surgeons and technicians can teach, communicate and broadcast locally, nationally and globally,” Boyers says.

As healthcare expands its use of VR and simulation, it’s encountering many of the challenges that other verticals face. A prime example is the shortage of people with coding and other skills necessary to create content. 

Although UNMC’s facility won’t be finished until November 2018, the school already has a prototype visualisation system so it could start hiring the operations staff and get them up to speed on the new technology.
“The American Medical Association are starting to define a mandated number of hours that healthcare professionals need to go through simulation.”

“It’s one thing to be able to understand and operate the technology,” Boyers says. “It’s yet another to be able to create content. The right technology is here, but you cannot buy the medical content ‘off the shelf.’ This content has to be extremely accurate and highly visual. We have brought together a four-person team who work with different skill sets to help create the medical content.” 

One member of that team needs to be a coding expert, a position that iEXCEL is struggling to fill. “It’s very, very hard to find the right people with the right skill sets,” Boyers says.

These challenges can create sales and differentiation opportunities for integrators, vendors and consultants targeting the healthcare AV market. One example is having business partners capable of providing specialised content, just as some integrators have partners and in-house teams that create and manage content for enterprise signage networks. 

Take a chill pill


Training and remote surgeries aren’t the only healthcare applications of VR. US-based StoryUP recently began offering a VR kit that can be used to calm patients during procedures and recovery.  For years, doctors and dentists have offered patients goggles and headsets—lately including VR models—to distract them. StoryUP’s kit goes a step further by adding a wearable brain-computer interface (BCI) that measures the user’s brainwave activity. By altering that activity, users can change their VR environment, such as making the sun shine brighter.

StoryUP’s technology is based on research (available at www.story-up.com/#blog) into how various regions of the brain respond to different types of VR content. For example, electroencephalogram (EEG) scans showed how activity in the areas responsible for stress response, empathy and compassion increases or decreases as a person is immersed in certain types of content. 

StoryUP is currently marketing its kit as a wellness rather than a medical product. That’s an important distinction from a regulatory standpoint, but it doesn’t rule out sales to healthcare providers.  “It’s for stress release and relaxation,” says Sarah Hill, CEO and chief storyteller. “It’s not a cure for depression or anxiety. However, hospitals and healthcare institutions use wellness products all the time.” 
“It’s one thing to be able to understand and operate the technology, it’s yet another to be able to create content.”

Healthcare providers also could use StoryUP’s technology to help nurses and physicians relax, potentially meaning fewer mistakes and sick days. That’s also an example of how some healthcare AV solutions can target additional verticals, such as corporate wellness programme call centres and other high-stress environments.  “Perhaps you had a difficult procedure,” Hill says. “What happens before you go the next person? Do you go in the break room and grab a candy bar? Or do you go in the break room and give your mind a little bit of a release?”

Meet the CXO


In just about every vertical, the organisation’s IT department buys and operates AV systems. That’s true for healthcare, too, with one emerging exception.  Over the past several years, many hospitals have created a chief experience office (CXO) position, whose role is to assess and improve the patient experience. In some countries, regulatory changes are growing the CXO ranks. For example, US patients now fill out satisfaction surveys thanks to the Affordable Care Act.

“Those scores are then used to determine the value of compensation through Medicare and Medicaid,” Nattress says.  So depending on the business need that a particular AV solution aims to fill, the CXO might be a better fit than the CIO.  “That’s a new sales channel,” Nattress says. “That’s a new person to get to know. If you’ve got an interesting solution for patient amenities, going to the IT department isn’t necessarily going to get you a sales point. But going to the CXO might.” 

The CXO position is like StoryUP’s virtual chill pill in the sense that both aren’t limited to healthcare.  “We’re seeing the same CXO role move into higher education and the enterprise because of valuing the employees and making employees comfortable,” Nattress says.  In healthcare, AV can help CXO’s ensure that their facilities provide patients with the kind of experience that speeds recovery. For example, chemotherapy and dialysis typically mean sitting for an hour or longer, so AV helps distract and pass the time.

“Patient hospitality and amenities are becoming very important so that an individual can bring their content with them,” Nattress says. “Giving them the ability to leverage their own content aids in their recuperation and well-being. Thus systems need to be able to allow for pushing my content onto displays and speakers in the room.” 

Sometimes that content is user-generated: Nattress had orthopaedic surgery and watched the video of it in recovery.