Brandon Birckhead MD, Co-Director of Virtual Medicine Conference, Cedars-Sinai
Twenty years ago, the use of virtual reality (VR) for pain reduction was just starting to develop. At the time head mounted displays (HMD) cost over $10,000 and were quite bulky. The technology stayed within a few academic centers until 2012 when the current era of low-cost HMDs began. Today you can get a device for a few hundred dollars that weighs about a pound. This is why our VR program at Cedars-Sinai Medical Center has been able to treat over 3,000 patients from the labor ward to the patient’s home.
Current Market Trends
The current market trends are still mostly driven by the mobilization of head mounted displays allowing the device to be used across the healthcare system. In adult VR pain reduction, our lab has shifted from clinical trials using the technology throughout the inpatient stay to home-based VR therapy recording patient outcomes and opioid use over several weeks. Opioid usage as an outcome will continue to be major focus in this field to assess if non-drug-based intervention can bring down the supply of the current epidemic.
Within the numerous mental health use cases the one with the longest history of clinical use is virtual reality exposure (VRE) therapy. Immersive technologies, like VRE provides the clinical psychologist with a powerful tool for the appointment. This technology is not only enhancing the therapist-driven interventions, but also leading to low-cost self-guided app-based VR cognitive behavior therapy that can be downloaded on the app store.
Though the use of VR therapy related products in the home is a current trend, its use inside the hospital is growing as well. Nonprofits, like the Chariot program, at Stanford Children’s Hospital have used VR in over 4,000 patients in the last year and have provided support for dozens of other pediatric hospitals to create their own immersive therapeutic consult service.
The technology has also revolutionized patient education. Neurosurgeons have used immersive platforms to help patients understand the pathology within their brain and the surgical approach needed to solve it. Hoag Hospital invested over 3 million dollars to provide VR therapy and patient education to multiple departments based on the results of their patient specific program and several other hospitals are integrating it into their practice.
The greatest challenges facing the industry are related to awareness, workflow integration, payment. Whenever we speak with physicians, they unaware of the numerous benefits of VR therapy randomized controlled trials and systematic reviews that have been published. This gap in knowledge is why there are conferences like Virtual Medicine which cover the evidence supporting the use of immersive technology within healthcare.
If immersive therapeutics is going to be implemented into the clinical workflow it will need to be integrated into the Eletronic medical records system. Over the next several years study will need to be conducted that show clinical benefit to the wealth of data that can be extracted from the HMD.
Currently there is no specific billing code for immersive therapeutics. There are a few insurance companies looking into the technology, our largest current clinical trial is being supported by Travelers Insurance. Dr. Brennan Spiegel also published an economic analysis on a virtualist pain service within the hospital demonstrating a savings. Though I cannot predict when this challenge will be solved it will be critical for mainstream use within healthcare.
There are numerous new developments within immersive therapeutics. The results of several pilot studies using full body immersion with a virtual avatar have led to fascinating results in areas such as chronic pain, eating disorders, racial bias reduction, and several more. Currently you can experience this at select location but that will change with time.
The combination of immersive technology with other innovations will lead to at least an order of magnitude increase in the reach of the healthcare system. Our colleague, Dr. Skip Rizzo at USC’s Institute of Creative Technology has developed virtual humans using AI and avatars.
Another important future goal is personalized VR therapy. Each patient has with a unique biopsychosocial profile. Patients may stay immersed longer or reach the desired outcome sooner if the virtual intervention is tailored to them. Currently companies are garnering this information with questionnaires, but a few researchers have incorporated emotional intelligence to change the virtual environment.
Immersive technology is one of the most powerful tool for the mind that runs on silicone. I have no doubt spatial computing will have a profound effect on society and that immersive therapeutics will someday be a pillar of mainstream therapy like pharmaceuticals. It’s been an honor to treat patients with pixels and witness the rise of immersive technology within healthcare.