“A lot of people think of VR as it relates to gaming and entertainment devices, but when used in a positive way, VR can be a profound benefit to human health.”

Brennan Spiegel, MD – Director of Health Services Research, Cedars Sinai

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The border between the virtual and real-world continues to break down, providing breathtaking experiences that, a short time ago, could only be found in the imagination of sci-fi writers. So much is happening so fast that the differences between VR, AR, and MR can seem a little puzzling at first. So first, let’s define the terminology.

Virtual reality (VR) – VR is the most widely known of these technologies. It is fully immersive, which tricks your senses into thinking you’re in a different environment or world apart from the real world. Using a head-mounted display (HMD) or headset, you’ll experience a computer-generated world of imagery and sounds in which you can manipulate objects and move around using haptic controllers while tethered to a console or PC.

Augmented reality (AR) – AR overlays digital information on real-world elements. Pokémon GO* is among the best-known examples. Augmented reality keeps the real-world central but enhances it with other digital details, layering new strata of perception and supplementing your reality or environment.

Mixed reality (MR) – MR brings together the real world and digital elements. In mixed reality, you interact with and manipulate both physical and virtual items and environments using next-generation sensing and imaging technologies. Mixed Reality allows you to see and immerse yourself in the world around you even as you interact with a virtual environment using your own hands—all without ever removing your headset. It provides the ability to have one foot (or hand) in the real world and the other in an imaginary place, breaking down basic concepts between real and imaginary, offering an experience that can change the way you game and work today.

Extended reality (XR) – Recently, experts settled on extended reality, or XR, as the catch-all term for devices that put computer-generated visuals in front of your face. And they decided on health care as one of the most promising frontiers for XR. So for this post, I’ll use XR to refer to the many uses of the various technologies in health care.

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What are some of the current use cases of XR in health care? –

As part of my previous work at Sg2, we held an innovation summit each year. We were fortunate in 2019 to have Dr. Brennan Spiegel from Cedars Sinai as a featured speaker. His groundbreaking work in the use of XR is highlighted in his recent book “VRx: How Virtual Therapeutics Will Revolutionize Medicine,” which is the best resource on the use of XR in health care I’ve seen. Based on his work at Cedars Sinai and his extensive research in the field, here are some current use cases in health care:

• Pain management – In the U.S., pain management is a growing healthcare concern, given that an estimated 100 million adults there suffer from chronic pain. An amount of approximately $17.8 billion is spent prescribing pain medication annually. From Dr. Spiegel’s book: “VR lowers the perception of pain in at least three different ways. First, it distracts the brain from harmful signals rising up from the body. Second, it creates an illusion of time acceleration, effectively shortening the length of pain episodes. And third, it nips signals in the bud at their origin, blocking pain from reaching the brain. The combination of these effects supports the ability of immersion to fight pain.”
• Schizophrenia, Dementia – Immersion can make a difference in the lives of people with schizophrenia in a way that medication cannot. Dr. Spiegel: “For conditions marked by an eroded sense of self, where the limits of traditional talk therapy make it challenging to access a patient’s inner world, VR offers a gateway into a fractured mind and an opportunity to rebuild its parts from within.” Beyond virtual reminiscence therapy, the literature is now full of studies demonstrating other benefits of VR for dementia care.
• PTSD and Anxiety Disorders – Virtual reality exposure therapy (VRET) is being examined as another way to help people recover from PTSD. VRET is a type of exposure therapy that has increasingly been used to treat a variety of anxiety disorders, including specific phobias. In VRET, an individual is immersed in a computer-generated virtual environment, either through the use of a head-mounted display device or entry into a computer-automated room where images are present all around.1 This environment can be programmed to help the person directly confront feared situations or locations that may not be safe to encounter in real life.
• Autism Spectrum Disorder – The technology is also helping children and adults with autism spectrum disorder (ASD). In one initiative, the Center for BrainHealth and Yale School of Medicine are collaborating to help young adults with ASD enhance their capacity for learning and developing the skills needed to achieve economic and social independence in life using VR. “Unlike other therapeutic options, such as role-playing, VR represents real-life experiences in a safe, controllable manner that allow for repeated practice and exposure, which is a key element in treatment,” says a study.
• Empathy – Virtual technology is being used to increase empathy among medical students and professionals. VR has been used to teach doctors what it’s like to experience the progressive blindness of macular degeneration and glaucoma, to experience an acute migraine headache, to live in a hospice receiving palliative care for advanced cancer, to experience hallucinations, and to enter an MRI scanner while undergoing a critical imaging study. Young doctors-in-training can practice interviewing virtual patients in low-risk environments, learn how to empathize meaningfully and reproducibly, and cultivate enhanced emotional and social awareness about their patients’ life experiences.
• Surgical training and simulation – A study from Harvard Business Review showed that VR training “improved participants’ overall surgical performance by 230% compared with traditional training methods.” The VR-trained participants were able to complete procedures on average 20% faster and more accurately.
• Rehabilitation from stroke and other neurological conditions – Over seventy trials are testing the benefits of VR for stroke rehabilitation. Although some programs work better than others, meta-analysis reveals that VR improves outcomes when augmenting traditional therapy. The science of VR neurorehabilitation has progressed beyond academics into the real world.

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What are the barriers to implementing XR in health care? – Currently, these are the main barriers to the scalable deployment of XR into health care:

• Clinician education – Today, few doctors know that these technologies and the evolving discipline of immersive therapeutics exist. The work of Dr. Spiegel and others is narrowing that gap. Also, there is growing enthusiasm among the newest generation of doctors. Young doctors are not only more knowledgeable than older physicians about technology in general, but they’re also the first generation to use VR as part of their medical training.
• Lack of payment – If doctors don’t get paid for administering VR, it will be difficult to scale the technology beyond research centers and motivated clinics. Are insurance companies willing to reimburse immersive therapeutics? The answer is yes, in certain instances. For example, VR phobia therapy is a reimbursable service that falls under the covered category of exposure therapy. But insurance does not yet cover VR for pain management, which is surprising since it’s the most widely used application of therapeutic VR and is currently offered by several hundred hospitals worldwide. In the absence of reimbursement, most hospitals directly pay for VR programs hoping it will save costs by reducing the need for medications and their costly side effects, improve patient satisfaction, or reduce hospital length of stay. In the meantime, short of insurance coverage, many hospitals turn to philanthropy to help deliver VR to their patients in need.
• Access to 5G networks and 5G-enabled devices – Any large-scale deployment of XR will likely require the high-bandwidth, low-latency capability that 5G brings to the table.

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Where we are today – Health Tech Magazine conducted an online poll in November 2020 asking where health care organizations were on the road to implementing VR technology. They received 303 replies to the survey, and the results are shown below:

Although the sample size in the poll was relatively small, the results mirror the overall market sentiment at this time. As the technology continues to mature and headsets come down in price, adoption will accelerate since the clinical benefits for most of the use cases discussed above are clear.

“The virtual reality (VR) in healthcare market size was $1.56 billion in 2018 and is projected to reach $30.40 billion by 2026, exhibiting a CAGR of 42.4% during forecast period.”

Fortune Business Insights

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So, what steps can your organization take to prepare for XR implementation? – If your organization is considering adding XR technologies to your portfolio of digital services, it is essential to prioritize safety and ease of use to optimize the user experience. Key elements to consider are listed below:

• Know your XR use case – Whether you are designing an XR experience to teach patients about their medical conditions or creating a distracting game for kids to play during flu shots, organizations must understand the unique parameters that each user requires. Work closely with physicians, nurses, child life specialists, and physical therapists to develop appropriate applications.
• Keep the XR Experience Simple – Most patients and providers have minimal experience with XR, and often there are incredible time pressures in a clinical setting. Many times, clinicians only have minutes to set up the VR system and teach patients.
• Identify physician champions to educate the clinical staff of the benefits of XR – To scale immersive therapeutics across healthcare, we need to train a new class of providers who are XR authorities. According to Dr. Spiegel: “These virtualists not only will be experts on the latest hardware and software but also will understand whether, when, and how best to integrate XR within the health care setting. They will be highly skilled and multidisciplinary clinicians who work in partnership with specialists to augment traditional therapies across a wide range of conditions.”
• Learn from experts in XR implementation in health care – Dr. Spiegel and his colleagues are publishing multiple studies on the use of XR in health care. He also holds an annual conference where leading organizations can share their experiences in deploying XR technologies at the point of care. You can learn more about their 2022 conference here.

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While there isn’t yet a strong case for cost savings in applying XR to virtual care and chronic disease management, that could shift as more data and research become available. As payers see the better outcomes and cost savings afforded by virtual care platforms, including XR, they will likely pay for these programs, making them part of routine care plans.