“Let’s face it: healthcare was late to computers (well, at least to PCs). It was late to the internet. It was late to mobile. It still doesn’t understand the importance of social media or gaming. It isn’t even thinking about the metaverse.”

Kim Bellard, Contributor, The Health Care Blog

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The concept of the Metaverse has been around for years — science fiction writer Neil Stephenson is believed to have first introduced it in his 1992 novel Snow Crash. And folks who have read the Ready Player One novels are intimately familiar with the metaverse concept in the author’s depiction of OASIS, a vast virtual world where most of humanity spends their days. And, of course there’s The Matrix (red pill or blue pill?). But for purposes of this post it’s important to provide some background on the topic.

What is the metaverse? – The metaverse is the next evolution of the internet, in which users are immersed and virtually present. The metaverse consists of several key features, including real-time persistency, economies, communities, digital avatars, and accessibility across multiple devices. Early versions of the metaverse exist today, offering investors a glimpse of its enormous potential. But a successful metaverse in the future is expected to feature a decentralized, open-architecture platform accessed by virtual reality headsets and powered by blockchain technology. The concept, if successful, is expected to yield trillions of dollars of opportunities for companies stemming from several areas, including Social Media, Video Games, E-commerce, and Blockchain. In the metaverse, digital platforms will contribute mainly to digital-world experiences. By jumping into an immersive experience using a virtual reality headset, one can work, play video games, buy digital items, socialize with friends, and consume media, all while present within the metaverse itself.

As already noted above, versions of the metaverse already exist. If you have children, they might already be using platforms that support the metaverse. For example, Epic Games’ Fortnite has hosted virtual concerts with Ariana Grande and Travis Scott, where users attended as their digital avatars to enjoy the shared experience with others. The success of these events has been staggering, drawing millions of fans that far outnumbered in-person shows.

Half of American children use Roblox. Two-thirds of its users are 16 and younger, and most of them were spending lots of time at home last year. It is now estimated to have 37 million unique daily users, spending some 30 billion hours on the site last year. It is available in 180 countries, in 11 languages.

“We see a future where tens of thousands of people can gather in a single instance to join a virtual business conference, attend a movie premier, or watch their favorite artists perform live. We are working to make this vision a reality, innovating towards new technologies such as spatial audio and high-fidelity avatars with lifelike facial expressions.”

David Baszucki, CEO and Co-Founder, Roblox

What’s it all about? – One word – money. The metaverse is still in its early days, but the infrastructure is being built piece by piece, and social attitudes are changing such that we may soon be ready to experience a new era of the internet. While it may take several years for fully formed, immersive metaverse experiences to become ubiquitous, earlier stage investment opportunities emerge across multiple areas, including Social Media, Video Games, E-commerce, and Blockchain. At the heart of the opportunity are the social media and video game companies leveraging their large user bases, creator platforms, experiences with live digital events, and cutting-edge hardware to build the foundations of the metaverse. Beyond that, influential e-commerce firms are likely to benefit from new sales channels and features. At the same time, blockchain companies are likely to be essential in providing the financial infrastructure underpinning the metaverse economy. While in the real world, each of these themes continues to disrupt and redefine the status quo, the metaverse presents billions of dollars of new opportunities for each of these areas.

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What does the concept of the metaverse have to do with health care? – Buzzwords like “health care metaverse” rarely live up to the hype. For all the adoption of EHRs, they still are not living up to the promise of better care and shared data. For all the trumpeted gains of telehealth during the pandemic, they’re already starting to dissipate. For all the investment in digital health, there’s no real evidence that it saves money or improves health. Healthcare usually takes new technologies and kludges them into submission.

“We overestimate the impact of technology in the short-term and underestimate the effect in the long run.”

Roy Amara, Stanford computer scientist, c1960

What we’ve experienced in the pandemic is an unprecedented acceleration and adoption of emerging technologies and a greater understanding of the vulnerabilities we have in managing global population health, as well as the opportunities offered by deploying innovative solutions powered by these emerging technologies. We’ve also seen the benefits of the digitization, decentralization, and democratization of health care in near real-time. Whether we continue to build on this progress or return to our “safe” pre-pandemic care routines is an open question. If you believe in the latter, you can stop reading now because creating a health care metaverse will rely on those technologies and lessons learned.

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My take – We can already hear the drumbeat of the hype train accelerating as other industries promote the potential financial profits that the metaverse will bring. “Metaverse” is all the rage today, referenced by the leaders of Facebook, Microsoft, and Apple, but also by many other inhabitors of virtual worlds and augmented reality. The land of imaginary 3D spaces has grown at breakneck speed, and that was before the self-imposed isolation of a worldwide pandemic.

Not surprisingly, health entrepreneurs are all over the metaverse as well. Or at least they think they are. Many new ventures are led by current or former health executives, attracted by investor demand, selling marginal moves in telemedicine, robotics, behavioral health, consumer wearables, and the like. They see the health tech invasion of the metaverse as “a prescription for disruption” by a growing base of health technology investors armed with funding from special-purpose acquisition companies (SPACs).

But, here’s the problem. There are multiple challenges to creating a metaverse. The challenges fall into several domains such a technical (interoperability, portability, stakeholder customization), human factors (skills, resistance, mistrust, cyberattacks), legislative and regulatory. (Let’s be clear, our track record in achieving just data interoperability has been a dismal failure.) So, don’t expect anything resembling a workable version of a health care metaverse any time soon. Experience with past industrial revolutions would indicate that the transition to a metaverse-powered ecosystem will happen gradually, with an initial phase of hybrid education, hybrid processes, and hybrid delivery of care.

Health care needs a platform where user-created content and tools, among other things, can be built upon. It requires a platform that engages users using the latest technologies. No doubt, in the future, there will be opportunities to create a workable health care metaverse. In this new digitized, virtualized, and hyperconnected health care environment, one can envision a new Meta Health Care Delivery System that would likely be a hybrid of existing and novel technologies. Virtual Reality, Augmented Reality, and Mixed Reality would be combined with IoT, DLT, 6G or even 10G networks, robotics, brain-computer interfaces, AI, cloud, edge, and quantum computing and be deeply embedded in healthcare prevention, diagnosis, and treatment.

Additionally, healthcare payments, healthcare insurance, healthcare data governance, healthcare privacy, and security will also have to be transformed and adapted to the demand of a Metaverse society. Futurists like Dr. Bertalan Mesko and his team at The Medical Futurist Institute are predicting new personalized healthcare digital identities, digital avatars, and digital smart cities that will be the hallmark of the Health Metaverse. But the company that creates this platform probably won’t come from within health care.

And who will use this platform in the future? Your kids and grandkids will be the likely users of the health care metaverse since they’re already digital “natives” and comfortable interacting in these immersive digital universes.

I don’t know what the health care metaverse looks like. I doubt that anyone does. Will it be utopian or dystopian? No one knows that either. But in previous posts, I’ve highlighted some of the technologies that will be used to build out the health care metaverse. Concepts like the “digital twin” could interact with your physician’s avatar for a virtual visit. Patient communities built around specific conditions like “Patients Like Me” could meet in the metaverse to share what works and doesn’t work for them in a more rich, immersive environment. And education will undergo a dramatic transformation when it can become highly immersive and customizable for each individual. Whether we can combine all of the technologies required to build the health care metaverse into a working system is unknown at this time (I’m skeptical). Overcoming the legal and regulatory hurdles will be a considerable effort (Big understatement). And then there’s reimbursement (highly unlikely).

For now, tune out the hype, watch the technology development in other business sectors, and talk with your kids about their experiences on the immersive internet. They’ll be the best leading indicator about whether the metaverse will work in health care.