Abstract/Introduction
In our case study we start by taking a very hard look at the
raw economic realities of Healthcare transactions. We then carefully consider how Virtual
Reality can solve a problem better
than any other solution. Next we pitch the concept to influential industry
leaders. Upon validation from, and contracting with, these industry leaders, we
deploy our Virtual Reality solution into Healthcare.
It may seem paradoxical to talk about a system in which the
greatest concern is for patient well being, and then to also claim that such a
system is “In the Money Flow”. In the
world of Healthcare, and Healthcare IT, Money-Flow refers to the steps that
transpire during a “Healthcare Transaction”.
A simple transaction could be: Patient goes to Doctor, Doctor submits a
claim to Payer, Payer pays Doctor. A
slightly more complicated transaction would introduce a Prescription for a drug
being written by the Doctor, the Payer then also paying the Drug Maker in
addition to the Doctor. Each step of the
process includes a payment or receipt of payment. This is the Money-Flow. This is the epicenter of Healthcare
Reform. If you build technology that is
necessary to facilitate the pay/receive tasks, your technology is considered
“Need to have”. If you do not facilitate one of these tasks, then you are “Nice
to Have”. If you want to build
technology for Healthcare, you must understand where you are positioned in
relation to the Money Flow. You can
certainly build Nice-to-Have systems, and you can succeed, but how you go about
pitching and selling your solution comes down to Money-Flow.
Virtual Reality
based tools are being designed to meet the needs of the patient. The technology that supports these tools
first comes into play in the lab, then the doctor’s office, and finally in the
patients home. For each user group, an
appropriate experience is required, but the underlying technology remains
seamless, and therefore consistent. The
tools that were employed to produce Outcomes in Clinical Trials, are the same
tools used to educate doctors on application, prescription, Adherence and
Consultation. The Patient gets access to
innovative features and functions packaged in a manner that is consistent with
their Adherence Profile. The resulting benefit to the patient is that many of
the forces that disrupt Adherence can be addressed in an intuitive and
captivating manner. The newly empowered patient now has the means necessary to
take better charge of their own well being.
Further, for any of these patients who may be participating in Day 2
clinical trials, and or Remote Monitoring the new level of engagement instilled
in the patient will yield improved Outcomes.
Virtual Integrated
Patient Care(VIPC)
Currently, the only real aggregator of a patient’s medical
history is the patient themselves. It is
the human body that serves as an archive for all that has happened in the past,
and all that is happening at present.
While the human body may have a fantastic physiological memory, its
archives can be difficult to access and interpret. Furthermore, when humans must not only
maintain a sense of history, but maintain a protocol of activity that reaches
into the future, performance of the system begins to suffer. But we believe, through the study and
application of Virtual Reality, that in conjunction with a small number of
additional innovations in healthcare, we can extract the best features of the
“human archive”, improve on some of the non-intuitive “human features”, add
improved engagement with ongoing protocols, and yield a solution that works
better for patients because, it has been modeled on the patients themselves.
What we know to be true, is that ultimately, everyone who
provides a health related service cares about the health of the patient. What exactly they care about, and why they care, are not such simple questions. But
for the application of Virtual Reality in health related services, it does not
matter so much. For example: a maker of
drugs cares a great deal about demonstrating the effectiveness of the drug in
producing Patient Outcomes. The maker
also cares a great deal about ensuring that the drug gets sold. Further, the maker continues to care about
ongoing Outcomes(even after trials are over) because continued evidence of
Outcomes produces favorable standing with the Payers, which in turn leads to
increased distribution. The
unpredictable variable in the middle of this equation is the Patient and
Adherence. Without Adherence, the entire
Pharma lifecycle comes crashing down. Pharma cares a great deal about this.
Without Adherence, Patient Outcomes suffer – which literally translates into
unstable and/or deteriorating health. The Patient certainly cares about this,
but, so do the Payers. Poor adherence to
both medication prescriptions and the lifestyle prescriptions that often
accompany them, are of great interest to payers, who time after time, are on
the hook to pay for major medical procedures that may result of poor Adherence,
and they also are on the hook for unnecessary hospital readmissions and/or
doctor consultations.
What we now understand is that while the different agents
who have a variety of roles in managing the well being of the patient may care
about the patient for vastly different reasons, we can provide tools to empower
the Patient, which in turn positively impacts variables that agents with the
ability to fund these tools care about deeply.
And although we have not yet addressed the mixed motivations and complex
business models of Hospitals(who in many cases are not yet incentivized to try
and reduce volumes), we believe that hospital business models will not be the
primary driver that we need to cater to. In addition, while we propose that
Virtual Reality based tools will redirect healthcare transactions away from the
brick-and-mortar office, we recognize that doctors looking to grow their
businesses, need to do more than simply increase transaction volumes anyway. So
for these agents within the system, we provide optimization and efficiency that enables an increase transaction volume
capacity, in a manner that actually improves patient care, and provides a means
of leveraging a truly scarce resource(the in-office visit) for situations that
truly require this type of haptic service. Not only is this coordination of
need to the extreme benefit of under-served populations and elderly, it is also
in line with the precise methods that business-oriented doctors employ to
increase cash flow. So who does not benefit
from Virtual Reality based patient care?
We will keep a sharp lookout as we proceed, and see if we can answer
that question
Begins in the lab
with clinical trials
Virtual
Reality kicks off its role as an essential scientific tool by providing a next
generation version of what computers first started doing in the lab: running
simulations. Generally speaking the less
abstract the experiment, the more intuitive the results will be, and the more efficiently
the results can be applied to real cases.
Many kinds
of lab work begin with data that is compiled to represent a sampling of
patients who form section of the intended target demographic. Variables that represent the sample
population’s physiology are fed into a computer which may also be integrated
with a pharmacokinetic drug database. Buttons are pushed, computations are
done, and reams of numbers are produced.
In some cases we are able to visually represent the output as a chart or
graph, and this helps tremendously. In
all of our work with sample populations and variable output, we have never once
seen a chart or graph that resembled a patient.
Fortunately, lots of very smart dedicated people are employed to
extrapolate, interpolate, and otherwise translate the charts and graphs into a
meaningful shape and consistency that resembles a sample population that now,
may be the actual queue that has formed to partake in the clinical trial. Time has elapsed, must time has been spent overlaying
data onto to our living breathing test subjects. What we think, and what we
know is that it would all be much easier if the clinical trials test subjects
EMR-based data was seamlessly fed into our Virtual Reality based population of
physiologically correct avatars, who happen to inhabit an environment that is
ideally configured for clinical trials testing.
Now, if we take our pharmacokinetic drug engines, and handshake them
with our avatars(who do have hands!), we can apply the subject medications to
fully rendered versions of our actual patients, and see the simulation occur in
a highly visual manner, that requires far less interpretation, and certainly
less tuning to meet our real test subjects.
Of course there are certain aspects of the testing that the scientists
care a great deal about, that is not of interest to the test subject, but we
recognize that this is true(in almost every industry) and through the use of
Engagement Skins, we overlay a visualization package that provides both
scientist and patient with the information that they want to see, in a format
that not only fulfills the need to communicate information, but also creates a
compelling portal for work, education, and, because we are using Virtual
Reality, interaction and communication. So what does this all mean to the
patient, and why is it important? For drugs to work on patients, the drugs must
get into the patient’s body, which generally means the patient must put them
there. We know that at least some of the
time, people do not Adhere because they have not connected with their ailment
in such as way that they become motivated to engage with their ability to
impact their own health. Why the disconnect? Broken bones aside, many ailments
are abstracted from the plane of what is easily discernable to the patient.
This can lead to a state of “out of comprehension, out of mind”. While this may seem counter-intuitive when
the patient has been told the seriousness of the ailment, and the dire need to
medicate, but we don’t make the rules, we just seek to understand them, and do
something about it. What can we do about
it? Again, using the tools derived from, and tested in the lab, we can apply an
Engagement Skin Appropriate to the patient, enable the patient to control the
Virtual rendering of the themselves,
and when they have succumbed to the immersive draw of virtual environments, we
demonstrate with a high degree of realism, exactly what their body is
struggling with, and exactly how the medication will work towards improving
whatever it is that is wrong. The
Patient does not need to interpret what they see. The simulation and impact on
the Patient is at no point dis-intermediated by a cloud of “science/medical
fuzz” that defies layperson comprehension. Rather, they see themselves on the
screen(with a photorealistic rendered head), they connect with their manifested
medical state, not because it looks like a chart of scribbling on a pad, but
because it looks like themselves. Better
yet, if the ailment is “hidden”, like high blood pressure or high cholesterol,
we can show the patient precisely what their arteries look like, or just how
hard their heart is working. We can
represent these visualizations with any degree of realism or sensationalism,
depending on what is appropriate. And
when the patient leaves the lab, or leaves the doctor’s office with an RX to
take to the pharmacy, they are also leaving with a WX(Website Prescription)
that gives them “doctor prescribed” access to a portal, that they can access at
home, to see everything that they saw in the lab, and like in the lab, they are
in the driver’s seat. From their study at home, or their office, they can see
exactly what will happen if they stop their meds. They can see what will happen
if they keep taking them.
We work with remote monitoring providers who supply
biometric devices. We can take this data as an input, apply it in real time to
the virtual patient, and the real patient can get not only up to the second
physiological information intuitively presented to them, they can also see
their history. Fast forward, rewind, replay. Intangible, unsensed changes are
made real. The Patient is engaged.
Predictive modeling provides data, but this data is only
impactful to the patient if it is presented in a manner that they can truly engage
with. Predictive modeling visualization,
combined with narratives that describe how the predictive data will be
manifested within the patient(“with these types of numbers, you should be
feeling like…”), and credibility that comes with predictive narratives aligning
with the patient’s reality, and the ability of the patient to poll a community
of like-patients to get their experiences, equals a powerful medium for taking
the abstract, and making it real.
Adherence
begins in the lab. It begins with clinical
trials. It begins by taking an additional look at the test subjects, and
recording what we find. The emphasis is
always on the patient history variables that have been determined to be of
importance in determining the medications effectiveness in combating the target
ailment. But, to quote C. Everett Koop, M.D., the
former U.S. Surgeon General, “Drugs don’t work in patients who don’t take
them.” There are many reasons why people
may not take medications that have been prescribed to them, but one thing is
for sure, an authority figure issuing instructions to Adhere, is generally not
enough of a driving force to ensure good levels of Adherence. What we also know is that
Drug Promotion and
Education to HCP’s
HCP’s are
well accustomed to receiving education on drugs via web portals that have been
established by the drug manufacturers.
These sites leverage the best technology afforded by web1.0 tools. In some cases, these portals enable the HCP
to view cases studies, or data that has been collected to fit basic patient
profiles.
Virtual
Reality is a natural extension of a service that already reaches into the doctor’s
office and onto the screen of doctor looking to come up to speed on a
medications designations and applications. What Virtual reality can do that
web1.0 cannot is present real patient data in a format that does not need to be
extensively interpreted. Our Virtual
Reality tools bring two discrete technologies, EMR and Pharmacokinetics,
together into to a fully rendered, interactive and relevant environment. The
HCP needs to be spend less time researching, less time interpreting barely
relevant case studies, and now has more time to consider and decide if the
medication is the best course of action for the patient. Visualized differential analysis using real
patient data and pharmacokinetic drug models reduces time-to-decision, and the
potential for mis-application. In
addition, the ability to work with real patient data enables the HCP to
integrate Adherence history data, resulting in an effective AX(Adherence
Prescription) which can be written for patient at the time of writing the
RX. The unique properties of Virtual
Reality will enable many AX’s to be
filled via an WX(web prescription) granting access to the patient to an Adherence
Profile-matching virtual environment.
Adherence
History(AHX) and Adherence Prescriptions(ARX)
Adherence is a common word when
we talk about medications, but what we think many people don't consider is that
Adherence is a process that is applicable to just about everything in our
lives, and we don't mean obvious things like "adhering to a diet", we
mean: teenage use of texting could be described in Adherence language, a drug
addicts' use of drugs could be described as Adherence, taking the car for
maintenance, getting your nails done. These all consist of protocols that are
easily followed or not, and the length of time for which they are followed can
be considered in terms of persistence. How about Religion? your job? same basic
formula. There is a protocol that describes the methods that need to be
followed to maintain the prescription, and there is a length of time over which
the protocol is followed. For almost every activity, adherence will wax and
wane. This is true for drug addicts, teenage texters, religious folk, and
everyone else.
Broadening our field of analysis
when we consider adherence is interesting because when we talk about adherence,
the conversation is almost always dominated by "negative adjustments"
that must be adhered to. Fine. We understand. People who don’t like to exercise, or who
need to eat less junk food, need to make what they perceive as "negative
adjustments" to their lives. Or in other words, the level of pleasurable
activity they are accustomed to is being curtailed, and the perception of this
requirement is "negative but necessary".
Lets now consider activities which
are inherently pleasurable, and should not need to be curtailed(due to adverse
effects) but demonstrate waxing and waning adherence. We use
Mafia Wars on Face Book as an example.
It failed to engage our research team, but it has succeeded with 5 million
other people. These folks comply with the protocol: they press the buttons, do
the jobs, make the money, etc. And they
persist. Every day, lots of times every
day....make the money, do the job, click, click. So now we have a sample size of 5m people
clicking away daily. All pleasure. They are not gaining weight, cholesterol is
not going up, etc. but........after awhile.......game players stop playing. If this were not true, everyone today would
still be obsessed with Pac Man. So what
happens? Why stop adhering to such an entertaining protocol? Boredom,
popularity shifts, competing games, who knows.
What is important is that even the most purely pleasurable activities
see Adherence wax and wane. We need to
know exactly why this is, in order to understand why people do not Adhere to
health prescriptions.
The solution is Adherence
Profiles. Adherence Profiles are constructed by gathering data that describes a
patients lifelong performance in regards to a myriad of activities: from
brushing teeth, to watching football, to mowing the lawn, religion, etc. The
point is: we must accept that there are unique profiles that describe a
person’s track record to adhere to anything. Through the definition and
analysis of this profile, we can then construct an Adherence Program that will
best suit the patient.
Adherence Program may in many
ways be exactly the same, but the essential difference will be an
"Engagement Skin", which is an overlay on top of a common
infrastructure, designed to provide an engaging Adherence Program to align with
an Adherence Profile. Virtual Reality is
the only medium that bring all of the resources required to make this possible,
in healthcare, but the concept of engagement overlays is a proven technique in
digital entertainment. Same customer base, different application of a proven
technique.
How Virtual Reality
addresses Persistence
Patients
fail with Adherence for a variety of reasons that include: lack of
understanding, and undesirable sides.
Patients who want to persist, but feel that they need support, quite
often seek out other patients who are like themselves: suffering from an
ailment and looking for support, information, and a safe environment comprised
of patients like themselves. This search for community is evidenced by the
popularity of web portals that enable this sort of gathering through message
boards and chat. We have also seen the
rise of Virtual Reality deployed for the benefit of patient groups. What we have not seen is the right
combination of an engaging environment, combined with safety, and wrapped in
medical authority. We believe that as an
extension of drug promotion, and with the goal being patient Outcomes driven by
adherence, a Virtual Reality based community, that is properly sanctioned, provides
safety, and can only be accessed by doctor prescription, provides the right
combination of captivating attributes needed to make great strides in
Adherence. The WX represents authority
and safety, certification and regulation ensures accuracy. Combined with
Virtual Reality, the patient now has access to special resources tailored to
meet their unique needs, provided via a mechanism that brings their health to
starting lifelike visualization and interaction, and the means to communicate
and receive knowledge and support. This is a powerful combination of
patient-engaging services that have never before been aggregated in such a
compelling way(if at all).
Accessibility and
Affordability
Virtual
Reality based health services are not only effective and unique, they are
universally accessible and affordable.
Cost should not be a factor when supplying meaningful solutions that can
and do impact patient outcomes.
Under-served populations and mobility restricted demographics are among
those that can benefit tremendously.
Combined with Payer-recognized Online Consultations facilitated via EMR
infrastructure, not only will more people be able to receive needed care, we
will be able to redirect a critical mass of in-office consultations to the
Virtual Reality platform. While the AMA estimates that as much as 70% of the
current volume of in-office consultations could be handled effectively using
digital communication, current Online Consultation methods will only be
suitable to facilitate a small percentage of the volume identified by the
AMA. The unique qualities of Virtual
Reality not only enable us to facilitate the majority of volume targeted by the
AMA without sacrificing quality of care, we believe that that there are many
inherent deficiencies associated with in-office consultations that we can
improve, such that in a variety of cases, Online Virtual Consultations will be
perceived as more desirable and effective than in-office visits.
Conclusion: Outcomes
and General Patient Health as impacted by Virtual Reality
In our
ongoing study, collaborations, and implementations, we will not only discover
and publish the useful information regarding Best Practices and efficient
methods of work, we will also be able to quantify the meaningful improvements
in Patient Outcomes as archived through the introduction of Virtual Reality in
healthcare.
In our ongoing work, we are cognizant that: Adherence
Strategy must be diversified, The Patient must be served, and that Payers and
Makers must be educated to the benefits of Virtual reality in healthcare.
The good news for Innovation and Patient Care is that The
Perfect Storm is brewing in Healthcare:
-
Regulation is forcing change in an industry that
is change averse
-
The Supply/Demand requires the introduction of
new methods of work
-
The healthcare industry’s systemic challenges
require a disruptive technology to be part of the fix
-
The required disruptive technology is now
available for the first time: Virtual Reality
Posts
No comments:
Post a Comment