In 1974, Star Trek’s animated series introduced its audience to the holodeck, a bit of futuristic technology that would eventually appear in multiple iterations of the science fiction classic from television programs to the big screen. This recreation room was designed to create simulated, alternative versions of reality. In this simulated world, crew members could engage with their virtual environment as if it was the real world. Sound familiar?

Today, you don’t need a full deck on a spaceship to experience an alternate reality. We have virtual reality headsets and augmented reality apps that run off our mobile phones. While there’s certainly a home for these applications as an entertainment medium, we are increasingly seeing the strength of extended reality (XR) as a health and wellness tool that can improve patient outcomes.

What’s XR?

Before we can explore how this technology can improve quality of care, and thereby improve outcomes, we need to define the category. Extended reality is the umbrella term that encompasses all real and virtual combined environments. It includes:

• Virtual Reality (VR) – full immersion in a digital environment.
• Augmented Reality (AR) – overlays virtual objects on the real-world environment.
• Mixed Reality (MR) – anchors virtual objects in the real world. Objects here are not just overlaid into the real world–the real world can interact with these virtual objects.

Improving Quality Through Training

According to the Association of American Medical Colleges, a traditional med school curriculum combines two years of pre-clinical science training – where students learn basic medical concepts – with two additional years of clinical study. In these clinical study years, students are given hands-on experience with patients.  Extended reality technologies add a new twist to this educational model. Virtual simulations of real-life medical scenarios allow students to make medical decisions in a safe environment before they engage with actual patients. Today’s technology isn’t a replacement for real-life clinical rounds, but it can be a good supplemental component that gives students an opportunity to prepare for direct patient engagement.

Improving Quality through Surgical Walk-Throughs

Imagine if your physician could walk through your surgery before you slip into a hospital gown the day of your procedure. Facilities like Stanford Medicine are using virtual reality to change the way physicians prepare for surgery. Stanford’s Neurosurgical Simulation and Virtual Reality Center feeds conventional MRI and/or CT scans into VR technology, which allows their physicians to see the brain in 3D and walk through complex procedures via a simulated surgery. This process can help mitigate any unexpected challenges the surgery may present.

Improving Quality through Surgery Guided by Extended Reality

In 2017, a team of researchers conducted a proof-of-concept study to explore the potential benefits of using augmented reality to superimpose digital images on top of the visual field during surgical procedures. In December of that year, a surgeon used an MR headset to access patient medical data and data of the operative technique during a procedure to implant a prosthesis into an 80-year-old patient.  The surgeon was also able to share his field of vision with four additional surgeons via Skype, which would allow collaborative input during the procedure. The study’s authors concluded that, “surgical practice and education can derive significant benefits from the implementation of AR and MR tools in daily practice.”

Improving Quality Using Extended Reality as Treatment

A number of studies have looked at virtual reality’s value as a treatment for psychiatric disorders and pain management. Through the course of these studies, virtual reality has proven to be an effective tool, particularly, as noted in a systematic literature review published in Harvard Review of Psychiatry in 2017, “with the most strength of evidence for use in exposure therapy for patients with anxiety disorders, cue exposure therapy for patients with substance use disorders, and distraction for patients with acute pain requiring painful procedures.”

Looking to the Future

As with any medical technology, extended reality’s value lies in its application as a tool. Effective use, for example, in medical training lies in recognizing that virtual experiences don’t replace real-life patient interaction. Simulated experiences offer supplementary practice, not substitution. Applications that tap into extended reality’s strength in pre-surgical planning, pain-management, or psychiatric treatment require thorough physician training prior to use. Like any other medical tool, medical personnel must be trained on how to appropriately utilize the technology for the benefit of the patient.

In the 1930s, it wasn’t at all uncommon for a sick patient to see their doctor from the comfort of their own home. Back then, about 40% of doctor visits took place in the patient home. By 1950, that number dropped to around 10%. Today, thanks in large part to telehealth technologies, checking in with your doctor from home is once again on the rise.

What is Telehealth?

Telehealth provides support and enhancement of healthcare through the use of digital information and communication technologies. It may include remote clinical services (often referred to as telemedicine), as well as remote patient monitoring, training for healthcare providers, and patient education.

Improved Access through Telehealth

A 2016 Commonwealth Fund study found that just over half of US adults were unable to get evening or weekend medical care without visiting the emergency department. In 2017, another survey found that residents in 15 major metropolitan areas waited nearly a month for an appointment with a new family medicine physician. That problem is likely to get worse. The Association of American Medical Colleges predicts that shortages of primary care physicians (PCP) will increase significantly by 2025. Today, an estimated 64 million Americans live in an area where the total number of primary care physicians can only meet 50% or less of the population’s needs.

Telehealth technologies can help alleviate some of these challenges by giving patients access to physicians that may be outside their usual geographic area. Patients may interact with the physician via video, talk, or text, depending on the service, and appointments can take place at any time of day, every day of the week.

Access to Specialist

Telehealth can be used for more than virtual visits to a PCP, and that’s a good thing. Access to specialists can be even more difficult to schedule, particularly in rural areas where there are roughly 40 specialists for every 10,000 Americans (compared to 134 per 10,000 in urban locales.)  An example of this in practice is PSLG portfolio company DermatologistOnCall, which provides an online care delivery platform that connects patients with online dermatologists for skin care diagnoses and treatment plans.

Reduced Cost

The average cost of an in-person doctor visit is $125. Conversely, telehealth visits average about $45. A 2016 article by the American Council on Science and Health reported that an average of $86.64 is saved every time a patient received care online at UPMC instead of visiting the ER or urgent care. Up to 40% of those patients also indicated that without the option of telehealth visits, they would have skipped care altogether.

Improved Follow-Up Care

Telehealth technologies include wearables and digital health apps that allow patients and doctors to monitor health between visits. This exchange of information can help doctors and patients coordinate long-term care and monitor progress. In addition to having a potentially positive impact on patient adherence, monitoring can also help doctors identify when treatment plans aren’t working so changes can be made.

Lack of Broadband as a Health Issue

Telehealth depends on internet access. Without affordable broadband to support reliable access to the technology, adoption of telehealth will be hampered. Unfortunately, rural communities, which are more likely to face physician shortages (both specialists and primary care), are also less likely to have access to the internet connection speeds required to support the transmission of data for telehealth services.

Policy Needs to Catch Up to Technology

As the American Hospital Association aptly suggests in their most recent fact sheet on telehealth, today’s limited Medicare coverage is impeding the expansion of telehealth services. The current statute limits access to services based on geographic locations, the types of technology that may be used, and the list of services covered.

Telehealth also requires compliance with federal and state regulations. Particularly with variances in laws between each state, providers and insurers may be limited on what services can be provided based on legal and regulatory challenges, ranging from coverage and payment to licensure, credentialing, and privileging, among other factors. If telehealth is going to become a viable, value-based care solution, federal and state hurdles must be addressed.

The Future is Now

Telehealth isn’t necessarily new. Nascent applications stretch back as early as the 1940s when radiology images were sent 24 miles between two Pennsylvania towns via a telephone line. Today’s technology, however, has brought telehealth applications into the mainstream as a viable and necessary healthcare service. While challenges remain to widespread adoption, many hurdles have already been overcome. The introduction of 5G networks and the ongoing evolution of government policy pertaining to telehealth will continue to pave the way to improved access of services.

Understanding Population Health and Public Health

The terms “population health” and “public health” sound similar. If you’ve used them interchangeably, you’re not alone. The similarities, both in name and concept, make it easy to overlook their nuanced differences. However, in order to have a productive conversation about the evolution of modern healthcare, it’s important to understand the distinction between these terms.

How Are They Similar?

Some of the confusion involving population health vs. public health stems from the fact that both focus on the health and wellness of a group or community. These concepts look beyond individual care to identify patterns of health and illness within groups of people. By monitoring trends, both population and public health seek to identify interventions or preventive models that can promote health, improve patient outcomes, and reduce overall costs.

Population Health

Population health is concerned with the medical outcomes of individuals in a specific group with a similar characteristic. This can be defined by geographic location or by other factors such as ethnicity, chronic illness or disability, socioeconomic status, employment, and age. Of course, individuals may belong to multiple populations. When studying population health, researchers look at societal structures, attitudes, and common behaviors that might influence health outcomes with the goal of identifying patterns of determinants and, ultimately, identifying what can improve those outcomes.

Public Health

Focusing on society at large, public health puts its attention on wellness programs and initiatives designed to prevent disease or injury. Researchers in this arena look to identify steps that can be taken to create conditions in which individuals can be healthy. The focus is often on large-scale initiatives such as smoking cessation, improved air quality, vaccinations, or management of disease outbreaks.

The Role of Health IT in Population and Public Health

The era of digital health tools has made it easier to collect relevant data used to identify specific populations and the social detriments that impact them. Further, innovations like artificial intelligence can be used to sift through the data to more efficiently identify patterns, and later automate tasks that facilitate improved outcomes.

For example, PLSG portfolio company Mental Health Metrics uses statistical process management techniques to intervene in patient care before adverse events occur. A great example of the way health IT can be used for population health initiatives, this start-up provides early detection of a pending patient crisis and triggers a treatment sequence. In turn, the early intervention may translate to a more effective and less expensive approach.

Digital health tools also help collect data used to identify public health issues and then widely disseminate information related those issues. A great example of a company working within this space is another PLSG portfolio company, Health Monitoring Systems (HMS), which aggregates healthcare data from more than 600 U.S. hospital systems and 3,600 ambulatory systems in order to monitor and quickly identify emergent threats to community health. HMS’s novel weather-map-like design is the largest private repository of this data.

Both population health and public health play significant roles in upgrading healthcare systems by improving access, reducing costs, and enhancing outcomes. They are two powerful disciplines working to make meaningful changes to better meet the healthcare needs of individuals.