Healthcare Innovation Isn’t Free

By Dov Z. Hirsch, general manager of The Immersive Health Group, a subsidiary of The Glimpse Group and founder of ContinuumXR and Martie Moore, MAOM, RN, CPHQ, clinical advisory board chair, ContinuumXR.

It’s no secret that healthcare is undergoing a transformation. One doesn’t need to be an industry insider to recognize it. A mere press release issued by Amazon can move markets like never before. Last September, Apple equipped Apple Watch 4 customers with the ability to take an ECG, a feature that AliveCor released two-years earlier through rigorous R&D with the FDA clearance of the Kardiaband. AliveCor recently pulled Kardiaband from the market. And earlier this week reports of tumult within Apple’s health team leaked to the press, citing tensions rising over differing visions for the future.

The current pace of change in healthcare has brought volatility with it. And while healthcare and volatility don’t typically mix well, the fundamentals of the market are supporting much greater tolerance for it, perhaps greater than any other time in modern history, and for good reason. Population demographics are shifting dramatically. According to Jonathan Vespa, a demographer with the U.S. Census Bureau, “within just a couple decades, older people are projected to outnumber children for the first time in U.S. history. It will be a very long time before this trend shifts direction, if ever. As featured in a recent Washington Post article, the combined growth of the retirement population and decline in young workers is playing a central role in labor shortages seen around the country.

To understand this challenge within the context of healthcare, technology and innovation, one only need to look within the walls of any major hospital system. An aging population requires complex medical care. Complex medical care is not only expensive (especially in the U.S.) but requires providers to act and think in a multi-focal manner. After all, care is delivered by doctors, nurses, therapists, social workers, family members, and countless other clinicians and caregivers. The system requires a balance of supply and demand between patients and caregivers. This need can only be met with a healthy pipeline of highly skilled, and experienced clinicians within the system (until the robots takeover that is). Yet according to the Bureau of Labor Statistics’ Employment Projections (2016-2026), healthcare workforce demand will outpace supply by 2025.

Above and beyond the issues of quantity, the clinical workforce shortage is greatest among the highly skilled — a challenge that is less discussed but well understood by those who work within the system. As America is aging so are the providers of care who are now looking at their own retirement plans. While exciting for them, it is terrifying for the rest of the population. Think of a water leak that begins as a slow drip and turns into a steady stream of water. In short, knowledge, experience and intuitive practice is leaving our healthcare system.

Exponential Challenges, meet Exponential Solutions

The traditional methods that healthcare uses in its approach to training and education are inadequate. It is no longer acceptable for evidence-based practice to migrate into clinical practice over a span of 10 to 15 years. New providers must develop core competencies and resilience much quicker, and existing practitioners need effective ongoing professional development solutions to meet higher quality standards. Addressing this challenge isn’t easy.

Healthcare leaders are exploring innovative methods of learning, such as virtual reality (VR), that support faster adaptation of knowledge and skills into the clinical practice, standardization to reduce variation in quality, and development of muscle memory to decrease burnout and nurture resilience.

According to the World Economic Forum’s 2018 Future of Jobs Report, 67% of healthcare organizations will adopt VR in some capacity over the next several years. Virtual and augmented reality will transform the way in which clinicians and caregivers gain knowledge, acquire skills and practice care delivery throughout their career.

In an op-ed published last year, former Senate Majority Leader, physician and entrepreneur, Bill Frist, MD, recalls his experience as a medical student.

“See one, do one, teach one. It was the best we had at the time. But is that really the best, or safest, way to learn? Or do patients deserve more? Experience matters. Things we actually experience stay with us in a way that things we are simply told, taught, or observe do not … VR is no longer just a source of gaming entertainment. Over the past 12 months, astounding technological advances coupled with seismic shifts in our healthcare sector toward value-based care are opening the door to its effective clinical use … It holds particular promise for accelerating medical education.

VR technology is a force multiplier in transferring knowledge to practice. While traditional educational and training resources sacrifice efficacy for scalability, VR offers an affordable digital alternative that is both scalable and efficacious. And a growing body of research shows that procedural, anatomical and medical knowledge acquired during VR simulation is on par with traditional teaching and simulation lab environments. A University of Maryland study found that individuals had an 8.8% improvement overall in recall accuracy using a VR headset compared to two-dimensional platforms.

VR technology may offer the single most impactful innovation available today to address the complex challenges within the healthcare environment. Yet, innovation isn’t free. Healthcare leaders cannot sit back and wait for innovation to come knocking on their door. The need for rapid change requires them to approach partnerships in a new way, adjusting not only their expectations, but the definition of what it means to partner.

Craig Lipset, former head of clinical innovation at Pfizer, offers a particularly simple, yet nuanced definition of innovation that applies here: “an idea from which you derive value.” Capturing the value of VR to address the supply and demand gap will come at the expense of digital transformation — a difficult, yet necessary path for most health systems.

Forward thinking industry incumbents in healthcare understand that deriving value from VR will require that they do the work of transformation, offering the best chance of thriving, or surviving for that matter, in an environment of disruption.

Healthcare incumbents can not only compete in this environment, they can lead radical change if they choose. Further, VR software and hardware companies need to rethink how they engage with the healthcare market and deliver the necessary services to support the industry. Because we are all consumers of healthcare, there is a bias of familial knowledge that is utilized by vendors in design and application of technology.

Unfortunately, because of this bias, many vendors attempt to circumvent necessary questions and utilization of human centered design principles to execute a small proof of concept/pilot project. However, assuming the goal is to go beyond a pilot project and deliver impact at scale, vendors will need to answer user acceptability, accreditation, legal and technology standards sooner or later.

According to Lipset, vendors “can’t put their head in the sand and pretend like it’s not going to come up sooner or later.” Simultaneously, health system incumbents rarely assess innovative solutions for scalability and longevity. “I think about pilots the way I think about the birth of my kids. And how you had nine months of really hard work, and after all that you reach a milestone. The difference is, when your preparing to have a child, you’re planning for the next 18 years. Teams running pilots are not really thinking about bringing the baby home. They’re not really thinking about the really hard work. It’s not sexy. Its grunt work. But without it, it’s all for not,” says Lipset.

Though imperfect, legal, compliance, institutional policies, hierarchical, information-technology and administrator-driven systems in healthcare need to be treated as an invitation to stress test the technology and vendor’s ability to deliver at scale.

VR as an emerging technology, brings its own challenges along with vast opportunity. How will health systems and academic centers incorporate VR into their daily standard of business? How will IT handle hardware management and how will the infection preventionist look at storage and cleaning to assure infection control? How do VR headsets connect to a health system network, or integrate with existing mobile device management? Does the organization have competency/performance standards today, and if not, how do they assess a training solution like VR in terms of scalability?

Will regulatory bodies accept VR as a legitimate source for staff development and an acceptable tool for course corrections when a deficiency is cited? There are many important considerations that health systems and VR vendors need to work through. Some might ask if the investment is worth the effort, but can safe, accessible, quality healthcare be sustained using current training and education methodologies?

Stakeholders and incumbents in the health system need answers to these questions; on their own terms, and at their own pace. Ultimately, everybody pays a price for innovation, but not everyone treats it as an investment and is able to derive value.

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