Virtual Reality Technology, AI, and Biosensing - Converging to Transform Mental Healthcare

hello I'm Stephen patteron uh executive director of Med VR a 501c3 nonprofit uh we have a global audience today including most of the EU countries Brazil Peru South America uh Malaysia Hong Kong and India so welcome uh to the medv VR talk series we host regular Talks by Medical XR experts thought leaders and and innovators that tell the story of the medical XR innovators Journey uh we have over 40 recording uh recorded talks on on our website as a community uh educate educational re research uh resource I'm sorry um in uh in partnership with some of Boston's um leading hospitals um uh we work to create the missing part of the medical XR R&D pipeline an in interdisciplinary network of clinical experts and immersive technology experts while we s simultaneously build the med VR uh uh uh accelerator uh before we get into today's talk I I'd like to uh talk talk just for a moment about our January 10th talk uh new VR diagnostic options in neuro Opthalmology uh brain disord presented by Matias Aber Berg um mdphd at the University of Zurich Hospital uh and founder director of machine M MMD this is um super interesting because it's using uh VR cameras and uh to uh actually measure visual responses um uh that a neuro opthalmologist would usually measure uh measure manually uh it'll be moderated by shauk uh Bashi uh MD uh he's a med VR advisor and Resident physician at USC Rosy ey Institute um let's get started um uh there's um just one housekeeping note if you look at the bottom of your screens there's uh two chats uh one is marked uh Q&A uh uh that's where you should put your questions uh the other chat is for the audience um so look for the um uh the the one marked QA when it comes to uh submitting questions let me introduce our moderator uh Margot Paul is a clinical assistant professor in the department of Psychiatry and Behavioral Science Stanford School of Medicine uh Dr Paul began her VR work in 2017 after joining doc Dr Kim Bullock's virtual reality immersive technology clinic and laboratory uh in the department of Psychiatry and behavior Sciences at at at Stanford Stanford School of Medicine Dr Paul won the Cheryl cooperman desertation uh of the Year award for for Designing and implementing a feasibility study and three arm pilot randomized control trial uh to examine the feasibility of using VR uh headsets as a way to administer behavioral activation therapy for for participants with a diagnosis of major depression dis disorder with that uh I'd like to turn things o over uh to Margot uh and I'm looking forward to this talk thank you so much Steve and thank you for having me I'm honored to be here and I'm honored to introduce our speaker today Dr Walter Greenleaf he's a neuroscientist and a medical technology developer at Stanford he worked for over three decades in the field of digital Health Systems with a focus on developing the use of VR technology for use and Healthcare he's an adviser to multiple Stanford programs he's also the founding Chief science officer for para Therapeutics a pioneering company in software as a medical device he's currently advising interaxon as Chief science officer in addition to his work at Stanford he's the business technology and Neuroscience adviser to several medical product companies investment groups and accelerator and incubator programs and today he's going to provide an overview of how VR and Ai and biosensing Technologies are converging and we elaborate on how this will impact Behavioral Medicine and mental health care so we're very excited to have him here today and to hear his talk well thank thank you uh Marco and Steve and I I am very excited to be here it's a very exciting time for our field and um it's I'll try and give a bit of a brief overview of what's going on and then also hopefully we may have some time left over for questions and and Margot in in particular I'm excited about uh your very relevant work um looking at behavioral activation and as a method to address uh a serious mental illness uh major depress disorder I I think it's a great example of how we can take this new technology and sometime soon I I'll probably stop I hope we all stop saying it's new technology and it's just part of how we do things but um currently VR techn ology is viewed as an emerging technology it's starting to move away from the academic research centers and the early adopting groups and is soon to be part of the standard of care and already is and I'll give some examples of that but um at this point uh it's uh still new and Margot I think uh you should be committed on your work there thank you so much yeah I agree I think for us and what we talk about at Stanford and the um VR Clinic we just talk about how important it is to get this research out there to get it disseminated so that clinicians feel comfortable to use it as a standard of care or at least an adjunct type of therapy and so that's what I definitely want to focus on coming up and coming you know into the future and we created a behavioral activation app and we're hoping to get it out there and disseminate that and um have that as an impetus and Catalyst for people to start to use VR in their standard of care and therapy yeah well let let me jump in I'll give a bit of an overview and then uh let's hopefully return to this part of the conversation um uh there are so many things emerging right now that are uh coming together in a very a supportive and confluent way um VR technology is emerging uh we no long longer just say VR um the terminology is still evolving we um I think most people now are saying immersive systems or extended reality because we no longer just have uh systems that uh block off the rest of the world we have systems that mix the real world with uh um the computer generated world or overlay it with video information and I think with the term spatial Computing mixed reality extended reality uh augmented reality we're we're still haven't yet come down to the final nomenclature but that's part of how it goes and the technology itself is starting to um pick up speed in terms of adoption and lower price points but what I'm particularly excited about is in our area of focus uh looking at um mental health Psychiatry and psychology and Behavioral Health in general um we now have some new tools by being able to Leverage the wearable sensor technology and machine learning AI technology to interpret the information generative AI to be able to rapidly develop new um environments to use to evoke a cognitive state or an emotional states and teach people skills to manage their emotional states it's it's just converging in a really amazing way so let me share my screen I'll start uh to give my overview and then um uh stop and then we can continue the dialogue okay is that coming through okay fantastic okay well um here's the overview well I'd like to start out by uh reminding everyone that we do need to pay attention that there's a looming Health Care crisis caused by an aging population um I became very conscious of this when I was working with Stanford center on longevity um just to talk about the us but this is really a worldwide problem um our population has doubled since the 1970s yet family sizes have gotten much smaller um this is creating a a large Demand on Healthcare and all we have to do is the math and we know that these demands will become even more impactful with an aging population with uh people living longer with neur uh neurogen disease and other problems uh uh it's going to become very expensive we need to get ahead of it and in particular we need to take a look at those issues that are becoming even more prevalent uh post pandemic and also just with the way our culture is evolving uh there's been a shift in demographics and lifestyle putting more and more pressure on our health care System to address issues in the field of mental health um we can't do anything to address this demographic shift um other than to leverage technology uh we we can't grow caregivers fast enough to make up for the difference and until we come up with u um better ways of preventing some of these mental health issues from occurring in general we need to come up with new ways of uh supporting and providing uh therapies that we know are effective um that's why I spend a lot of time working with some of the groups at Stanford that are involved in clinical uses of virtual reality technology both on a research uh level but also on an applied level but I also um because we need to translate the work that's done the academic arena out into the field I also work with a number of U Healthcare networks um pharmaceutical companies medical device companies helping them bring in um AR and VR technology to the Next Generation Healthcare um we're in the middle of a digital Health Revolution where the shift of where healthc care is provided has shifted to the clinic although we still use clinics but now the patient is the center of care and Care can be provided in many cases um in the field uh to wherever the patient is located and that's a good shift allows us to reach previously underserved populations we also now are seeing a move from the analog to digital what used to be um handwritten records uh now we have great ways of capturing information from almost every medical device that we use and we're entering the era of medical wearables where there's a large amount of information related to our physical status that we can collect by the technology that we wear or the technology that we use and we're also seeing change in our thinking about how digital technology can play a way role in healthcare uh we can now have U combination therapy where we might have an app that goes along with a prescription medicine or with a medical device too and this allows us to do some very powerful things uh we're also seeing that now that the world more than half the people have access to a digital Health uh system uh digital Health platforms is becoming part of our therapeutic process um this allows us to collect a large amount of data and with the evolution of some very powerful AI systems we're able to at a population level or a community level or for research sift through this data and come up with better understandings of both Trends uh and also what types of approaches um can make a big difference in terms of helping support our population and we can conduct research on this data and come up with better paradigms related to clinical care um and it's not just the physical aspects of our health that we're able to capture and put into this analytical system we also can capture things related to our brain health or to our um emotional State and not just as individuals but as families or as communities and groups we see the evolution of passive data collected for example from cell phones of U how fast someone is typing or what they're typing um if they opt in and allow access to that we can come up with a brain health biomarker we see voice analytics being used as a biomarker for anxiety and depression and pain facial expressions tell us a lot about emotional states and we're getting better at capturing that along with pupil dilation and an eyee gaze and then we can evoke a cogn state using technology like an AR tablet or a VR system to um come up with ways to challenge and measure the response of an individual so it's really exciting so some of the emerging and confluent technologies that we're seeing is well of course sensors are promulgating we're seeing them um being built into so many systems out there and we can passively collect data that relates to behavior um we're seeing new systems that can collect uh data that otherwise we might have to do a blood draw to get we collect from the surface of the skin and collect that information um again with the evolution of machine learning and Predictive Analytics generative AI we now have some new tools to evoke and measure um um and quantify and analyze the very rich data that we're able to get from U these systems we're also seeing a change in um how digital health is delivered and how it's perceived the tech Titans are moving into healthcare Apple and Google and Samsung and uh it's it's really going to be pretty profound to see it's shifting from just being healthc care networks um insurance carriers medical device uh pharmaceutical companies U government regulation agencies being the major players now seeing other groups come in and with the speed that um the technology companies move at developing and the emphasis on personalizing of the experience and making with good design um systems that are appealing to use I think we'll see um um changes in our health care System occur over the next five to 10 years that will be quite profound um our regulatory landscape is adapting and uh we're starting to be more comfortable with u leveraging tele medicine where appropriate and nicely enough um we are shifting our attitudes about Mental Health Care the stigma seems to be dissipating and we now have uh as I'll mention more tools to help provide U more impactful uh Health Care in the mental health Arena um one thing to keep in mind is the technology companies are now starting to focus on how to leverage technology to personalize the user experience experience instead of one size fits all interface we'll have Dynamic interfaces to um information that U uh is being used to um make our use of Technology uh more appropriate for our cognitive level uh if we are alert or if we're um um sleepy or perhaps not focused the technology can adapt to us and we're also looking at ways that we will um allow our technology to help us interact in a more um comfortable easy to ous manner with our buildings with our refrigerators with uh uh our transportation systems so this emphasis on collecting information about the user the tech companies are developing we can leverage and and are leveraging and applying it to Mental Health Care um again the emphasis on personalizing the user interface is something that we can use to to help uh improve our delivery mental health care and personalize that delivery of healthare uh the field of Effective computing has uh always focused on developing systems that interpret our emotional state and can adapt um accordingly this is something that um there's been a lot of deep research for decades in it's not an easy task taking the signals that we can collect and interpreting them correctly to understand someone's emotional state but we've had U DEC es of very um very talented researchers looking into this area and now finally we have more tools to help them do their work and leverage what they're doing I'm excited by the um the way we're seeing um biomarkers that are related to cognitive state or emotional state being moved out into the healthc care system one example is the company ellipses Health which has a voice based Vital sign for mental health anxiety and depression but there's other groups also Al working in this area and being U brought into the clinical ecosystem we're also seeing groups that are um leveraging facial expressions and other signals like such as EEG to provide these to go hand inand with our VR systems so that we can both um evoke a congress state by using a VR system and then measure the individual's response to that evocative system uh the other thing that's pretty cool is we're starting to see um the concept of the digital twin Paradigm that's been used previously by cities and by manufacturing uh U systems that are expensive to maintain and to predict when a problem might occur move over to our health care ecosystem so that we now can come up with a model of us and bring in our genetic information our metabolic information our medical history Medical Imaging and then do some predictive modeling to understand um what may impact us and help prevent that and then when we do have a clinical problem have a specific model about us where we can say well what if we tweak and change this parameter so again this change in concept will make a big difference and one thing that I think is important to keep in mind is that this digital twin Paradigm although it can be used to leverage biosensing and all the other data that can come in to come up with a model of someone's Health Care System we also can look at the impact of the community we can look at the family we can look at U the work environment and again we need to be careful about protecting this information but we can make sure that we build things that are not just uh based in isolation for the individual but how they function in the community and their support network uh this allows clinicians to come up with a very precise way of managing the patient and we're seeing starting to see this move forward in a robust way um one company that I'm excited about is octave biosystems they take a Precision patient management approach to Multiple Sclerosis and um I think as more and more U groups move forward with coming up with the tools to go beyond just the clinic but to look at the patient and look at all the factors impacting them keep the clinician alert as to that um we're going to see some very amazing changes and improved functions so you know it's important for us to keep in mind our FAL infrastructure is already very overburdened and um as we move to an informatics based profession we need to design these systems so they don't create additional time burdens um and um certainly reduce the amount of paper work we have to deal with but um well-designed tools will uh help us do that allow a clinician to manage their patients in a more robust manner without creating more of a burden so shifting ge now to see well what's going on in the uh immersive um field specific to um mental health we're seeing a lot of things move forward uh we've had more than three decades of opportunity to do the research and development with the cost of U VR and AR technology coming down we're seeing things move uh beyond the research Arena out into the clinical care Arena um we have systems that have been validated but with small numbers of um patients in the trial we need to go beyond that and extend that to more robust clinical validation but um we're seeing things move Beyond just the early adopters and and out into the field so really the full stack of Health Care is being impacted by this starting with training to improved assessments improved interventions new ways to um facilitate adherence uh ways to reach uh people in remote and underserved areas and new ways to facilitate uh uh prevention and uh facilitate wellness and of course uh new ways to facilitate um um research so that we can keep a cycle going of improving these systems so again with um technology starting with the head Amed display but moving into other ways of collecting information um we're seeing new players into the arena um coming from the tech sector and I think as is going to U um give us new tools for uh clinical care um I think it's important to mention though that although people tend to think of the icon of VR is the headset there is so much that goes beyond the headset that is part of the systems that are developed the creation of the user experience the analytics of that experience the dynamic change of that experience based on the user's response all that is um very powerful but we don't tend to see it we tend to focus on the headset and and that is what we think of when we think of VR for clinical care but so much going on behind the curtain um it's been exciting for me to see how the field has evolved I got involved back in the late 1980s When U systems were uncomfortable to wear and and expensive but we were able to do research and find out where the pathways were that were useful and where the blind alleys were and many amazing colleagues have spent their careers focusing on bringing us to this point and I mention this because many people think VR is such a new thing that we don't have a large amount of background literature but but we do there's been a lot published and it's worth going back and taking a look at it if you haven't had a chance and you're interested in the field uh it's worth um looking back because a lot of the problems that are we're currently addressing now as we move the technology out have already been addressed in uh some uh BAS basic studies again we need to do redo some of those studies with today's technology but we we've done a lot of work already laying the ground workor what's exciting is the technolog is evolving pretty fast too we're having new ways of bringing New Sensations into the VR experience with haptic feedback um we now have spatial or factory systems where we can bring the sensus smell into the VR system in a three-dimensional manner where we can hold something close to us and smell the pizza or the or turn around and walk across the virtual room and see um see where the U the garbage might be or the flowers might be it it's really quite amazing how this L adds another layer of of um stimulus that can evoke memories and uh change the tone of an experience we're also getting much better at our avatars they don't have to look like robots and they can capture our facial expressions our mannerisms um of course there's a whole level of concern about not having our avatars escape and be used uh for purposes we wouldn't want them to be but uh the fact is now VR doesn't have to be a lonely experience where you are interacting with a virtual uh environment on your own or if other people are there they look like robots now we can start having more robust experiences with um avatars that look and sound much more realistic should we choose to of course we could look like a lobster if we choose to also we're we're also seeing the evolution of with cloud-based rendering and gener AI very robust virtual world technology where we can meet other people and have experiences um um that are um very believable and that's I think giving us new tools to help address clinical problems uh last time I had a chance to do a bit of a survey there were more than 427 emerging medical VR companies uh addressing almost all sectors of Health Care so the momentum is growing um and we're also seeing uh in the US U new ways to finance the use of this technology through better uh coding and ways for reimbursement I'm excited by what um our friends at the VR Healthcare Network are doing the tremendous momentum there um these numbers are already old but when I last had a chance to talk with the group of the immersive systems at the VA they were rolling out VR at more than 160 clinical sites they trained thousands of staff and members to use it for more than 30 different clinical indications so it's moving fast so why is this um well clinical VR systems have more adherence and more engagement we're able to uh facilitate better learning and memory um by creating a better sense of presence and context for the user by making our systems engaging and novel and uh fun we can create U more of an experience as opposed to what you might see by reading something or um looking at something on a flat screen this cognitive engagement is so important especially in the field of mental health and by having someone actively involved we facilitate retention and memory so there's a whole Neuroscience of how VR and systems have impact and support clinical care um it it's um very nuanced but the top level message is that because we can activate um experiences that have um um all our senses involved and create a reward feedback loop we can show people progress in their therapies have them focused on what needs to be focused on provide insights and perspective and create experiences that have emotional impact and gives this gives a clinician new tools to um help the patient with their healthc care journey and um we're able to Leverage The Power of Storytelling um usually in a clinical experience it's very hard to have the time to bring forward a narrative but we can help people by leveraging technology and providing system that people can use at home and not necessarily in the clinic we can create an overarching context and and make the um healthc care experience more of a health care journey and um it's really amazing how we can leverage some of the tools and techniques that our our colleagues in the gaming industry or the gambling industry have used to promote adherance and help people come back for be part of their therapeutic process so and this is so important because with mobile Health we've seen a lot of Dropout rates there's been some wonderful systems developed leveraging mobile Health technology but the adherence rates are unfortunately low we haven't seen that with VR and AR systems the uh much better adherence uh rates to this technology and I believe it's because of what I mentioned before that we're able to create more of a cognitive engagement and show people progress and give them the feedback they need to keep coming back to use the system we can leverage our U mirror neuron systems in the brain um for example one of the projects at s for virtual human interaction lab was to age progress an avatar of an individual facilitate a dialogue with your future self so that you can see in real time how your choices you make about use of alcohol or nicotine or exercise or nutrition can impact you a powerful way to help motivate people so to um to give a more of an overview of the impact in mental health healthare we see starting at the training area um ways to come up with simulations of the patient experience to have standardized patient simulation um to teach people how to handle um a difficult situation to have a critical conversation to deliver bad news in an empathetic way and to also learn how to um learn from our patients what we need to learn to help them with their Healthcare Journey um we can teach skills using uh VR of course these can be surgical skills but it can also be um skills that a mental health professional needs to have to to work with a patient we're coming up with a tremendous new amount of objective assessments relevant to Mental Health Care um we can of course collect physical movement for um Physical Therapy occupational therapy but we can do neuropsychological assessments and new ways of applying the technology to uh Behavioral Medicine um and we don't always have to you wearing a headmount display we can you create an interactive experience to do a cognitive assessment using a room environment for example um I'm excited by some of the things are going on in terms of uh assessments of cognitive function executive function one company um I recently had a chance to take a look at their work is view mind they do a complete um assessment of all the executive functions using a VR headset focusing on looking at pupil dilation and eye gaze and challenging people's cognitive system using that as a platform where they can standardize the amount of light that's going into the eye and come up with some very robust measurements that uh that are rapid there's no learning effect and they come up with a detailed assessment U very precisely for all the executive functions our brain I'm also impressed by groups like NE ARA that are challenging our social emotional systems using VR and doing a very robust assessment of of our responses um so what we do need to know is to come up with new standardized environments um we now have some tools to evoke and measure a person's response to a VR experience as we want to promate clinical care and research we need to come up with a better library of culturally appropriate age appropriate diverse environments that we can use as a foundation for research and clinical care um I'm impressed by what our colleague Lee Williams is doing at the Stanford center for precision mental health and wellness by combining information captured from wearable sensors from um Imaging from metabolic and genetic data and using VR as an evocative environment to help come up with the different biotyping uh for looking at anxiety and depression and other mental health issues I think this is going to be really important we need to not treat um everyone with particular diagnosis with the same clinical pathway but be able to identify the different subtypes and send people down the right clinical pathway and VR and AR technology will be an important part of this um I'm excited by what we're seeing with groups like altoida using a tablet to do evoke um a memory or cognitive process and do a cych motor index that correlates very strongly helps identify patients that are converting from mild C pyramid over to neren disease um so I've been talking mostly about the assessments but now moving into some of the interventions um we see um great work being used for pre Optive planning and image guided surgery in that field but if we move into uh physical therapy and into mental health care we're also seeing some really amazing things um I was impressed by the work of Adam gaz's group uh at the neuroscape um lab up in UCSF where they've used um video game paradigms to challenge the cognitive processes and evoke a response um related to age related uh conf Decline and being able to reverse uh for people in their 60s with who've had the standard decline in some aspects of Inu of function but by using the engag M of a dynamic VR system reverse that score and when they look back years later to see if the changes in that aspect of executive function had persisted after the VR Eng gendered experience um even six years later they see that some of the the reversal of the decline had persisted uh that's really exciting uh there's group starting like virtually focusing on neurocognitive evaluations and uh Therapies and as we move into mental health care we know how acute the need is we've had a backlog that we've been trying to reach to for years people make that difficult phone call saying they need help with an addiction or with an anxiety disorder and they're often told well your appointment will be months from them we can do better and technology is allowing us Pathways to do better um and nicely enough it's the full stack of um um issues of mental health care where we've seen VR and AR technology applied ranging from anxiety disorders addictions depression we've already talked about chronic pain autism attention deficit disorder uh psychosis um anger management issues um it's a it's really been remarkable to see so many aspects of mental health care where new therapeutic interventions are being developed that Leverage The improved cognitive assessments but also um leverage ways of reaching the patient and helping the patient through exposure therapy for example um a lot of work using VR as a way to mitigate um both acute and chronic pain a lot of work looking going back decades looking at post-traumatic stress disorder and phobias and other anxiety disorders using exposure therapy and then um evoking using VR as a way to help evoke a craving in an individual and teaching them the situational confidence or the refusal skills uh to help manage their their Cravings um it's it's wonderful now that with the use of generative AI we can come up with um um evocative environments specific to the users's experience so that we can help them manage peer pressure Etc um and learn to manage their cravings and understand their own processes behind uh the the problems that they're trying to address and um course um we can also help with um providing new systems to support preventive medicine and health and wellness some great systems are out there that support reducing um stress and reducing anxiety on a non-clinical level um with individuals can download and use on their own um issues teaching people um better skills for weight management for example um so what are the constraints what are the gating steps to adoption um well I think it's really important that we appreciate that with these profound new ways of measuring emotional uh States and reactivity and evaluating our cognitive State we also have some risks um I've I'm very impressed by the work of Nita fani who has published the book The Battle for your brain and and talking about not only the power of these new technologies but also the concerns that uh um in her book she details uh uh issues like um the need for privacy protections because if we're getting better at evaluating someone's response to a stimulus or their current emotional state especially if we can do that with Technologies such as webcams or voice analytics although these are powerful tools in the mental health field these can also be used for um companies to try and understand what to sell to us or uh worst case scenario in um um environment where u a dissonant might need to be identified and uh punished for their thoughts um or um another example might be uh evaluating someone based on their online gaming Behavior and the voice tones and and reactivity and situational confidence and planning and using that to make um decisions about their career opportunities uh on the employment level without their consent or understanding that this information that they're putting out there just because of their online Behavior can be used to um discriminate about their employment Pathways so we need to get ahead of this and pay attention to the um not just the power of this technology to help us do better health care but also the concerns and how to protect the data that we're collecting there's a lot of research gaps that we need to address um you know we we have a lot of underlying research but it's been with small sample sizes and with technology that because it evolved so rapidly that needs to be redone with today's technology and we're also dealing with percep VR is some sort of science fictiony gaming um experience and not appropriate for clinical care far from it uh it's a powerful tool for clinical care but because of its Evolution it's viewed as something that's not quite a serious technology by many we also have an interoperability issue there's many powerful systems that run on VR platforms now but um they don't necessarily use the same data system back in the same user interface at the front end and they're not necessarily um positioned to work on if you have a comorbid condition you're trying to address depression and chronic pain and maybe a Mobility disorder um you might not be able to put them on the same headset and uh again the data doesn't um easily support um um comparisons across groups so that's something that uh we're grappling with and um there's Solutions on the horizon but there's a lot more work to be done to get there and then I think one of the biggest challenges we have right now is that U despite the good design skills that many of the groups are developing this next generation of Technology have they're often f focused on the technology the measurements uh the reporting but they're not um looking uh as deep as they should at the constraints of our Healthcare ecosystem it's one thing to come up with a profound technology that can help our patients um but if we don't understand its impact on the current ecology the healthcare e system if um if the technology requires another person to be hired just to manage the the batteries for charging for example or if uh creates an extra time or paperwork burden on the clinician uh no matter how profound it is in terms of helping patients it's going to be unacceptable to move into Healthcare ecosystem so we need to do a better job of understanding uh how to best move new technologies into the Health Care system while reducing the burden on the Health Care System instead of increasing it um nicely enough I mentioned at the beginning of talk how I'm very concerned about the looming problem of U um an aging population and the impact on cognitive aging on our seniors um many of the things that are being developed will address this U this issue um and that's wonderful but I'm also very concerned what we don't want to do is job of design that we overburden ourselves with too many sensors we need to use too many gadgets that we need to wear or or um sign into we don't want to have a future where we're over measured in a burdensome way that isn't U useful and as I mentioned earlier might be problematic in terms of protecting the data so we have to do a good job of design there so in summary um things are amazing the technology has been evolving for more than three decades and it's finally at a point where it's crossing over into clinical care in a robust way um there's the full spectrum of Health care is being impacted and in particular with new tools uh for measurement and therapies and mental health care we finally are able to move forward in a in a way that scales more easily and is more precise for the individual um and the momentum is growing and we have some challenges but it's exciting and I think we'll see things move forward in a pretty Rapid Way um there's um for those of you who um are interested in learning more U there are two conferences specific well there's more but there's two major conferences specific to VR and Healthcare one is organized by IA the international virtual reality Health Association their next meeting is uh late February early March in Florida um and then the virtual medicine conference is in late March in Los Angeles um both are amazing groups if you are interested in learning more and thank you and uh Margo I hope we have a chance to continue our dialogue and maybe take a few questions from the audience yes thank you so much Walter what a amazing and comprehensive talk explaining how technology is constantly evolving and is used to treat many different mental health and healthare um problems and I know a few questions came up for me and so I would like to take the time to ask you and pick your brain given that you are an expert in this field and I also see that some people have other um questions coming into the Q&A so um rather than raise your hand please um write any questions in the Q OFA and hopefully we'll we'll get to that um so for me the main thing that came up is just in seeing your presentation you've shared the many ways Technologies evolving to help improve lives and augment Medical Care and something that I frequently get is a clinician who uses VR um is from people that have been influenced by apocalyptic movies and movies where Ai and technology is taking over the world um and I know you briefly addressed this in terms of um talking about um safety and privacy and security and I know hipa compliance is definitely something that I consider as a clinician um but I'm wondering what you would say to those people who inquire about the potential downsides of just technology being so ubiquitous and thinking of those movies and those warnings that techn ol is taking over the world and people aren't going to be interacting with each other as much um what would you say to those people and what do you suggest to help mitigate that risk that's such an important question and again I I I guess I should apologize for needing to be so superficial um about the whole topic but hopefully I I give a bit of a broader Rush stroke and we can go into details a little bit more now um well you know we are asked about the singularity we're asked about uh what will happen as as AI moves out will jobs be uh eliminated um will and will our privacy be compromised will our future be attenuated by U the downside of these Technologies and I think this is our our time to address this issue we must get ahead of it um the and there are a lot of groups working on this um the XR safety and for example in other groups um I do um I do think there's can be tradeoffs that when we look at a health care issue um and put it to a patient that um we need to collect some information from you we will um keep it confidential but there's always a risk that somewhere along the line the information could Escape um but do you are you still interested in opting in to let us collect this information here is the benefit for you so I think we need to do a better job of identifying the tradeoffs identifying the risks and making sure that patients are comfortable with the the tradeoff the benefit versus the risk I I think we can do a better job of that I think with um with blockchain and other ways of securing data I think there's ways that we can both give patients agency over their data maybe give them a click charge of some Financial turn when their data is aggregated and used as part of a Federated Learning System for example they should get some upside from that um I think the tools are there the policies need to be put into place um I think it should be possible to provide um very profound security for these these issues but we need to put in the the the rules for doing that U and we've seen in Germany for example with gdpr and some of their restrictions it can slow down sometimes the advancements of the technology but that's inappropriate if it gives us a better future and better comfort for our patients it's it's on us to make sure we as we evolve this technology we do it in a in a way that respects confidentiality and privacies and gives patients agency of over you know the use of their data yeah I totally agree and I was as you were speaking I was just thinking of the translation from actually having a chart to then EMR and very similar concerns that people had of like oh I don't want my data online and just available for people to look at it and view it and um all the policies that have come into place around EMR and giving patients more autonomy and the ability to actually view their records and I think that that could be important when translating this into um XR Technologies as well thinking about those same considerations you know in a related vein we need to be careful that as we collect data for the powerful things we can do in health care that we just don't do it from the people who are going to major medical centers we need to make and we are striving to make a conscious effort to reach underserved populations is the term but people who don't go to major medical centers we need to both reach them but also make sure the data we collect is we build systems that are doing better Diagnostics and better Therapeutics that it's comprehensive in terms of cultural diversity age diversity and you know personal choice diversity um that that's also important it's not just protecting the data but also as we collect the data make sure that it's um as it feeds into our systems for decisionmaking that it is appropriately diverse yeah and that dubv Tails into a question that I had and I see that someone else um has a very similar question as well so in order to um avoid just collecting the data from these Maj U major medical centers thinking about something I've encountered and I see this person um I'm sorry I can't pronounce your name uh Grizz aor wi wictor um also said is being in the clinical field and a clinical psychologist I've encountered clinician hesitation to use these emerging Technologies um outside of these larger medical centers people are private practice clinicians and maybe do work in more rural areas um there's a huge preference for just what would be considered the traditional face-to-face therapy and I know that you had shared that there's a plethora of background literature showing that these they are evidence-based treatments um but what would you say could be the best way to help translate this research and what's going on and the research that I'm doing um to these more rural clinicians um and clinicians that work in areas that are seeing underserved populations and aren't in these larger medical centers well I I think there's two ways um that we can do that one is um again I'm very impressed what the US veterans Health Administration is doing in terms of moving technology out and not viewing presenting it as this exotic new technology but just how they can address the major problems and bringing it out to um you know to people who otherwise uh the VA Health Care System often functions as as a safety net Health Care System it does go into remote and rural areas it's not constrained by the coding requirements that other Healthcare networks are often constrained by in terms of reimbursement Pathways so I think I think the the answer Margo is we need to show the data I think we if we talk about the power of these Technologies but we don't show the data we're just expressing an opinion so we need to have facts that show here's the value of the technology here's the facts behind its impact and just really show uh everyone um its value and then give examples of Where It's Made A Difference um and the examples are there so we just need them to bring it to the attention of these clinicians who are still learning about the power and provide it to them in a way that it's not a barrier for them to adopt it again we have an overburden health system so if learning to use this new technology is burdensome so we it's really a matter of putting good design in place I think and U um good design for the patients use but also good design for the clinicians use yeah absolutely and I think that that's happening with these emerging Technologies and also with talks such as this and as you said in IA and um the vmed talks just to disseminate the data and to let people know that there's actually data behind uh what we're saying and then we're not just expressing these opinions um okay so I do have because we only have about seven minutes um I do want to get to some questions here uh Dany said in terms of length of time is there any data that suggests a minimum Optimum or maximum length of time for a VR experience another another question that is very important but also hard to answer in a few minutes but you know there is an issue there's a couple issues one is uh there's a vestibular ocular disconnect when we use the VR systems we basically fool our brain and our visual system by placing um screens close to the eye about distance and there're may be a concern for um younger uh users um that if they spend too much time and they have a developing visual system that there could be some Downstream effects um I think that by limiting the amount of time time that we have people spend in our systems and we can do a lot in just 20 minutes um so I think there that is one concern is to um understand and do some research on uh what is the safe amount of time but I think also as we have more augmented reality systems where you're not fully blocking out the built environment you're interacting with it and using it I I think we'll start seeing um systems that don't have quite that concern um but by and large most of the VR clinical systems don't have the patient in the systems for very long um we should also acknowledge that the systems aren't designed to fit the smaller face of our youngsters um as well as maybe um not you know we need we need to understand the impact of the use of and in terms of the technology as an impact on our culture I think we're VR technology is reversing a downward spiral in terms of U the application technology ology I think when we started texting and typing and focusing on cartisian coordinates and flat screens we narrowed the view of our world and we stripped away the robust communication we have with facial expressions and gestures and by Zoom where you know we have the always looking at someone's head instead of looking around the room so I think technology this techn level of Technology will reverse some of the adverse effects of an over technologized world and I think it may hope just F in the background we're back to 3D yeah yeah and um I I I think I think that it's really important um to yeah to also just address too the idea that um people are people I know that some people ask me is you know with these kids and these youngsters um how is this any different than just gaming and becoming addicted to to like Gaming Technologies and is a clinician I get that too from patients that I say like okay like let's use this for depression to um incorporate Pleasant activities people say well how is this any different than like watching Netflix or watching TV and with youngsters something to consider too is just I know when these Gaming Technologies first came out the addiction concerned to gaming and the fact that their brains are still developing and focusing on a screen and not interacting with other people and I think that person personally that's why AR can be so helpful as you said um but I would also love to know your thoughts on that as well and to for those people that are concerned um in using these Technologies for these these youngsters and how is it very different than you know gaming and just using video games for example well it's um it it's different than gaming and that it's designed to have a purpose and we designed some of the guard rails that are necessary to make sure it's curated and safe um we also can make sure that if we do a good job of design that the the impact is um the cost tradeoff of leveraging technology to provide benefit is there and it's can open up the world for people often people who are socially isolated we can help them Reach Out to other people learn this if they're they have trouble with social skills we can exaggerate facial expressions and body language and reinforce uh understanding the emotional state of others using that to help with uh feeling comfortable do role playing in a safe way people often will say things to um avatars that they may not say to someone in real life so it's a powerful tool we have to design how best to use it but I think we can mitigate some of the uh issues of the layers of Technology have created by um opening up the pathways and then teaching people how to identify where problems are are and how best to to identify it's such a complex issue I wish I had more time to I know I know I know um and I want to be cognizant of time and the hard stop at 10 um so I would like to invite Steve back but thank you so much Walter this was really enlightening and um I really enjoyed picking your brain on your expertise and vast knowledge and I know I personally feel like I could just continue this conversation for several more hours um but unfortunately don't have the time but thank you so much well let's let's follow up and keep our dialogue going Marco and see AB for in bringing me giving me the opportunity to talk to this group yeah it's a it's a pleasure to have have you back Walter uh thank you so much it's um uh it's it's it's nice to have um a a projection a road map of where we're going uh with these these Technologies that's concise and uh and and um and and well considered um uh the um and and I I think this will be be some good curriculum on our on our website uh when it's up up and uh and available uh it it should be available in a couple of days so um if you want to go back and and listen to uh What uh what's been discussed uh please go ahead um uh Margo uh thank you again for joining us uh and and moderating it I can't tell you how how much better the talks are that when we have moderators that are our domain experts like yourself uh so so thank you uh I know you've got a a patient right now so I'm going to thank you I'm going to thank uh our audience for coming uh and please go to our website uh register uh and uh take a look at the U the coming up on on January 10th I think it's it's going to be really really unique and and the the ability to measure um uh to really diagnose people's conditions with VR is is is a new capability uh so thank you and we'll see you next time take care thank you so much bye-bye

2023-12-21 08:45

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