Using Second Life to enhance doctor-patient relationship

Second Life and similar 3D virtual environment will improve healthcare access for a number of specialty patients and improve the care experience for rest of us in certain situations. I found one interesting eye opening video on YouTube on use of second life (http://www.youtube.com/watch?v=UV52WRXm1Cg&feature=player_embedded). Alex Krueger, who has multiple sclerosis, is unable to walk without the crutches. In virtual world she leads an extraordinary existence. She is the avatar “Gentle Heron”, is co-founder of Heron sanctuary, a support community for others facing similar diseases.

Alex is just one example of an increasing number of sick, disabled and troubled people who say virtual worlds are helping them fight their diseases, live with their disabilities and sometimes even begin to recover. Researchers say they are only starting to appreciate the impact of this phenomenon. The virtual environment has several possibilities in improving care experience by creating a delightful patient experience.


Creating virtual social connections: In my mind this may become very impactful especially for patient like Alex. Second Life will soon be able to help people visualize their dreams, leave their dysfunctional bodies behind. Keeping people connected is the key to the human experience and Second Life and others like are creating a place where handicap is forgotten and true interaction can take place. Loneliness could be removed by engaging in meaningful online games, events that would energize patients.

Online Consultation: Second Life could be used as Telemedicine Platform. Dr. Peter Yellowlees, a psychiatrist at UC Davis Medical Center in Sacramento and my Health Informatics professor, set up a "virtual psychosis" environment through Second Life to help people understand the kinds of hallucinations that those with schizophrenia and other mental disorders have.

A relevant New Yorker article describes how virtual environment could be utilized for early treatment of Post Traumatic Stress Disorder (PTSD). http://www.newyorker.com/reporting/2008/05/19/080519fa_fact_halpern

Many US soldiers returning from Iraq and Afghanistan are being treated using virtual experiences. The soldiers are generally embarrassed to discuss mental health issues while they are still in battlefield. Second Life could provide a safe environment for them to discuss the challenges from the remote battle location. We do not need to fly expensive and scarce resources to battlefield for treatments.

Along the same line, second life is a great open consultation platform for persons with socially embarrassing diseases: premature ejaculation, and HIV/AIDS.


Helping patients to become “Compliant”: Several doctors including my professor, Dr. Yellowlees, complained that patients do not follow their advice, especially patients with chronic diseases such as diabetes. One of the possible mitigation could be second life. If patient could experience the Yoga, Meditation, Running etc. in second life with their socially connected avatars, possibly they would be delighted and motivated to perform the same in real life. I think we have to move away from “compliance” to “compassion” – delight the patients with meaningful interactive experience. Of course, a lot of thought needs to be given on how to design such a platform to create a memorable experience.

Furthermore, second life could be used as a platform to demonstrate usage of certain devices or therapy options. Visualization is a powerful memorization tool.

Now, let’s investigate what system elements are required to make virtual reality a platform for telemedicine:
Establish Trusted Relationships: The second life must be linked to real life. The doctors have to display their credentials, provide a e-mail or phone numbers. And short bios.

Strengthen System Security: Second Life has improved security and privacy in recent years. A better system for sign-up and authentication is required.

Use real patient data: A check to make sure the person used real names, gender etc.

Create a payment model: The insurance industry needs to create a reimbursement model for this type of consultation.

Integrate with onsite model: Integrated with other care settings. For example- accessibility of medical record while treating patients in second life.

Comparative Effectiveness: An approach to cost control and quality improvement

Comparative Effectiveness (CE) is “a rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients”. “Such a study may compare similar treatments, such as competing drugs, or it may analyze very different approaches, such as surgery and drug therapy. The analysis may focus only on the relative medical benefits and risks of each option, or it may also weigh both the costs and the benefits of those options.” (Source: CBO report)

Why comparative effectiveness research is receiving so much attention:
It is one of the disruptive components of health reform. Recent research by Institute of Medicines and articles published by Atul Gwande and others show that heath care cost and quality varies greatly among regions. High cost does not necessarily correlate with high quality of care; more care doesn’t mean better care. Comparative Effectiveness is a hot topic because it offers the prospect of cutting costs while improving health care quality.

CE research data and knowledge dissemination challenges:
In my mind, performing these types of research and disseminating and translating the knowledge is a challenging endeavor at this moment.

Current data sources are fragmented and limited in terms of clinical robustness and longitudinal data capture. We need patient registries, claims, pharmacy, and laboratory data, which may not be available for most part of the population. First, we need EHR in hospitals and clinics and then link those systems using NHIN. Then, data would be available to be used by researchers in a standardized format for apples to apples comparison. Meantime, the hope is VA, DoD, and IHS, who use some version of Vista and have considerable patient data (at least better than other private systems) that could be utilized as a starting point. However, the data will not cover all demographics, which is an important factor in CE research.


Second point is dissemination and usage of knowledge gathered by CE researchers. • Tools and mechanisms to support clinicians and patients in incorporating available CE information are lacking. This information needs to be delivered to the front line of care where health decisions are made and results measured. So, comprehensive approach is required to define how knowledge can become practice. We may need a separate body like FDA to coordinate the knowledgebase. The countries such as UK, Canada, Australia, and Germany have government bodies to handle similar knowledge dissemination.

Questions and Fears:
It is unclear at this time whether cost effectiveness will be part of CE. Also, people are concerned about how government will set priorities for research, what research methods would be used, and when will a new intervention be subject to CE. Additionally, it is not clear in what extent cost effectiveness will become part of the research I think these are natural anxieties for such a big change in medical practice.

Business Model Disruption and Innovation:
Some doctors mentioned that CE will create cook-book medicine and stifle innovation. As an engineer I do not agree with this thinking process. In Computer Science or in most branches of engineering, we have codified practices that most of us follow. That does not mean innovation has stopped. I think innovation will move to a different level and may be disruptive for some providers/payers/drug companies/medical device companies. In my next post I will describe some of the new business models that may emerge when CE could be used effectively in America.


Some initial thoughts on impact to various stakeholders:
Patients: Could make more informed decisions.

Providers/Hospitals: May reduce avoidable errors. Hospitals may be penalized for variations in outcome.

Payers: They may encourage the adoption of most valuable treatment options.

Drug Companies: Use of generics may become widespread if patented version is not more effective. The hurdle for new product adoption may increase as bar for new innovation would be higher.