Augmented Reality in Healthcare
Augmented reality (AR) is at the forefront of the ever-evolving healthcare industry. It gives us hope for tools that help navigate common practice challenges in ways we have not been able to imagine. At MedCognition, we are excited about how this blossoming technology will benefit the human experience in the world of healthcare and beyond.
In this article, Dr. Hector Caraballo will take a look at how augmented reality is impacting healthcare.
What is Augmented Reality?
According to a 2018 article from Live Science, “augmented reality is the result of using technology to superimpose information — sounds, images, and text — on the environment around you.” In simple terms, AR uses computers to generate virtual objects and integrate them into the real environment. Another name that is virtually interchangeable with AR is mixed reality.
Today, AR is changing the face of healthcare by creating low-risk training environments and enhancing the safety of medical procedures. It offers millions of healthcare professionals and their patients an incredible tool to improve their quality of life, both at home and at work.
Technological advancements, like AR, when married with artificial intelligence (AI), have the potential to revolutionize medical education, reduce patient harm and create new ways to deliver healthcare.
Five Ways AR is Transforming Our Healthcare
Augmented reality is leading to innovations that are reinventing the way we approach problems in healthcare. What was once a dream in the medical industry is now taking shape into reality.
While AR is impacting healthcare in many ways, in this article, we focus on five ways augmented reality is helping healthcare professionals and patients:
Needles and Things: How AR is being used to deliver faster, better, more cost effective IV placement
Doctor + Patient + Screen Time = Ugh! Use of AR in shifting the focus back to the human experience
Augmented Daily Living (ADL): How AR is aiding those with disabilities navigate the challenges of daily life just a bit better
X-ray Vision? Augmented surgery
Augmented POCUS: Looking at what happens when AR and point-of-care ultrasound meet
Needles and Things
The difficult intravenous (IV) stick is a typical scenario. The reasons for difficult IV access are numerous, ranging from chronic IV drug use, obesity, dehydration, advanced aging, and more. Anyone working at the patient’s bedside knows the pain, anxiety, and frustration, as well as delays in care experienced by all involved in these encounters.
By the way, even in patients without difficult vein access this common bedside procedure has a first-attempt failure rate of more than 40%.
Fortunately, a U.S. based company leveraged the use of AR to tackle the challenges of IV access. AccuVein uses a laser-based scanner paired with projection-based AR in a hand-held device to map veins. The vein mapping is all done at the patient’s bedside. AccuVein reports that 39% of patients experience less pain and an increased likelihood of a successful first-stick by 3.5 times.
Accuvein is being used in thousands of hospitals around the world by nurses who aren’t even familiar with the term augmented reality. The company reports that this device has helped over 10 million patients worldwide and most have no idea AR is at the heart of this technology.
Doctor + Patient + Screen Time = UGH!
Is your doctor spending more time looking at a computer screen than looking at you? Alternatively, have you ever wondered, why does my doctor spend so much time on the computer during my visits?
Over the past decade, healthcare paper charts and ordering systems have been replaced by electronic health records (EHRs). The relatively rapid transition to EHRs has led to some quite unpleasant and unintended consequences.
Perhaps the most noticeable consequence to EHRs is your physician’s bedside manner. Most of your experience with doctors nowadays entails sitting on the edge of the bed and talking to your physician while he or she looks at a computer screen that displays your medical records and history.
The lack of eye contact and multitasking makes you feel disconnected from your physician, as if you are not the primary focus. No one can multitask indefinitely, not even doctors.
Physicians, too, are frustrated with EHRs because it distracts them from connecting with you — the patient — and involves literally dozens of clicks just to complete one patient encounter. Not only that, but the introduction of EHRs has slowed physicians down, making wait times for patients an even bigger problem.
EHRs have also spurred the creation of a cottage industry of medical scribes. So now your physician may be late, distracted, and accompanied by yet another person standing in the same room as you share your most intimate concerns. These conditions are not an ideal setup for fostering a therapeutic alliance.
Augmedix is a company utilizing AR glasses, remote scribes and a platform that allows a doctor to focus on the patient instead of clunky hardware and glitchy EHRs. By minimizing the time needed for administrative tasks, like documenting in an EHR, a more personal doctor/ patient experience in the exam room is being restored.
Augmented Daily Living
AR has become a major component in assisting those with various disabilities and impairments such as vision impairment, blindness, autism, phantom-limb pain, and more. Many of these technologies offer an avenue for greater autonomy and empower those living with challenging conditions.
For example, NuEyes is a type of smart glasses for those who are visually impaired or blind. Through voice activated directions you can gather more detailed information about your surroundings that make navigating your environment easier. The AbilityNet 20 Organization published a report in 2018 that further explains that NuEyes comes complete with “12x magnification, the ability to change the colours and contrast of what you are looking at, bar/QR code scanning and OCR (optical character recognition) to recognise and speak out print documents.” NuEyes allows those with vision impairment the ability to perform simple activities of daily living, such as counting money or reading the label of a medication bottle, creating greater possibilities of self-reliance.
Brain Power is one of the first smart glasses to enter the healthcare market for those with brain-related challenges like autism. The AR-based software helps transform wearable devices such as Google Glasses into neuro-assistive AI systems that relay information to the wearer about the surrounding environment.
Here is a video from Brain Power about this incredible software and how it can help people with autism gain self-sufficiency and change their lives for the better. In 2017, ARPost reported Brain Power hosts apps that help those with autism overcome communication barriers, behavior issues, overstimulation from the environment, and trouble transitioning — all common challenges with those living with autism.
AR is redefining the way we treat psychological and mental disorders, particularly obsessive behaviors and phobias. In a 2015 study, published in Hindawi Publishing Corporation, AR proved to be successful in treating those with animal phobias.
The system displayed the feared animal within the patient’s environment. The patient was then asked to interact with the animal. After multiple sessions, patients reported and demonstrated less anxiety and fear toward the animal. While this affliction may seem small to some, it is life altering for others.
Phantom Limb Pain
Having a limb removed is physically and mentally traumatizing. It entails major surgery, severe pain, physical and psychological therapy, and many patients experience complications.
As if losing a limb wasn’t bad enough, many patients also go on to experience phantom limb pain (PLP). PLP is pain, sometimes excruciating, or discomfort at the site where the limb use to be and “65–70% of (amputees) suffer from PLP” states a 2018 study in Frontiers in Neurology.
However, a system that combines virtual and augmented reality is effectively treating PLP and bringing relief to amputees. The software creates a digital version of the removed limb similar to the intact arm or leg. The patient moves and interacts with the the virtual limb in their environment.
Frontiers in Neurology’s study found that VR and AR sessions can reduce PLP by “an average of 64%.” By allowing the patient to interact with their phantom limb their brain can release the feeling of pain in a limb that no longer exists.
Augmented surgery allows surgeons to stand on the edge of science fiction, like displaying a holographic image of a patient’s CT scan. With this technology, surgeons can interact with 3D and 4D images of a patient’s anatomy, aiding them in deciding the safest and most successful intra-operative approach.
Traumatic limb reconstruction is an excellent example of an ideal use case for AR. In these situations, the normal anatomy of the limbs is distorted by severe trauma. Saving an injured extremity requires the surgeon frequently access computed tomography angiography (CTA) images.
A hands free tool, such as the HoloLens, offers the ability to overlay CTA imagery onto a traumatic limb. Because the medical professional no longer has to refer back to charts and static images, this can potentially reduce error, curtail intraoperative time, and provide valuable information to the surgical team in real-time without compromising the sterile field.
Compelled by the clinical implications of AR in advancing anatomically-precise invasive-procedural approaches Novarad secured the first ever FDA clearance, under section 501(k) of the Federal Food, Drug and Cosmetic Act for use of the HoloLens as part of pre-operative planning.
A 2018 article in Health Imaging states:
The FDA approved OpenSight Augmented Reality System the first AR system for Microsoft HoloLens to be used for surgical planning. OpenSight displays 2D, 3D and 4D images of patients interactively by overlaying them onto the patient’s body and utilizes the Microsoft HoloLens headset that allows simultaneous visualization of the 3D patient images and the actual patient and their real-world surroundings. The technique may decrease operative times and improve pre-operative planning and the understanding of anatomic relationships.
Optimizing successful surgical approaches and minimizing the chances of finding unexpected anatomical anomalies during the procedure is ideal for both the surgeon and the patient. AR has the potential to overcome these limitations by giving surgeons full view of anatomical structures prior to and during surgery, leading to safer treatment.
AR can soon revolutionize the way doctors use and experience ultrasonography (US). Through ultrasound technology medical professionals gain in-depth visualization of a patient’s internal structures. The tool is so useful that point-of-care ultrasound (POCUS) has become a growing part of medical bedside care. Some even claim POCUS should replace the stethoscope.
The use of POCUS in Emergency Medicine has enhanced the diagnostic capabilities and speed at which some life threatening conditions are identified and interventions implemented. Some innovators have married the skills of US with the possibilities of AR to create a mode of use that has the potential to change the way POCUS is engaged in patient physical examinations, assessment, and procedures.
NBC News’ 2018 article reports:
“Dr. Amitabh Varshney together with Dr. Sarah Murthi, professors at the University of Maryland developed an AR system which displays real-time ultrasound data through an AR headset. With the use of AR headsets, doctors are able to see a unified view of ultrasound data gathered by a probe directly attached to the patient.” With Dr. Varshney and Dr. Murthi’s system, doctors have more detailed and valid information, data, and view of the patient and their vitals.
This video will give you a sense of the possibilities when AR meets POCUS.
Augmented Reality, and devices like the HoloLens, promises to reshape healthcare by transforming the human experience.
Balancing high tech with high touch experiences in healthcare is always a challenge. As technology advances there are growing opportunities for the human touch to be lost or forgotten. However, the heart and core of medicine still exist in that vulnerable therapeutic space between the practitioner and the patient. Most often the best technology is hardly noticeable, yet it enables a stronger bond between two humans.
The future of augmented reality and it’s emerging use in healthcare has the promise to deliver care that can be both high touch and high tech.
References and Readings
Live Science: What Is Augmented Reality?
Harvard Business Review: How Augmented Reality Will Make Surgery Safer
HealthTech Magazine: Healthcare Teams Gain Edge by Using VR, AR for Surgery, Training
University of Maryland Baltimore: Augmenting Reality in the Operating Room
Hindawi Publishing Corporation: Augmented Reality: A Brand New Challenge for the Assessment and Treatment of Psychological Disorders
Frontiers in Neurology:Immersive Low-Cost Virtual Reality Treatment for Phantom Limb Pain: Evidence from Two Cases
Clinical Gastroenterology and Hepatology: Use of Augmented Reality and Virtual Reality Technologies in Endoscopic Training